Intraventricular Conduction Disturbances After Transcatheter Aortic Valve Implantation

Lin, Shu-I; Miura, Mizuki; Tagliari, Ana Paula; Lee, Ying‐Hsiang; Shirai, Shinichi; Puri, Rishi; Taramasso, Maurizio

doi:10.15420/icr.2020.07

Cited by 13 publications

(10 citation statements)

References 74 publications

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“…These ndings are particularly important in the current era, in which younger and relatively healthier patients are being treated with TAVI and in whom the durability of the device is extremely important to minimize the need for future reintervention. Importantly, the use of a larger THV in BAAS patients was not associated with increased adverse outcomes commonly encountered with large prostheses, such as conduction disturbances, annular rupture and coronary occlusion 15,16 . Given the above results, the present study advocates the selection of a large THV for BAAS patients undergoing TAVI with either SE or BE prostheses.…”

Section: Discussionmentioning

confidence: 97%

Device Selection in Patients with Borderline Size Aortic Valve Annulus Undergoing Transcatheter Aortic Valve Implantation

Talmor‐Barkan¹,

Kornowski²,

Bar³

et al. 2021

Preprint

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Transcatheter heart valve (THV) selection for transcatheter aortic valve implantation (TAVI) is crucial to achieve procedural success. Borderline aortic annulus size (BAAS), which allows a choice between two consecutive valve sizes, is a common challenge during device selection. In the present study, we evaluated TAVI outcomes in patients with BAAS according to THV size selection. We performed a retrospective study including patients with severe aortic stenosis (AS) and BAAS, measured by multidetector computed tomography (MDCT), undergoing TAVI with self-expandable (SE) or balloon-expandable (BE) THV from the Israeli multicenter TAVI registry. TAVI outcomes were assessed according to the Valve Academic Research Consortium-2 (VARC-2). Out of 2,352 patients with MDCT measurements, 598 patients with BAAS as defined for at least one THV type were included in the study. In BAAS patients treated with SE-THV, larger THV selection was associated with lower rate of paravalvular leak (PVL), compared to smaller THV (45.3% vs. 64.5%; pv = 0.0038). Regarding BE-THV, larger valve selection was associated with lower post-procedural transvalvular gradients compared to smaller THV (mean gradient: 9.9 ± 3.7mmHg vs. 12.5 ± 7.2mmHg; p = 0.019). Of note, rates of mortality, left bundle branch block, permanent pacemaker implantation, stroke, annular rupture and/or coronary occlusion did not differ between groups. BAAS is common among patients undergoing TAVI. Selection of a larger THV in these patients is associated with lower rates of PVL and better hemodynamic profile in patients implanted with SE and BE-THV, respectively, with no effect on procedural complications.

show abstract

Section: Discussionmentioning

confidence: 97%

Device Selection in Patients with Borderline Size Aortic Valve Annulus Undergoing Transcatheter Aortic Valve Implantation

Talmor‐Barkan¹,

Kornowski²,

Bar³

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…These findings are particularly important in the current era, in which younger and relatively healthier patients are being treated with TAVI and in whom the durability of the device is extremely important to minimize the need for future reintervention. Importantly, the use of a larger THV in BAAS patients was not associated with increased adverse outcomes commonly encountered with large prostheses, such as conduction disturbances, annular rupture and coronary occlusion ( 16 , 17 ). Given the above results, the present study strengthens recent results from the PARTNER 3 trial ( 6 ) and advocates the selection of a large THV for BAAS patients undergoing TAVI with either SE or BE prostheses.…”

Section: Discussionmentioning

confidence: 99%

Impact of Valve Size on Paravalvular Leak and Valve Hemodynamics in Patients With Borderline Size Aortic Valve Annulus

Talmor‐Barkan

Kornowski

Bar

et al. 2022

Front. Cardiovasc. Med.

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BackgroundTranscatheter heart valve (THV) selection for transcatheter aortic valve implantation (TAVI) is crucial to achieve procedural success. Borderline aortic annulus size (BAAS), which allows a choice between two consecutive valve sizes, is a common challenge during device selection. In the present study, we evaluated TAVI outcomes in patients with BAAS according to THV size selection.MethodsWe performed a retrospective study including patients with severe aortic stenosis (AS) and BAAS, measured by multi-detector computed tomography (MDCT), undergoing TAVI with self-expandable (SE) or balloon-expandable (BE) THV from the Israeli multi-center TAVI registry. The aim was to evaluate outcomes of TAVI, mainly paravalvular leak (PVL) and valve hemodynamics, in patients with BAAS (based on MDCT) according to THV sizing selection in between 2 valve sizes. In addition, to investigate the benefit of shifting between different THV types (BE and SE) to avoid valve size selection in BAAS.ResultsOut of 2,352 patients with MDCT measurements, 598 patients with BAAS as defined for at least one THV type were included in the study. In BAAS patients treated with SE-THV, larger THV selection was associated with lower rate of PVL, compared to smaller THV (45.3 vs. 64.5%; pv = 0.0038). Regarding BE-THV, larger valve selection was associated with lower post-procedural transvalvular gradients compared to smaller THV (mean gradient: 9.9 ± 3.7 vs. 12.5 ± 7.2 mmHg; p = 0.019). Of note, rates of mortality, left bundle branch block, permanent pacemaker implantation, stroke, annular rupture, and/or coronary occlusion did not differ between groups.ConclusionBAAS is common among patients undergoing TAVI. Selection of a larger THV in these patients is associated with lower rates of PVL and optimized THV hemodynamics with no effect on procedural complications. Additionally, shift from borderline THV to non-borderline THV modified both THV hemodynamics and post-dilatation rates.

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“…In this study, we analyzed leaflet sectors of the aorticvalvular complex with respect to the need for PPI. Usually, patients requiring PPI had larger right coronary cusp (RCC) or noncoronary coronary cusp (NCC) sector calcification in the region of the leaflets (Dasi et al, 2017;Li and Sun, 2017;Lin et al, 2020;Padala et al, 2021). When a prosthesis was deployed within a severely and asymmetrically calcified leaflet during TAVR, there was a large pressure generated from the calcified leaflets.…”

Section: Feature Extractionmentioning

confidence: 99%

Biomechanical Identification of High-Risk Patients Requiring Permanent Pacemaker After Transcatheter Aortic Valve Replacement

Zhang

Liu

2021

Front. Bioeng. Biotechnol.

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BackgroundCardiac conduction disturbance requiring new permanent pacemaker implantation (PPI) is an important complication of TAVR that has been associated with increased mortality. It is extremely challenging to optimize the valve size alone to prevent a complete atrioventricular block (AVB).MethodsIn this study, we randomly took 48 patients who underwent TAVR and had been followed for at least 2 years to assess the risk of AVB. CT images of 48 patients with TAVR were analyzed using three-dimensional (3D) anatomical models of the aortic valve apparatus. The stresses were formulated according to loading force and tissue properties. Support vector regression (SVR) was used to model the relationship between AVB risk and biomechanical stresses. To avoid AVB, overlapping regions on the prosthetic valve where AV bundle passes will be removed as cylindrical sector with the angle θ. Thus, the optimization of the valve shape will be predicted with the joint optimization of the θ and valve size R.ResultsThe average AVB risk prediction accuracy was 83.33% in the range from 0.8–0.85 with 95% CI for all cases; specifically, 85.71% for Group A (no AVB), and 80.0% for Group B (undergoing AVB after the TAVR).ConclusionsThis model can estimate the optimal valve size and shape to avoid the risk of AVB after TAVR. This optimization may eliminate the excessive stresses to keep the normal function of both AV bundle and valve leaflets, leading to a favorable clinical outcome. The combination of biomechanical properties and machine learning method substantially improved prediction of surgical results.

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Intraventricular Conduction Disturbances After Transcatheter Aortic Valve Implantation

Cited by 13 publications

References 74 publications

Device Selection in Patients with Borderline Size Aortic Valve Annulus Undergoing Transcatheter Aortic Valve Implantation

Device Selection in Patients with Borderline Size Aortic Valve Annulus Undergoing Transcatheter Aortic Valve Implantation

Impact of Valve Size on Paravalvular Leak and Valve Hemodynamics in Patients With Borderline Size Aortic Valve Annulus

Biomechanical Identification of High-Risk Patients Requiring Permanent Pacemaker After Transcatheter Aortic Valve Replacement

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