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Anatomical Annulus Predictors of New Permanent Pacemaker Implantation Risk After Balloon-Expandable Transcatheter Aortic Valve Implantation.
- Source :
-
The American journal of cardiology [Am J Cardiol] 2024 Aug 01; Vol. 224, pp. 26-35. Date of Electronic Publication: 2024 Jun 04. - Publication Year :
- 2024
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Abstract
- New-generation transcatheter heart valves have significantly improved technical success and procedural safety of transcatheter aortic valve implantation (TAVI) procedures; however, the incidence of permanent pacemaker implantation (PPI) remains a concern. This study aimed to assess the role of anatomic annulus features in determining periprocedural conduction disturbances leading to new PPI after TAVI using the last-generation Edwards SAPIEN balloon-expandable valves. In the context of a prospective single-center registry, we integrated the clinical and procedural predictors of PPI with anatomic data derived from multislice computed tomography. A total of 210 consecutive patients treated with balloon-expandable Edwards transcatheter heart valve were included in the study from 2015 to 2023. Technical success was achieved in 197 procedures (93.8%), and 26 patients (12.4%) required new PPI at the 30-day follow-up (median time to implantation 3 days). At the univariable logistic regression analysis, preprocedural right bundle branch block (odds ratio [OR] 2.24, 95% confidence interval [CI] 1.01 to 4.97, p = 0.047), annulus eccentricity ≥0.25 (OR 5.43, 95% CI 2.21 to 13.36, p <0.001), calcium volume at annulus of the right coronary cusp >48 mm <superscript>3</superscript> (OR 2.60, 95% CI 1.13 to 5.96, p = 0.024), and prosthesis implantation depth greater than membranous septum length (OR 2.17, 95% CI 1.10 to 4.28, p = 0.026) were associated with new PPI risk. In the multivariable analysis, preprocedural right bundle branch block (OR 2.81, 95% CI 1.01 to 7.85, p = 0.049), annulus eccentricity ≥0.25 (OR 4.14, 95% CI 1.85 to 9.27, p <0.001), and annulus <subscript>right coronary cusp</subscript> calcium >48 mm <superscript>3</superscript> (OR 2.89, 95% CI 1.07 to 7.82, p = 0.037) were confirmed as independent predictors of new PPI. In conclusion, specific anatomic features of the aortic valve annulus might have an additive role in determining the occurrence of conduction disturbances in patients who underwent TAVI with balloon-expandable valves. This suggests the possibility to use multislice computed tomography to improve the prediction of post-TAVI new PPI risk.<br />Competing Interests: Declaration of competing interest Dr. Romagnoli received speaker fees from Abbott Vascular and Terumo. F. Burzotta and C. Trani received speaker fees from Abbott Vascular, Abiomed, Medtronic, and Terumo. Dr. Aurigemma received speaker fees from Abbott Vascular, Abiomed, Medtronic, Terumo, and Daiichi Sankyo. Dr. Bianchini received a research grant from Abbott. The remaining authors have no competing interests to declare.<br /> (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Humans
Male
Female
Aged, 80 and over
Prospective Studies
Aged
Postoperative Complications epidemiology
Risk Factors
Bundle-Branch Block therapy
Bundle-Branch Block etiology
Registries
Transcatheter Aortic Valve Replacement methods
Transcatheter Aortic Valve Replacement adverse effects
Aortic Valve Stenosis surgery
Pacemaker, Artificial
Multidetector Computed Tomography methods
Aortic Valve surgery
Aortic Valve diagnostic imaging
Heart Valve Prosthesis
Prosthesis Design
Subjects
Details
- Language :
- English
- ISSN :
- 1879-1913
- Volume :
- 224
- Database :
- MEDLINE
- Journal :
- The American journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 38844197
- Full Text :
- https://doi.org/10.1016/j.amjcard.2024.05.034