Incidental findings on computed tomography for preoperative assessment before transcatheter aortic valve implantation in Japanese patients

• Published in: Heart and vessels 2021-12, Vol.36 (12), p.1911-1922
• Main Authors: Tobe, Akihiro, Tanaka, Akihito, Tokuda, Yoshiyuki, Miki, Yusuke, Furusawa, Kenji, Akita, Sho, Fujii, Taro, Tsutsumi, Yoshinori, Ishii, Hideki, Iwano, Shingo, Naganawa, Shinji, Usui, Akihiko, Murohara, Toyoaki
• Format: Article
• Language: English
• Subjects: Aorta; Aortic valve; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - surgery; Biomedical Engineering and Bioengineering; Cardiac Surgery; Cardiology; Computed tomography; Heart Valve Prosthesis Implantation; Heart valves; Humans; Implantation; Incidental Findings; Japan - epidemiology; Medicine; Medicine & Public Health; Mortality; Original Article; Patients; Retrospective Studies; Tomography, X-Ray Computed; Transcatheter Aortic Valve Replacement - adverse effects; Treatment Outcome; Vascular Surgery
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-021-01875-2

Extra-cardiovascular incidental findings (IFs) on preoperative computed tomography (CT) are frequently observed in transcatheter aortic valve implantation (TAVI) candidates. However, the backgrounds of TAVI candidates and comorbidities differ based on the race and/or country, and data on IFs in a specific population are not always applicable to another. The aim of this study was to assess the prevalence, type, and clinical impact of IFs in Japanese TAVI candidates. This was a retrospective, single-center, observational study. CT reports of 257 TAVI candidates were reviewed, and IFs were classified as (a) insignificant: findings that did not require further investigation, treatment, or follow-up; (b) intermediate: findings that needed to be followed up or were considered for further investigation but did not affect the planning of TAVI; and (c) significant: findings that required further investigation immediately or affected the planning of TAVI. At least one IF was found in 254 patients (98.8%). Insignificant, intermediate, and significant IFs were found in 253 (98.4%), 153 (59.5%), and 34 (13.2%) patients, respectively. Newly indicated significant IFs were found in 19 patients (7.4%). In 2 patients (0.8%), TAVI was canceled because of significant IFs. In patients who consequently underwent TAVI, the presence of significant IFs was not associated with the duration from CT performance to TAVI [28 (19–40) days vs. 27 (19–43) days, p  = 0.74] and all-cause mortality during the median follow-up period of 413 (223–805) days ( p  = 0.44). Almost all Japanese TAVI candidates had at least one IF, and the prevalence of significant IFs was not negligible. Although the presence of significant IFs was not associated with mid-term mortality, appropriate management of IFs was considered important.