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Background: Aortic stenosis (AS) is the most common valvular heart disease and untreated has a bleak prognosis. The only effective method of treatment is valve replacement, surgical (SAVR), or transcatheter (TAVI). Aims:We decided to analyze outcomes and predictors of long-term mortality in patients undergoing TAVI and SAVR.Methods: A retrospective analysis of 1229 patients with advanced AS, comprising TAVI (n = 211), SAVR (n = 556), SAVR, and additional procedures (n = 462), operated on from 2014 to 2018, was performed.Results: No significant differences between SAVR and TAVI were found for 24-month mortality in groups of consecutive patients. Postoperative stroke or transient ischemic attack (TIA), chronic obstructive pulmonary disease (COPD), and transfusion of red blood cells (RBCs) were independent predictors of 1-year mortality after SAVR. The above-mentioned factors regarding the increased estimated surgery risk in the EuroSCORE II (>4%) were predictors of 2-years mortality after SAVR. Risk factors for 6-and 12-month mortality after TAVI were EuroSCORE II, new onset of atrial fibrillation (NOAF), and the increased RBC distribution width (RDW). Postoperative respiratory failure was an independent risk factor for 6-, 12-and 24-month mortality in both groups of patients.Conclusions: There were no significant differences regarding prognosis after TAVI and SAVR at the 24-month follow-up in the propensity score matching model. Independent predictive factors of late mortality after both procedures were EuroSCORE II and respiratory failure. Independent predictive factors of late mortality specific for TAVI were NOAF, increased RDW, and for SAVR: TIA, stroke, COPD, and RBC transfusion.

Computed tomography assessment of the aortic root morphology in predicting the development of paravalvular leak following transcatheter aortic valve implantation

Background and purpose of the study Echocardiography remains the gold standard for the diagnosis of prosthetic valve endocarditis (PVE). But in around 15% of cases, its results can be false negative due to the acoustic shadow of artificial valves. The aim of the study was compare cardiac computed tomography (CT) with other imaging modalities in the diagnosis of perivalvular complications in patients with PVE. Material and methods The study included 35 consecutive patients with PVE. Thirty of them had an artificial aortic valve (17- mechanical valve, 13-biological valve), 7-mechanical mitral valve, and one patient was after biological pulmonary valve implantation. Three patients were after aortic and mitral valve replacement. Each patient underwent transthoracic (TTE) and transesophageal (TEE) echocardiography. ECG-gated CT examinations were performed with a dual source CT system. All patients were qualified for surgical treatment. The assessment included the presence of vegetation, perivalvular abscess/pseudoaneurysm, inflammatory infiltration and prosthesis dehiscence. Results Intraoperative assessment revealed the presence of vegetations in 16 patients. The sensitivity of echocardiography (TTE+TEE) and CT examinations was 100% and 93% respectively. Twenty one abscesses/pseudoaneurysms were found intraoperatively. The sensitivity of echocardiography and CT examinations was 76% and 85%, respectively. The analysis of total TTE, TEE and CT findings showed that supplementing echocardiography with CT had increased the sensitivity of the method for detecting abscess/pseudoaneurysms to 95%. In a patient in whom no abscesse was found, inflammatory infiltration was diagnosed in echocardiography. Inflammatory infiltration was diagnosed intraoperatively in 13 patients. The sensitivity of echocardiography and CT was 69% in both examinations. The sensitivity of the combination TTE + TEE + CT was 92%. Perivalvular leakage was found intraoperatively in 17 patients. The sensitivity of echocardiography and CT for the diagnosis of this complication was 100% and 87%, respectively. Conclusions CT is better than echocardiography in diagnosing abscesses/pseudoaneurysms and has the same sensitivity in detecting inflammatory infiltration. Adding CT to echocardiography improves the sensitivity of these complications detection. CT is not superior to echocardiography in the diagnosis of vegetations and perivalvular leakage, but it can be a useful tool when echocardiography findings are inconclusive. Funding Acknowledgement Type of funding source: None

The purpose of this study was to assess by multislice computed tomography (MSCT) imaging geometry of the ascending aorta, the aortic root, the aortic annulus and the left ventricle outflow tract (LVOT) in aortic stenosis (AS) patients, to compare aortic root morphology in patients with AS with healthy controls and to evaluate sex differences. Fifty patients with severe AS and 50 age-and gender-matched controls who underwent MSCT were included in the study. The dimensions of the LVOT, the aortic annulus, the aortic root, the ascending aorta, and the volume of the aortic root were retrospectively assessed and a comparison was made between patients with severe tricuspid AS and controls. Patients with tricuspid AS in comparison with controls had smaller dimensions of the sinus of Valsalva resulting in reduction of the aortic root volume, whereas the dimensions of the other structures were comparable. MSCT revealed larger annular, LVOT and the sinus of Valsalva dimensions and the aortic root volume in men than women. Men with AS differed from healthy men only in regard to the dimensions of the sinus of Valsalva, while women showed significant differences also in the LVOT, and the aortic annulus. MSCT showed accurately aortic root remodeling in tricuspid AS patients and indentified sex-dependent differences. Women with tricuspid AS differ from healthy women more than men did. A high degree of the variability in the aortic root dimensions requires further careful research.