Rapid Ventricular Pacing Using Pre-Existing In-Situ Permanent Pacemaker for TAVR in Lieu of Temporary Venous Pacemaker

Kaur, Nirmal; Bakhit, Ahmed; Farley, Jennifer; Bojar, Robert M.; Hannan, Joseph

doi:10.1080/24748706.2020.1751365

Cited by 1 publication

(1 citation statement)

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“…A transient pacemaker lead was introduced through a jugular sheath and placed in the RV to allow pacing during valve deployment (up to 100 bpm) or rapid pacing during balloon valvuloplasty (180–220 bpm and a drop in the systolic blood pressure less than 50 mmHg and a pulse pressure less than 10 mmHg) [ 19 ]. Balloon valvuloplasty under rapid pacing was performed before device placement in 36 patients due to severe aortic calcification and the high probability of under-deployment of the device, after which, over a stiff guide wire placed in the left ventricle, the device was deployed under fluoroscopic guidance.…”

Section: Methodsmentioning

confidence: 99%

Impact of prosthesis oversizing on clinical outcomes of transcatheter aortic valve implantation using a self-expandable Evolut R valve

Elnwagy,

Baraka,

Hafez

et al. 2024

Egypt Heart J

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Background Transcatheter Aortic Valve Implantation (TAVI) has a growing target population after being indicated even in low-surgical-risk patients with severe symptomatic aortic stenosis. However, postoperative outcomes can be compromised due to para-valvular leakage (PVL). A lot of procedural steps have been investigated to decrease this partially avoidable operational hazard. Oversizing is a main technique to decrease the PVL, despite being itself a risky step. Many studies have been conducted to identify the optimum degree of oversizing. However, studies about oversizing by more than 20% are scarce. We aimed to evaluate the safety and efficacy of oversizing equal to or more than 20%. Results 209 patients who underwent TAVI using the self-expandable valve Evolut R were initially included. 66 patients were excluded because of the baseline conduction disturbance and lack of sufficient data, so 143 patients, 60 females and 83 males, were enrolled in our study as two groups based on the degree of oversizing: Group A included 97 patients with an oversizing index (OI) of less than 20%, and Group B included 46 patients with an OI of 20% or more. We conducted a new technique for more accurate measuring of the OI in the context of the implantation depth, and our patients were categorized using this technique. Our findings have met our primary end point in terms of the safety and efficacy of oversizing by 20% or more. There was no significant difference between both groups in terms of new-onset conduction disturbance (NOCD), with zero cases of annular rupture or coronary encroachment. In terms of efficacy, The incidence of significant PVL (grade 2 or more) in group B was less than in group A (P value 0.007). The ROC curve found that the minimum depth of implantation-derived oversizing (DIDO) to predict no significant PVL was less than 17%. Conclusion Prosthesis oversizing by 20% using the self-expandable Evolut R valve is safe and effective, with no significant effect on the conduction system, coronary encroachment, or annular injury, and warrants a greater reduction in the incidence of significant PVL.

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Section: Methodsmentioning

confidence: 99%