Background: Severe calcification of the ascending aorta increases the peri-operative risk for neurological complications in patients with severe aortic stenosis. TAVR seems to be an optimal treatment option in these patients. However, the impact of the extent of aortic calcification on procedural and neurological outcomes during TAVI is unclear.

Methods: Data from 3010 patients with severe native aortic valve stenosis treated with Acurate neo/neo2 from 05/2012 to 07/2022 were evaluated and matched by 2-to-1 nearest-neighbor matching to identify one patient with PA (n=492) compared with two patients without PA (n=984). PA was additionally subdivided into circumferential (classic PA) (n=89; 3.0%) and non-circumferential (partial PA) (n=403; 13.4%) calcification. We compared outcomes according to VARC-3 criteria among patients with and without PA and identified predictors for occurrence of stroke in the overall population. 

Results: Technical success (88.52% vs. 87.40%, p=0.589) and device success at 30 days (82.32% vs. 81.50%, p=0.755) after transcatheter ACURATE neo/neo2 implantation according to VARC-3 definition was high and did not differ between non-calcified aortas or PA. The rate of in-hospital complications according to VARC-3-definitions was low in both groups. Rate of stroke (3.15% (n=31) vs. 2.64% (n=13), p=0.705) or transitory ischemic attacks (1.12% vs. 1.22%, p=1.000) did not differ significantly. Thirty-day all-cause mortality did not differ (3.0% vs. 3.2%, RR 1.1; p=0.775). Device migration/embolization (OR 5.0 (2.10;11.87)), severe bleeding (OR 1.79 (1.11;2.89)) and major structural cardiac complications (OR 3.37 (1.32;8.57)) were identified as independent predictors for in-hospital stroke in multivariate analysis. 

Conclusion: A porcelain aorta does not increase the risk of neurological complications after transfemoral ACURATE neo/neo2 implantation. Based on these findings, transfemoral ACURATE neo/neo2 implantation is safe in these particularly vulnerable patients.