TCT-690 Influence of calcium, implantation depth and oversizing on the occurrence of conduction disturbances and need for pacemaker implantation after implantation of the balloon-expandable Edwards Sapien 3 valve

Abstract

occurrence. THV design selection based on the presence of risk factors for PVR may reduce the occurrence of PVR while mitigating the impact on new pacemaker rate.METHODS All TAVI cases performed in our center before May 2014 were done with the SAPIEN or XT (Edwards Lifesciences, Irvine CA) valve; from June 2014, the THV design (SAPIEN XT, SAPIEN 3 (Edwards Lifesciences) or LOTUS (Boston Sci, Boston, MA) was selected based on anatomical factors known to influence the risk of PVR. Patients without risk factors were implanted with the SAPIEN XT (n ¼ 51) while patients at higher risk received a LOTUS (n ¼ 25) or SAPIEN 3 (n ¼ 3). We compared the incidence of PVR and new pacemaker implantation in 112 patients implanted with SAPIEN or SAPIEN XT (Group A) before May 2014 to the 79 patients treated with either the SAPIEN XT, LOTUS or SAPIEN 3 valve (Group B) after June 2014. We prospectively recorded VARC II success rate, procedural complication and residual PVR.RESULTS Baseline patient characteristics and procedural data for group A vs group B are presented in Table 1. Success and complication rates were largely similar in both groups but bleeding complications were lower in group B. The occurrence of more-than-mild PVR decreased from 27.4% (group A) to 7.6% (OR 0.218, 95% CI 0.09-0.56; p¼0.001). New PM implantation were 9,8% and 13,9% (p¼0.38) respectively for group A vs group B.