Impact of implantation technique on conduction disturbances for TAVR with the self‐expanding portico/navitor valve

Wang, Xi; Wong, Ivan; Bajoras, Vilhelmas; Vanhaverbeke, Maarten; Nuyens, Philippe; Bieliauskas, Gintautas; Jørgensen, Troels Højsgaard; Chen, Mao; Søndergaard, Lars

doi:10.1002/ccd.30517

Cited by 7 publications

(3 citation statements)

References 29 publications

(49 reference statements)

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“…Notably, while not-negligible, rates of permanent pacemaker implantation were reasonably low, especially in light of the patient risk profile (mean age of > 82 years, and features of frailty in almost 40% of patients). It is plausible that technical refinements, such as use of the right-left cusp overlap view for TAVI deployment, may further reduce this risk [ 30 ]. In addition, and in keeping with other pragmatic studies on patients undergoing TAVI, we found evidence of a constant accrual of adverse events well after the index procedure.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes following transcatheter aortic valve implantation with the Portico self-expanding valve

et al. 2023

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Aim Transcatheter aortic valve implantation (TAVI) is a mainstay in the management of severe aortic valve stenosis in elderly patients, but there is uncertainty on their long-term effectiveness. We aimed to assess the long-term outcome of patients undergoing TAVI with the Portico valve. Methods We retrospectively collected the data on patients in whom TAVI with Portico was attempted from 7 high-volume centres. Only patients theoretically eligible for 3 or more years of follow-up were included. Clinical outcomes, including death, stroke, myocardial infarction, reintervention for valve degeneration and hemodynamic valve performance were systematically assessed. Results A total of 803 patients were included, with 504 (62.8%) women, mean age of 82 years, median EuroSCORE II of 3.1%, and 386 (48.1%) subjects at low/moderate risk. The median follow-up was 3.0 years (3.0; 4.0). The composite of death, stroke, myocardial infarction, and reintervention for valve degeneration occurred in 37.5% (95% confidence interval: 34.1–40.9%), with all-cause death in 35.1% (31.8–38.4%), stroke in 3.4% (1.3–3.4%), myocardial infarction in 1.0% (0.3–1.5%), and reintervention for valve degeneration in 1.1% (0.6–2.1%). The mean aortic valve gradient at follow-up was 8.1 ± 4.6 mmHg, and at least moderate aortic regurgitation was present in 9.1% (6.7–12.3%). Independent predictors of major adverse events or death were: peripheral artery disease, chronic obstructive pulmonary disease, estimated glomerular filtration rate, atrial fibrillation, prior pacemaker implantation, EuroSCORE II, and reduced left ventricular ejection fraction (all p < 0.05). Conclusions Portico use is associated with favorable long-term clinical outcomes. Clinical outcomes were largely impacted by baseline risk factors and surgical risk.

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Section: Discussionmentioning

confidence: 99%

Long-term outcomes following transcatheter aortic valve implantation with the Portico self-expanding valve

et al. 2023

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“…[ 17 ] Even if the COT was established for specific self-expandable valves due to their greater extension into the LVOT, it has already been shown how this technique might influence ID, PPI need, and haemodynamic performance using balloon-expandable and other devices. [ 22 , 23 ] However, according to current data, there is no evidence for a potentially increased risk of coronary obstruction or upward dislocations (pop-outs) with a higher ID (within appropriate limits).…”

Section: Membranous Septum Lengthmentioning

confidence: 94%

Factors Influencing Implantation Depth During Transcatheter Aortic Valve Replacement

Veulemans,

Maier,

Zeus

2024

Interv Cardiol

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Optimised implantation depth (OID) is crucial to obtain the best haemodynamic and clinical outcome during transcatheter heart valve (THV) deployment. OID ensures a better haemodynamic profile and is associated with a potential reduction in permanent pacemaker implantations, both of which are important during transcatheter aortic valve replacement (TAVR). Apart from patient-related anatomic conditions, many factors, such as THV and wire selection, as well as implantation strategies, can be controlled by the operator and facilitate the implantation process. However, there are only limited data dealing with predictors for OID. Therefore, the aim of this review was to outline factors and tools that might influence the final implantation depth during TAVR procedures, potentially influencing the outcome.

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“…However, post-TAVI new-onset conduction disturbances and permanent pacemaker implantation (PPMI) are still common procedural complications [6]. Even though a patient-tailored pre-procedural planning together with optimized implantation techniques have been studied and conducted in most Heart Centers, the PPMI rate following TAVI remains a double-digit value, especially in TAVI using self-expanding THVs [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes of TAVI patients undergoing different pacing modality: LBBAP versus RVP

Wang,

Xu,

Zeng

et al. 2024

Preprint

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BackgroundNew-onset permanent pacemaker implantation (PPMI) is still a common complication after transcatheter aortic valve implantation (TAVI), leading to adverse clinical outcomes. This study aims to compare the long-term clinical results between traditional right ventricular pacing (RVP) and left bundle branch area pacing (LBBAP) in a large cohort of patients requiring PPMI following TAVI.MethodsA total of 237 consecutive patients undergoing RVP (N=117) or LBBAP (N=120) following TAVI from April 2014 to May 2021 at 3 centers were included. The primary outcome was the composite of all-cause death or heart failure rehospitalization (HFH). Secondary outcomes included all-cause death, HFH and left ventricular ejection fraction (LVEF) change compared to baseline.ResultsThe mean age of the overall population was 74 years with a mean surgical risk score as 4.4%. The paced QRS duration was significantly shorter in LBBAP group compared to RVP group (151 ± 18 vs. 122 ±12 ms, P<0.001). There was a more marked evolution of LVEF over time in LBBAP group (mean LVEF at baseline/follow-up: RVP group: 56/59%; LBBAP group: 57/63%; P=0.046 for LVEF changes over time between groups). There was no remarkable difference between two groups in the primary outcome (29.9% vs. 19.2%, adjusted HR: 1.22; 95% CI: 0.70 to 2.13; P=0.476), however, the risk of HFH was significantly reduced in LBBAP group compared to RVP at 5 years after TAVI (21.4% vs. 7.5%, adjusted HR: 2.26; 95% CI: 1.01 to 5.08; P=0.048).ConclusionsLBBAP improved long-term clinical outcomes compared to RVP in patients undergoing PPMI after TAVI.Graphic abstractLong-term outcomes of LBBAP compared to RVP in TAVI patients.LBBAP is a feasible physiologic pacing modality for TAVI patients in need of permanent pacemaker, resulting in a narrow paced QRS duration. LBBAP was associated with more LVEF improvement compared to traditional RVP in TAVI patients at long-term follow-up, while the risk of death or HFH was not significantly different between two groups. HFH, heart failure rehospitalization; LBBAP, left bundle branch area pacing; LVEF, left ventricular ejection function; RVP, right ventricular pacing; TAVI, transcatheter aortic valve implantation.What is knownNew-onset permanent pacemaker implantation is still a common complication after transcatheter aortic valve implantation (TAVI). Conventional right ventricular pacing (RVP) results in adverse clinical outcomes in TAVI patients.What the study addsLeft bundle branch area pacing (LBBAP) is a feasible and effective physiologic pacing modality for TAVI patients in need of permanent pacemaker. LBBAP improves long-term clinical outcomes compared to RVP in TAVI patients.

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Impact of implantation technique on conduction disturbances for TAVR with the self‐expanding portico/navitor valve

Cited by 7 publications

References 29 publications

Long-term outcomes following transcatheter aortic valve implantation with the Portico self-expanding valve

Long-term outcomes following transcatheter aortic valve implantation with the Portico self-expanding valve

Factors Influencing Implantation Depth During Transcatheter Aortic Valve Replacement

Long-term outcomes of TAVI patients undergoing different pacing modality: LBBAP versus RVP

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