Mitral Annular Calcifications (MAC) and Thoracic Aortic Calcifications (TAC) represent 2 well-established predictors of mortality after TAVI; they could be combined to enhance the prediction of outcome after TAVI and improve patient selection.

To evaluate the cumulative prognostic value of MAC and TAC in patients with aortic stenosis, treated with TAVI on 1-year all-cause and cardiovascular (CV) mortalities.

Between 2010 and 2014, 1382 TAVI patients were included, in 4 high volume french centers. High MAC was defined as ≥2cm³ and high TAC was defined as >3.6cm³(boundary of third tertile). Three groups were considered; 1: low MAC and low TAC, 2: high MAC or high TAC, and 3: high MAC and high TAC. Outcomes were all-cause and CV deaths. Kaplan Meier graphs, PLogRank test and multivariable Cox analysis were used to assess the prognostic value of MAC and TAC: Model 1 adjusted for EUROSCORE, Model 2 for age, gender, atrial fibrillation, coronary artery disease, left ventricle ejection fraction, mean aortic gradient, renal function, peripheral vascular disease, history of stroke, chronic obstructive pulmonary disease, and vascular access.

Groups 1, 2 and 3 comprised 839 (60.7%), 492(35.6%), and 51(3.7%) patients respectively. At 1-year post TAVI, 25 patients were lost to follow-up and 230(16.6%) died, of whom 164(11.9%) from CV causes. Fig. 1 displays all-cause and CV deaths according to the 3 groups (PLogRank=0.005 for both). In model 1, group 3 had an excess risk compared to group 1: HR 2.21 CI(1.27–3.85), p=0.005, and HR 2.29 CI(1.19–4.42), p=0.013 for all-cause and CV mortality, respectively. Similar results were found in model 2: HR 2.06 CI(1.18–3.60), p=0.01, and HR 2.14 CI(1.10–4.16), p=0.025 for all-cause and CV mortality, respectively.

A cumulative impact of MAC and TAC on post-TAVI mortality is demonstrated. A special attention for potential futility should be payed to patients with a high MAC/TAC burden.