Prosthesis depth and conduction disturbances after last generation balloon-expandable transcatheter aortic valve implantation

Iacovelli, Fortunato; Pignatelli, Antonio; Giugliano, Giuseppe; Stabile, Eugenio; Cicala, Mariangela; Salemme, Luigi; Cioppa, Angelo; Popusoi, Grigore; Pucciarelli, Armando; Verdoliva, Sebastiano; Bortone, Alessandro Santo; Losi, Maria Angela; Coscioni, Enrico; Esposito, Giovanni; Contegiacomo, Gaetano; Tesorio, Tullio

doi:10.1093/europace/euw310

Cited by 5 publications

(6 citation statements)

References 19 publications

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“…97 For each millimeter of increase in the depth of the valve at the septal side, the risk of PPMI increased 1.41 times. 98 This metaanalysis pooled five articles enrolling 854 patients including 151 cases with PPMI after TAVR and 703 cases without PPMI after TAVR (Table 8) and compared the average depth between patients with and without PPMI after TAVR. The depth was defined as the lowest site of annular plane to the distal site of valve device.…”

Section: The Influence Of Implantation Depth On Post-tavr Ppmi Riskmentioning

confidence: 99%

Predictors for the risk of permanent pacemaker implantation after transcatheter aortic valve replacement: A systematic review and meta‐analysis

Wang

Xia

et al. 2021

Journal of Cardiac Surgery

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Background: Transcatheter aortic valve replacement (TAVR) is a less invasive treatment than surgery for severe aortic stenosis. However, its use is restricted by the fact that many patients eventually require permanent pacemaker implantation (PPMI). This meta-analysis was performed to identify predictors of post-TAVR PPMI. Methods:The PubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched. Relevant studies that met the inclusion criteria were included in the pooling analysis after quality assessment. Results:After pooling 67 studies on post-TAVR PPMI risk in 97,294 patients, balloon-expandable valve use was negatively correlated with PPMI risk compared with self-expandable valve (SEV) use (odds ratio [OR]: 0.44, 95% confidence interval [CI]: 0.37-0.53). Meta-regression analysis revealed that history of coronary artery bypass grafting and higher Society of Thoracic Surgeons (STS) risk score increased the risk of PPMI with SEV utilization. Patients with pre-existing cardiac conduction abnormalities in 28 pooled studies also had a higher risk of PPMI (OR: 2.33, 95% CI:1.90-2.86). Right bundle branch block (OR: 5.2, 95% CI: 4.37-6.18) and first-degree atrioventricular block (OR: 1.97, 95% CI: 1.38-2.79) also increased PPMI risk. Although the trans-femoral approach was positively correlated with PPMI risk, the trans-apical pathway showed no statistical difference to the trans-femoral pathway.The approach did not increase PPMI risk in patients with STS scores >8. Patientprosthesis mismatch did not influence post-TAVR PPMI risk (OR: 0.88, 95% CI: 0.67-1.16). We also analyzed implantation depth and found no difference between patients with PPMI after TAVR and those without.Conclusions: SEV selection, pre-existing cardiac conduction abnormality, and transfemoral pathway selection are positively correlated with PPMI after TAVR. Preexisting left bundle branch block, patient-prosthesis mismatch, and implantation depth did not affect the risk of PPMI after TAVR.

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Section: The Influence Of Implantation Depth On Post-tavr Ppmi Riskmentioning

confidence: 99%

Predictors for the risk of permanent pacemaker implantation after transcatheter aortic valve replacement: A systematic review and meta‐analysis

Wang

Xia

et al. 2021

Journal of Cardiac Surgery

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“…Our analysis confirmed that the ID and ΔMSID were independent predictors of new PMI after TAVR, as well as conventional predictors. Because of the proximity between the aortic valve and conduction system, deep prosthesis implantation is associated with an increased risk of conduction disturbance, and therefore, these factors have been reported as predictors of new PMI after TAVR 11,16–18 . The importance of ΔMSID might indicate that the current TAVR practice should focus not only on ID and MS length but also on the balance them.…”

Section: Discussionmentioning

confidence: 99%

“…We assessed the MS length using two methods as previously described by Hamdan et al 7 and Jilaihawi et al 8 In brief, Hamdan et al 7 measured the MS length as the distance between the aortic annulus and the top of the muscular septum using the non‐reformatted standard coronal plane view (defined as the “coronal view method”), whereas Jilaihawi et al 8 measured it using the perpendicular annular plane view (defined as “annular view method”) (Supporting Information: figure). The ID of the prosthesis was defined as the distance from the bottom of the non‐coronary cusp to the ventricular end of the valve stent frame in the final angiogram after valve implantation, based on the previous studies 8,11,12 . Using the parameters mentioned above, the differences between the MS length and the ID were calculated and defined as ΔMSID 7,8 …”

Section: Methodsmentioning

confidence: 99%

“…The ID of the prosthesis was defined as the distance from the bottom of the non-coronary cusp to the ventricular end of the valve stent frame in the final angiogram after valve implantation, based on the previous studies. 8,11,12 Using the parameters mentioned above, the differences between the MS length and the ID were calculated and defined as ΔMSID. 7,8…”

Section: Imaging Analysismentioning

confidence: 99%

“…Because of the proximity between the aortic valve and conduction system, deep prosthesis implantation is associated with an increased risk of conduction disturbance, and therefore, these factors have been reported as predictors of new PMI after TAVR. 11,[16][17][18] The importance of ΔMSID might indicate that the current TAVR practice should focus not only on ID and MS length but also on the balance them. Recent technical advancement focused on ID have enabled intentional high implantation for both balloonexpandable and self-expandable valves, which may lead to a lower incidence of conduction disturbance.…”

Section: Difference Of Predictor For Pmi Between Balloon-expandable A...mentioning

confidence: 99%

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Validation of reliability and predictivity of membrane septum length measurements for pacemaker need after transcatheter aortic valve replacement

Hioki

Watanabe

Kozuma

et al. 2022

Cathet Cardio Intervent

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Objectives To assess the inter methodological agreement of membrane septum (MS) length measurement and additive value for risk stratification of new pacemaker implantation (PMI) over the established predictors after transcatheter aortic valve replacement (TAVR). Background Recent studies have suggested MS length and implantation depth (ID) as predictors for PMI after TAVR. However, the measurement of MS length is neither uniform nor validated in different cohort. Methods We retrospectively analyzed patients who underwent TAVR at five centers. The MS length was measured by two previously proposed methods (coronal and annular view method). Predictive ability of risk factors, including MS length and ID, for new PMI within 30 days after TAVR were evaluated. Results Among 754 patients of study population, 31 patients (4.1%) required new PMI within 30 days of TAVR. There was a weak correlation (ρ = 0.47) and a poor agreement between the two methods. The ID and the difference between MS length and ID (ΔMSID), were independent predictors for new PMI, whereas MS length alone was not. Further, for predicting new PMI after TAVR, discrimination performance was not significantly improved when MS length was added to the model with ID alone (integrated discrimination improvement = 0, p= 0.99; continuous net‐reclassification improvement = 0.10, p= 0.62). Conclusions External validity and predictive accuracy of MS length for PMI after TAVR were not sufficient to provide better risk stratification over the established predictors in our cohort. Moreover, the ID and ΔMSID, but not MS length alone, are predictive of future PMI after TAVR.

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Conduction delays after transcatheter aortic valve implantation with balloon-expandable prosthesis and high implantation technique

Iacovelli¹,

Giugliano

Gerardi

et al. 2021

Heart Vessels

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Prosthesis depth and conduction disturbances after last generation balloon-expandable transcatheter aortic valve implantation

Abstract: A low AVR is associated to higher ΔPR and PPMI rates. The correlation between LVOT prosthesis depth with ΔPR and higher PPMI rate suggests the need of a careful S3-THV implantation.

Cited by 5 publications

References 19 publications

Predictors for the risk of permanent pacemaker implantation after transcatheter aortic valve replacement: A systematic review and meta‐analysis

Predictors for the risk of permanent pacemaker implantation after transcatheter aortic valve replacement: A systematic review and meta‐analysis

Validation of reliability and predictivity of membrane septum length measurements for pacemaker need after transcatheter aortic valve replacement

Conduction delays after transcatheter aortic valve implantation with balloon-expandable prosthesis and high implantation technique

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