Risk factors for atrioventricular block after transcatheter aortic valve implantation: a single-centre analysis including assessment of aortic calcifications and follow-up

Pollari, Francesco; Großmann, I.; Vogt, Ferdinand; Kališnik, Jurij Matija; Cuomo, Michela; Schwab, Johannes; Fischlein, Theodor; Pfeiffer, Steffen

doi:10.1093/europace/euy316

Cited by 43 publications

(28 citation statements)

References 20 publications

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“…The annulus coverage is broader regarding annulus range and contact zone, possibly resulting in more stress of nearby structures and challenging PPM predictors. LCC leaflet and DLZ calcification was previously analyzed in particular (16,18,19) and defined as PPM predictor. Additionally, in asymmetrically calcified leaflets, the "contre-coup" phenomenon during valve-deployment was already described (20), leading to a calcification-related stentframe movement towards the opposite side.…”

Section: Discussionmentioning

confidence: 99%

New insights on potential permanent pacemaker predictors in TAVR using the largest self-expandable device

Veulemans¹,

Frank²,

Seoudy³

et al. 2020

Cardiovasc Diagn Ther

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Background: Post-procedural conduction disorders following transcatheter aortic valve replacement (TAVR) still remain frequent, especially using the largest self-expandable device (Medtronic Corevalve Evolut R TM , 34 mm, STHV-34). We, therefore, assessed previously described, predictive factors of permanent pacemaker (PPM) implantation in the context of the STHV-34, including calcification distribution, implantation depth and membranous septum length (MSL). Methods: We performed a dual centre analysis of 130 of 182 consecutive patients treated with STHV-34, further stratified into subjects without post-procedural PPM (-PPM n=100, 76.9%) and those requiring postprocedural PPM (+PPM n=30, 23.1%). These events were further analyzed by univariate and multivariate analysis according to several underlying conditions. Results: Multivariate analysis only depicted previous right bundle branch block [RBBB; OR: 11.52 (2.63-50.44), P=0.001] and eccentricity index of the left ventricular outflow tract (LVOT-EI) >0.3 [OR: 3.07 (1.22-7.77), P=0.018] as highly predictive for PPM-need, being also confirmed by c-statistics [area under the curve (AUC) =0.68; 95% confidence interval (CI): 0.57-0.80; P=0.0025]. There was only moderate correlation of implantation depth over the MSL in terms of PPM prediction (r=0.23; P<0.0001).Conclusions: This study offers new insights into potential PPM predictors using the STHV-34: previous RBBB and a pronounced LVOT-EI were independent predictors of PPM, while most of the previously reported determinants failed to predict PPM-need including MSL and implantation depth.

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Section: Discussionmentioning

confidence: 99%

New insights on potential permanent pacemaker predictors in TAVR using the largest self-expandable device

Veulemans¹,

Frank²,

Seoudy³

et al. 2020

Cardiovasc Diagn Ther

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“…6 Several former studies assessing the risk for conduction disturbances after TAVR have pointed to the importance of anatomic circumstances like aortic valve dimensions, calcification patterns of the device landing zone (DLZ), and surrounding structures potentially affected by mechanical compression during valve deployment. [7][8][9][10][11][12][13][14][15][16] In this regard, our meta-analysis aimed to identify predictors of PPI after TAVR with focus on MSCT-derived anatomic patterns and the particular role of calcium distribution of the DLZ.…”

Section: Introductionmentioning

confidence: 99%

Computed tomography derived predictors of permanent pacemaker implantation after transcatheter aortic valve replacement: A meta‐analysis

Maier

Piayda

Afzal

et al. 2021

Cathet Cardio Intervent

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Objectives: This meta-analysis sought to assess predictors of permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR) with focus on preprocedural multi-slice computed tomography (MSCT) derived data.Background: Transcatheter aortic valve replacement (TAVR) has expanded to a wellestablished treatment for severe symptomatic aortic stenosis at high and intermediate surgical risk. PPI after TAVR remains one of the most frequent procedure-related complications and appears to be influenced by several factors. Methods:The authors conducted a literature search in PubMed/MEDLINE and EMBASE databases to identify studies that investigated preprocedural MSCT data and the rate of PPI following TAVR with new-generation devices.Results: Ten observational studies (n = 2707) met inclusion criteria for the final analysis. PPI was performed in 387 patients (14.3%) after TAVR. Patients requiring PPI had a larger annulus perimeter (MD: 1.66 mm; p < .001) and a shorter membranous septum length (MD: À1.1 mm; p < .05). Concerning calcification distribution, patients with requirement for new pacemaker implantation showed increased calcification of the left coronary cusp (MD: 47.6 mm 3 ; p < .001), and the total left ventricular outflow tract (MD: 24.42 mm 3 ; p < .01). Lower implantation depth (MD: 0.95 mm; p < .05) and oversizing (MD: 1.52%; p < .05) were procedural predictors of PPI following TAVR.Conclusions: Besides the well-known impact of electrocardiographic and procedurerelated factors on conduction disturbances, MSCT derived distribution of the aortic valve and left ventricular outflow tract calcification, as well as membranous septum length, are associated with an increased risk of PPI following TAVR.

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“…With our modified technique we reduced the overall rate of postoperative AVB to 4.30%. Firstly, the modification of the technique advocates a more thorough decalcification, which aims to avoid the impaction of calcium against the conduction system, similar to that which happens in TAVIs (12). Secondly, the repositioning of the prosthesis prior to the release, together with the reduction in ballooning time, allows the prosthesis to be expanded in the aortic annulus instead of being positioned below the valve plane and avoids the generation of a greater radial force on the membranous septum, factor that other groups have identified and therefore attempted to avoid by modifying the implantation technique.…”

Section: Discussionmentioning

confidence: 99%

Surgical technique modifies the postoperative atrioventricular block rate in sutureless prostheses

Barbeito¹,

Estévez-Cid²,

Martínez³

et al. 2019

J. Thorac. Dis

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Background: The main objective was to analyse the impact of the modification of the Perceval S implantation technique on the prevalence of postoperative atrioventricular block, which requires a permanent pacemaker, in our aortic valve replacement series. In addition, we attempted to identify those risk factors that are related to the appearance of this complication. Methods: Five hundred and seventy-two valve replacements were carried out with PERCEVAL S in our centre up to July 2018. Use of modified technique (n=302). Minimally invasive approach (n=340). Associated coronary surgery (n=95). Patients with pacemakers prior to surgery (n=27) and associated mitral or tricuspid valve surgery (n=26) were excluded. We analysed variables of interest that could influence the increase in postoperative atrioventricular block. Technique performed, disorders of intraventricular conduction and pre/ intraoperative characteristics. The influence of the modified technique was analysed. Results: Five hundred and nineteen aortic valve replacements with PERCEVAL S. Age (years) (median 77, interquartile range 8). Height (cm) (159, 13.5). Euroscore II (%) (2.25, 2.27). Postoperative atrioventricular block standard technique (n=23, 10.14%). Modified technique (n=14, 4.30%) (P=0.009). Multivariate regression analysis. Final model AUC =0.740, maximum model AUC =0.774 (P>0.05). Includes: Technique used (P=0.024), height (P=0.043) and disorders of interventricular conduction, right bundle branch block (P=0.005), trifascicular block (P=0.008).Conclusions: In our experience, the modified technique significantly decreases the incidence of postoperative atrioventricular block that requires a permanent pacemaker in the aortic valve replacement with PERCEVAL S. The prior electrocardiographic presence of right bundle branch block, trifascicular block and the height of the patient are associated with an increased risk of blocking.

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Risk factors for atrioventricular block after transcatheter aortic valve implantation: a single-centre analysis including assessment of aortic calcifications and follow-up

Cited by 43 publications

References 20 publications

New insights on potential permanent pacemaker predictors in TAVR using the largest self-expandable device

New insights on potential permanent pacemaker predictors in TAVR using the largest self-expandable device

Computed tomography derived predictors of permanent pacemaker implantation after transcatheter aortic valve replacement: A meta‐analysis

Surgical technique modifies the postoperative atrioventricular block rate in sutureless prostheses

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