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June 12, 2026Clinical Research in CardiologyOpen Access

Prognostic impact of iliofemoral access-site calcification volume on outcomes after transcatheter aortic valve implantation

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Key result

High computed tomography-derived iliofemoral access-site calcification volume was independently associated with increased 3-year all-cause mortality after TAVI (HR 1.24 per standard deviation increase).

Why the study?

Does high iliofemoral access-site calcification volume predict increased mortality in patients undergoing TAVI?

Population

1,067 patients undergoing transcatheter aortic valve implantation with pre-procedural computed tomography…

Comparison

High iliofemoral access-site calcification… vs Low iliofemoral access-site calcification volume

Design

Cohort

Follow-up

5 years

Authors

VVVivian VijKSKatja SchauwienoldJSJasmin Shamekhi

Discussion

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Overview

High IASC-volume was associated with higher long-term mortality; leaves open its value for risk stratification or intervention.

Key Points

  • To assess the prognostic value of iliofemoral access-site calcification volume on outcomes after transcatheter aortic valve implantation.
  • Included 1067 patients undergoing TAVI with pre-procedural CT to quantify IASC-volume.
  • Outcomes were compared using propensity score matching based on median IASC-volume.
  • Primary endpoint was all-cause mortality at 1, 3, and 5 years.
  • 1-year mortality was 11.7% with no difference between low and high IASC-volume (10.5% vs. 12.8%; p = 0.20).
  • Higher mortality at 3 years for high IASC-volume (34.3% vs. 22.3%; p < 0.01).
  • IASC-volume independently associated with long-term mortality (HR 1.24, 95% CI 1.11-1.38; p < 0.01).

Study Design

Type

Cohort (n=1,067)

Multicenter

No

Structured PICO

Does high iliofemoral access-site calcification volume predict increased mortality in patients undergoing TAVI?

P
Population
1,067 patients with severe symptomatic aortic stenosis undergoing transcatheter aortic valve implantation, stratified by iliofemoral access-site calcification volume, followed for up to 5 years.
E
Exposure
High iliofemoral access-site calcification (IASC) volume (median 1839 mm3) assessed via pre-procedural CT
C
Comparator
Low iliofemoral access-site calcification (IASC) volume (median 354 mm3)
O
Outcome
All-cause mortality at 1, 3, and 5 years after TAVIhard clinical

Main Result

Hazard Ratio: 1.24 (95% CI 1.11–1.38)

Absolute Event Rate: 34.3% vs 22.3%

p-value: p=<0.01

CT-derived iliofemoral access-site calcification volume provides incremental prognostic information for mid- and long-term mortality after TAVI, reflecting systemic disease burden rather than just procedural risk.

Limitations

  • Retrospective and observational design
  • Selection bias due to restriction to patients with available assessment of iliofemoral access-site calcification
  • Stratification into low and high IASC-volume groups was based on the cohort-specific median rather than a validated threshold
  • Residual confounding due to unmeasured or incompletely captured aspects of systemic atherosclerotic disease
  • Incomplete follow-up
  • Cause-specific mortality was not available, precluding differentiation between cardiovascular and non-cardiovascular mortality

Cite This Study

Vij et al. (2026) conducted a cohort in Severe symptomatic aortic stenosis (n=1,067). High iliofemoral access-site calcification volume vs. Low iliofemoral access-site calcification volume was evaluated on 3-year all-cause mortality (HR 1.24, 95% CI 1.11-1.38, p=<0.01). High computed tomography-derived iliofemoral access-site calcification volume was independently associated with increased 3-year all-cause mortality after TAVI (HR 1.24 per standard deviation increase).

synapsesocial.com/papers/6a2bd1386550ea4541ffe9b5https://doi.org/10.1007/s00392-026-02956-w
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