Contribution of pre-interventional CT in the prediction of the risk of periprocedural complications in patients treated with percutaneous trans-femoral aortic valve replacement ; Apport du scanner pré-interventionnel dans la prédiction du risque de complications péri-procédurales chez les patients traités par remplacement valvulaire aortique percutané trans fémoral

Background: Percutaneous aortic valve replacement (TAVI) via the femoral approach is the treatment of choice for severe aortic stenosis in patients at medium and high operative risk. The pre-TAVI CT angiography is used to assess the feasibility of the procedure and to plan it. While the indications for TAVI are broadening towards patients at lower risk, the occurrence of peri-procedural complications continues to impact prognosis. These complications could be reduced if they were better predicted before the procedure. Objective: The aim of our study was to identify risk factors for peri-procedural complications on the pre-TAVI CT scan. Method: We carried out a single-center retrospective study at the Hospices Civils de Lyon. We included all patients with a severe aortic stenosis, treated by femoral TAVI between January 2011 and April 2022, with an exploitable pre-TAVI scan. The CT parameters studied were: puncture depth, ratio of the smallest iliofemoral diameter to the external diameter of the introducer, iliofemoral tortuosity, aortic atheroma, aortic tortuosity, and aortic valve calcification. Our end point was the occurrence of complications from the procedure to hospital discharge. Complications were classified into the following four categories: major vascular complications, embolic complications, high complications, and death. Predictive factors for complications were studied by uni and multivariate binary logistic regression. Results: 598 patients were included in our study. Aortic tortuosity (TAS) calculated using a subtractive method (central line length - direct line length) was associated with an increase in embolic complications in continuous analysis (OR 1.015; 95% CI [1.004-1.026]; p 0.007) and high complications for TAS >95th percentile (OR 3.44; 95% CI [1.19-9.97]; p0.023). Severe aortic atheroma (Shaggy score ≥8) was associated with an increase in embolic complications (OR 9; 95% CI [3.47-23.48]; p 0.0001), high complications (OR 3.28; 95% CI [1.55- 6.94]; p 0.002) and periprocedural deaths ...