Phd in ARTERIAL HYPERTENSION AND VASCULAR BIOLOGY

Thesis title: Impact of Left ventricular outflow Calcification on early outcome in patient with bicuspid aortic valve undergoing Transcatheter aortic valve implantation

The aim of this study was to assess the impact of left ventricular outflow (LVOT) calcification on early device outcomes in a contemporary patient cohort with bicuspid aortic valve undergoing transcatheter aortic valve replacement (TAVR). Background LVOT calcification is known to be associated with adverse outcomes after TAVI in patient with tricuspid anatomy with no dedicated studies on cohort of patients with bicuspid anatomy. Methods Pre-TAVR CT scans from 198 BAV patients were analyzed to assess the presence and the quantification of LVOT calcification. The amount of LVOT calcification was measured quantitatively from contrast-enhanced CT, using 3mensio Structural Heart software (Pie Medical Imaging). Echocardiographic data were collected and analyzed as well in order to assess parameters determining 30-days device success. Results LVOT calcification, defined as a volume superior to 10 mm3, was observed in 48.22% of the patient cohort, with a median of 7.5 [0.0-88.0]. Apart LVOT calcium, baseline CT anatomical features were similar in both groups. The overall rate of VARC-3 device success was reached in 163 patients (83.2%). Rates of device success were significantly lower in the LVOT+ group (75.8%) compared to the LVOT- group (75.8% vs. 90.1%; p<0.007). Conclusions LVOT calcification is highly prevalent in BAV anatomy and is linked to poorer 30-day VARC-3 device success compared to patients without LVOT calcification.