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Clinical Impact of Preexisting Right Bundle Branch Block after Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. J Interv Cardiol 2020; 2020:1789516. [PMID: 32774182 PMCID: PMC7396100 DOI: 10.1155/2020/1789516] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/20/2020] [Accepted: 06/30/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction Transcatheter aortic valve replacement (TAVR) is now the treatment of choice for patients with severe aortic stenosis regardless of their surgical risk. Right bundle branch block (RBBB) can be a predictor for development of significant atrioventricular (AV) block after TAVR, requiring permanent pacemaker implantation (PPI). However, data related to the risk of PPI requirement with preexisting RBBB is scarce. Hence, this systematic review and meta-analysis aims to assess clinical outcomes of patients undergoing TAVR with RBBB on preexisting electrocardiogram. Methods We performed a systematic literature review to identify randomized and nonrandomized clinical studies that reported any clinical impact of patients undergoing TAVR with preexisting RBBB. A total of eight databases including PubMed (Medline), Embase, Cochrane Library, ACP Journal Club, Scopus, DARE, and Ovid containing articles from January 2000 to May 2020 were analyzed. Results We identified and screened 224 potential eligible publications through the databases and found 14 relevant clinical trials for a total of 15,319 participants. There was an increased 30-day pacemaker implantation rate of 38.1% in the RBBB group compared to 11.4% in the no RBBB group with a risk ratio of 3.56 (RR 3.56 (95% CI 3.21–3.93, p < 0.01)). There was an increased 30-day all-cause mortality in the RBBB group of 9.5% compared with 6.3% in the no RBBB group with an odds ratio of 1.60 (OR 1.60 (95% CI 1.14–2.25, p < 0.01)). Conclusion This study indicates that patients with preexisting RBBB have higher incidence of PPI and all-cause mortality after TAVR compared with patients without RBBB. Further trials are needed to compare the clinical outcomes based on TAVR valve types and assess the benefit of PPI in patients with new-onset RBBB after TAVR.
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202
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Useini D, Beluli B, Christ H, Mügge A, Patsalis P, Schlömicher M, Haldenwang P, Bechtel M, Strauch J. Oversized versus Non-oversized Prosthesis: Midterm Outcomes after Transcatheter Aortic Valve Replacement Using SAPIEN 3 Valve. Thorac Cardiovasc Surg 2020; 69:445-454. [PMID: 32688405 DOI: 10.1055/s-0040-1713168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND A certain degree of prosthesis oversizing is recommended for the SAPIEN 3 (S3; Edwards Lifesciences Corp., Irvine, California, United States) to ensure device success. We aimed to investigate midterm outcomes in patients who received oversized (OS) S3 valve after transapical-transcatheter aortic valve replacement (TA-TAVR). METHODS Out of 122 patients with aortic stenosis who underwent TA-TAVR using S3 at our institution, 42 received OS prosthesis. We used computed tomography (CT) derived effective diameter to assess oversizing. We defined oversizing if the labeled diameter of the selected valve for implantation was ≥2 mm bigger than the effective annulus diameter calculated by the annulus area. We conducted a midterm follow-up and compared the OS cohort with the non-OS (nOS) cohort. RESULTS The study groups showed similar risk score and age (STS [Society of Thoracic Surgery] score: 5.4 ± 3; mean age: 80.7 ± 5.7). The 30-day mortality was 7.1% in OS versus 2.4% in nOS. The 30-day all-stroke was 2.4% in OS versus 0% in nOS. The 1- and 3-year all-cause mortality were 28.5 and 42.8% in OS versus 21.9 and 26.8% in nOS, respectively. Midterm freedom from death and from cardiocerebral events was similar in both groups. Moderate/severe paravalvular leakage occurred in 0% in OS versus 5.4% in nOS. The postdilation rate was 7.1% in OS versus 15.3% in nOS. The rate of new permanent pacemaker implantation (PPI) was 15.7% in OS versus 9.3% in nOS. The STS score was detected as an independent predictor of mortality. CONCLUSION Oversizing reduces the risk of device failure and intraprocedural postdilation but increases the risk of PPI. Early and midterm morbidity and mortality after OS and nOS with S3 are comparable.
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Affiliation(s)
- Dritan Useini
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Blerta Beluli
- Department of Internal Medicine, St. Anna Hospital, Herne, Germany
| | - Hildegard Christ
- Institute of Medical Statistics and Computational Biology (IMSB), University Hospital of Cologne, Cologne, Germany
| | - Andreas Mügge
- Department of Cardiology and Angiology, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Polykarpos Patsalis
- Department of Cardiology and Angiology, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Markus Schlömicher
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Peter Haldenwang
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Matthias Bechtel
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Justus Strauch
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
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203
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Fontana GP, Bedogni F, Groh M, Smith D, Chehab BM, Garrett HE, Yong G, Worthley S, Manoharan G, Walton A, Hermiller J, Dhar G, Waksman R, Ramana RK, Mahoney P, Asch FM, Chakravarty T, Jilaihawi H, Makkar RR. Safety Profile of an Intra-Annular Self-Expanding Transcatheter Aortic Valve and Next-Generation Low-Profile Delivery System. JACC Cardiovasc Interv 2020; 13:2467-2478. [PMID: 33153563 DOI: 10.1016/j.jcin.2020.06.041] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The aim of this study was to characterize the safety profile of an intra-annular self-expanding valve with a next-generation low-profile delivery system (DS). BACKGROUND Key design modifications to the FlexNav DS include the addition of a hydrophilic-coated, integrated sheath and stability layer to facilitate gradual, controlled deployment in vessels with diameter ≥5 mm. METHODS Patients were pooled from 2 concurrent prospective, multicenter, single-arm studies (FlexNav DS arm of PORTICO IDE [Portico Re-Sheathable Transcatheter Aortic Valve System U.S. IDE Trial] [n = 134] and the FlexNav EU CE Mark Study [n = 46]) for the analysis. The primary endpoint was Valve Academic Research Consortium-2-defined major vascular complications at 30 days. Clinical outcomes and valve performance were assessed through 30 days by an independent clinical events committee and an echocardiography core laboratory, respectively. RESULTS One hundred forty high-risk and 40 extreme-risk subjects enrolled between October 15, 2018, and December 10, 2019, from 28 sites in the United States, Australia, and Europe who underwent attempted transfemoral Portico valve implantation were included. The mean age was 85.1 ± 5.6 years, 60% were women, the mean Society of Thoracic Surgeons score was 5.3%, and 96.1% presented with ≥1 frailty factor. Technical device success was 96.7%. At 30 days, the rate of major vascular complications was 5.0%, with 4.4% of complications adjudicated as access site-related (3.3% transcatheter aortic valve replacement DS access site-related). Death (0.6%) and disabling stroke (1.1%) were rare. The rate of new permanent pacemaker implantation was 15.4%. Echocardiography revealed a mean gradient of 7.1 ± 3.2 mm Hg, mean valve area of 1.77 ± 0.41 cm2, and a 4.1% rate of moderate paravalvular leak at 30 days. CONCLUSIONS Portico valve implantation with the FlexNav DS was associated with an excellent safety profile at 30 days.
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Affiliation(s)
- Gregory P Fontana
- Cardiovascular Institute, Los Robles Regional Medical Center, Thousand Oaks, California.
| | | | - Mark Groh
- Mission Health and Hospitals, Asheville, North Carolina
| | - David Smith
- Morriston Hospital - Swansea Bay University Health Board, Swansea, United Kingdom
| | - Bassem M Chehab
- Ascension Via Christi Hospital, University of Kansas, Wichita, Kansas
| | - H Edward Garrett
- Department of Surgery, University of Tennessee, Memphis, Tennessee
| | | | - Stephen Worthley
- Royal Adelaide Hospital, Adelaide, Australia; Genesis Care, Sydney, Australia
| | | | | | | | - Gaurav Dhar
- Sparrow Clinical Research Institute, Lansing, Michigan
| | - Ron Waksman
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, District of Columbia
| | - Ravi K Ramana
- Advocate Christ Medical Center, Oak Lawn, Illinois; Heart Care Centers of Illinois, Palos Park, Illinois
| | - Paul Mahoney
- Sentara Norfolk General Hospital, Norfolk, Virginia
| | - Federico M Asch
- MedStar Health Research Institute, Washington, District of Columbia
| | - Tarun Chakravarty
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Raj R Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
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204
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Luthra S, Leiva-Juárez MM, Ohri SK. Surgical vs transfemoral aortic valve replacement in low-risk patients: An updated meta-analysis of trial and registry data. J Card Surg 2020; 35:2264-2274. [PMID: 32652702 DOI: 10.1111/jocs.14802] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transfemoral aortic valve replacement (TAVR) has been studied extensively in patients with improving safety and efficacy in high to intermediate-risk patients with aortic stenosis. TAVR has been now approved for patients with low surgical risk. OBJECTIVE The purpose of this study is to integrate the evidence from randomized controlled trials (RCT) and large registry data comparing TAVR to surgical aortic valve repair (SAVR). METHODS Seven studies (three RCTs, one post hoc study of a RCT, and three registries) were included. Incidence rate ratios (IRR) of outcomes of interest (overall mortality, 30-day mortality, cardiovascular death, stroke, pacemaker implantation [PPMI], myocardial infarction, moderate-severe paravalvular leak [PVL], and re-intervention) were compared using a random-effects model. RESULTS The pooled analysis included 24 819 patients (TAVR, 8227 and SAVR, 16 592). 2,952 (11.9%) patients were from RCTs and 21 867 (88.1%) were registry patients. Thirty-day mortality was lower in TAVR (logIRR, -0.43; 95% CI. -0.61 to -0.25; P < .001), whereas the rate of moderate-severe PVL (logIRR, 1.44; 95% CI, 0.58-2.3; P < .001) and PPMI (logIRR, 1.13; 95% CI, 1.02-1.24; P < .001) were higher. There were no significant differences in the rates of overall mortality, reintervention, cardiovascular death, myocardial infarction, or stroke between SAVR and TAVR. CONCLUSIONS Early mortality is higher in SAVR while rates of PVL and PPMI are substantially higher in TAVR. There is no significant advantage with TAVR for overall survival, cardiovascular death, stroke, MI, and re-intervention rates.
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Affiliation(s)
- Suvitesh Luthra
- Wessex Cardiothoracic Centre, Southampton University Hospitals NHS Trust, Southampton, UK
| | - Miguel M Leiva-Juárez
- Department of Surgery, Brookdale University Hospital and Medical Center, Brooklyn, New York
| | - Sunil K Ohri
- Wessex Cardiothoracic Centre, Southampton University Hospitals NHS Trust, Southampton, UK
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Mubashir T, Balogh J, Chaudhry R, Quiroz C, Kar B, De Armas IAS, Liang Y, Markham T, Kumar R, Choi W, Akkanti B, Gregoric I, Williams G, Zaki J. Transcatheter and Surgical Aortic Valve Replacement Outcomes for Patients with Chronic Heart Failure. J Cardiothorac Vasc Anesth 2020; 35:888-895. [PMID: 32718887 DOI: 10.1053/j.jvca.2020.06.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/23/2020] [Accepted: 06/26/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To determine in-hospital outcomes and assess high-risk groups among chronic heart failure (CHF) patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). DESIGN A retrospective analysis of the Nationwide Inpatient Sample database from January 2012 to September 2015 was performed. SETTING Hospitals across the United States that offer TAVRs or SAVRs. PARTICIPANTS Adults with a diagnosis of CHF and AS. INTERVENTIONS The patients underwent either TAVR or SAVR. MEASUREMENTS AND MAIN RESULTS Totals of 5,871 and 4,008 CHF patients underwent TAVR and SAVR, respectively. TAVR patients were significantly older, more were female, and had a higher comorbidity burden. No significant differences in in-hospital mortality were noted between TAVR and SAVR. However, mean length of stay was significantly longer by 3.5 days in the SAVR group, as was the mean total cost. With the exception of complete heart block, permanent pacemaker implantation, and vascular complications, the majority of postoperative events were higher among the SAVR group. Multivariate regression analysis identified postoperative cardiac, respiratory and renal complications as significant predictors of in-hospital mortality for both groups. Additionally, age ≥75 years and vascular complications were significant predictors of mortality for patients undergoing TAVR. CONCLUSIONS Among CHF patients with symptomatic AS, TAVR had similar in-hospital mortality rate compared with SAVR despite higher comorbidity burden. TAVR patients are at a lower risk of cardiovascular, respiratory, and renal complications and might lead to reduced length of hospital stay and cost. Hence, TAVR may be a safer option in this population.
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Affiliation(s)
- Talha Mubashir
- Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston (UT Health), Houston, TX
| | - Julius Balogh
- Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston (UT Health), Houston, TX
| | - Rabail Chaudhry
- Department of Anesthesiology, University of Toronto, University Health Network, Toronto, Canada
| | - Cooper Quiroz
- Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston (UT Health), Houston, TX
| | - Biswajit Kar
- Department of Cardiology, Center for Advanced Heart Failure, Memorial Hermann Heart & Vascular Institute, McGovern Medical School, University of Texas Health Science Center at Houston (UT Health), Houston, TX
| | - Ismael A Salas De Armas
- Department of Cardiothoracic Surgery, Center for Advanced Heart Failure, Memorial Hermann Heart & Vascular Institute, McGovern Medical School, University of Texas Health Science Center at Houston (UT Health), Houston, TX
| | - Yafen Liang
- Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston (UT Health), Houston, TX
| | - Travis Markham
- Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston (UT Health), Houston, TX
| | - Rishi Kumar
- Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston (UT Health), Houston, TX
| | - Warren Choi
- Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston (UT Health), Houston, TX
| | - Bindu Akkanti
- Department of Pulmonary, Critical Care and Sleep Medicine, McGovern Medical School, University of Texas Health Science Center at Houston (UT Health), Houston, TX
| | - Igor Gregoric
- Department of Cardiothoracic Surgery, Center for Advanced Heart Failure, Memorial Hermann Heart & Vascular Institute, McGovern Medical School, University of Texas Health Science Center at Houston (UT Health), Houston, TX
| | - George Williams
- Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston (UT Health), Houston, TX
| | - John Zaki
- Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston (UT Health), Houston, TX.
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206
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Risk factors for permanent pacemaker implantation in patients receiving a balloon-expandable transcatheter aortic valve prosthesis. Heart Vessels 2020; 35:1735-1745. [DOI: 10.1007/s00380-020-01653-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/17/2020] [Indexed: 11/27/2022]
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Editorial: TAVR: Can't You Just Feel the Rhythm? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:479-480. [PMID: 32563525 DOI: 10.1016/j.carrev.2020.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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208
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A validated computational framework to predict outcomes in TAVI. Sci Rep 2020; 10:9906. [PMID: 32555300 PMCID: PMC7303192 DOI: 10.1038/s41598-020-66899-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/28/2020] [Indexed: 11/08/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) still presents complications: paravalvular leakage (PVL) and onset of conduction abnormalities leading to permanent pacemaker implantation. Our aim was testing a validated patient-specific computational framework for prediction of TAVI outcomes and possible complications. Twenty-eight TAVI patients (14 SapienXT and 14 CoreValve) were retrospectively selected. Pre-procedural CT images were post-processed to create 3D patient-specific implantation sites. The procedures were simulated with finite element analysis. Simulations' results were compared against post-procedural clinical fluoroscopy and echocardiography images. The computational model was in good agreement with clinical findings: the overall stent diameter difference was 2.6% and PVL was correctly identified with a post-processing algorithm in 83% of cases. Strains in the implantation site were studied to assess the risk of conduction system disturbance and were found highest in the patient who required pacemaker implantation. This study suggests that computational tool could support safe planning and broadening of TAVI.
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209
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Piayda K, Hellhammer K, Veulemans V, Afzal S, Heidari H, Wimmer AC, Al Juburi M, Antoch G, Kelm M, Zeus T. Performance of the CoreValve Evolut R and PRO in Severely Calcified Anatomy: A Propensity Score Matched Analysis. Heart Lung Circ 2020; 29:1847-1855. [PMID: 32646637 DOI: 10.1016/j.hlc.2020.05.096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 05/02/2020] [Accepted: 05/11/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The CoreValve Evolut R and PRO (Medtronic, Minneapolis, MN, USA) are among the newest-generation of self-expandable transcatheter aortic valve replacement (TAVR) devices and show excellent results. Treating patients with severely calcified (SC) native aortic valve anatomy may be challenging because of the increased risk of periprocedural complications. This study investigated the performance of Evolut R and PRO in this special patient subset. METHODS Patients who underwent TAVR with the CoreValve Evolut R or PRO (n=381) from September 2015 to March 2018 were divided by aortic valve calcification extent. Patients with SC aortic valve anatomy (n=98; men, >2,062 and women, >1,377 Agatston units) were compared with those with non-severely calcified (NCS) aortic valve anatomy after 1:2 propensity score matching. Outcomes were evaluated according to the updated valve academic research consortium criteria. RESULTS Patients with SC anatomy were older (83 years vs 80 years, p<0.001) and had a smaller aortic valve area (0.63 cm2 vs 0.70 cm2, p=0.028). Pre-dilatation was more often performed (30.6% vs 15.8%, p=0.003) and a permanent pacemaker implantation was more often necessary (32.9% vs 8.8%, p<0.001) in the SC group. None/mild aortic regurgitation (AR) was evenly distributed (SC, 96.9% vs NCS, 99.5%, p=0.109); moderate AR was present in 3.1% of SC patients and in 0.5% of NSC patients. Severe AR was not observed. CONCLUSION The CoreValve Evolut R and PRO showed good clinical safety profiles and excellent haemodynamic results in patients with SC anatomy and who more often required permanent pacemaker implantation.
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Affiliation(s)
- Kerstin Piayda
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Katharina Hellhammer
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Verena Veulemans
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Shazia Afzal
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Houtan Heidari
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Anna Christina Wimmer
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Maryam Al Juburi
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Gerald Antoch
- Medical Faculty, Department of Diagnostic and Interventional Radiology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Malte Kelm
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; CARID (Cardiovascular Research Institute Düsseldorf), Düsseldorf, Germany
| | - Tobias Zeus
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
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His-Purkinje Conduction System Pacing Following Transcatheter Aortic Valve Replacement. JACC Clin Electrophysiol 2020; 6:649-657. [DOI: 10.1016/j.jacep.2020.02.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/18/2020] [Accepted: 02/21/2020] [Indexed: 12/29/2022]
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211
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Lee HA, Chou AH, Wu VCC, Chen DY, Lee HF, Lee KT, Chu PH, Cheng YT, Chang SH, Chen SW. Balloon-expandable versus self-expanding transcatheter aortic valve replacement for bioprosthetic dysfunction: A systematic review and meta-analysis. PLoS One 2020; 15:e0233894. [PMID: 32479546 PMCID: PMC7263630 DOI: 10.1371/journal.pone.0233894] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/14/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Transcatheter aortic valve-in-valve (VIV) procedure is a safe alternative to conventional reoperation for bioprosthetic dysfunction. Balloon-expandable valve (BEV) and self-expanding valve (SEV) are the 2 major types of devices used. Evidence regarding the comparison of the 2 valves remains scarce. METHODS A systematic review and meta-analysis was conducted to compare the outcomes of BEV and SEV in transcatheter VIV for aortic bioprostheses dysfunction. A computerized search of Medline, PubMed, Embase, and Cochrane databases was performed. English-language journal articles reporting SEV or BEV outcomes of at least 10 patients were included. RESULTS In total, 27 studies were included, with 2,269 and 1,671 patients in the BEV and SEV groups, respectively. Rates of 30-day mortality and stroke did not differ significantly between the 2 groups. However, BEV was associated with significantly lower rates of postprocedural permanent pacemaker implantation (3.8% vs. 12%; P < 0.001). Regarding echocardiographic parameters, SEV was associated with larger postprocedural effective orifice area at 30 days (1.53 cm2 vs. 1.23 cm2; P < 0.001) and 1 year (1.55 cm2 vs. 1.22 cm2; P < 0.001). CONCLUSIONS For patients who underwent transcatheter aortic VIV, SEV was associated with larger postprocedural effective orifice area but higher rates of permanent pacemaker implantation. These findings provide valuable information for optimizing device selection for transcatheter aortic VIV.
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Affiliation(s)
- Hsiu-An Lee
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - An-Hsun Chou
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Victor Chien-Chia Wu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Dong-Yi Chen
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Hsin-Fu Lee
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Kuang-Tso Lee
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Yu-Ting Cheng
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Shang-Hung Chang
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Shao-Wei Chen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- * E-mail:
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212
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Konsensuspapier der Deutschen Gesellschaft für Kardiologie (DGK) und der Deutschen Gesellschaft für Thorax‑, Herz- und Gefäßchirurgie (DGTHG) zur kathetergestützten Aortenklappenimplantation (TAVI) 2020. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2020. [DOI: 10.1007/s00398-020-00373-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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213
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Kuck KH, Bleiziffer S, Eggebrecht H, Ensminger S, Frerker C, Möllmann H, Nef H, Thiele H, Treede H, Wimmer-Greinecker G, Walther T. Konsensuspapier der Deutschen Gesellschaft für Kardiologie (DGK) und der Deutschen Gesellschaft für Thorax‑, Herz- und Gefäßchirurgie (DGTHG) zur kathetergestützten Aortenklappenimplantation (TAVI) 2020. KARDIOLOGE 2020. [DOI: 10.1007/s12181-020-00398-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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214
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Wang YH, Ke HY, Cheng CC, Lin TC, Tsai CS, Lin CY. Cardiac Tamponade after Removal of a Temporary Pacing Wire for Transcatheter Aortic Valve Implantation: A Case Report. ACTA CARDIOLOGICA SINICA 2020; 36:276-278. [PMID: 32425444 DOI: 10.6515/acs.202005_36(3).20191211a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ying-Hsiang Wang
- Division of Cardiovascular Surgery, Department of Surgery, Division of Cardiology
| | - Hung-Yen Ke
- Division of Cardiovascular Surgery, Department of Surgery, Division of Cardiology
| | | | - Tzu-Chiao Lin
- Department of Internal Medicine, Tri-Service General Hospital
| | - Chien-Sung Tsai
- Division of Cardiovascular Surgery, Department of Surgery, Division of Cardiology
| | - Chih-Yuan Lin
- Division of Cardiovascular Surgery, Department of Surgery, Division of Cardiology.,Department of Biochemistry, National Defense Medical Center, Taipei, Taiwan
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Reichlin T, Pilgrim T. Functional Assessment of the Conduction System: The Key to Early Discharge After TAVR? JACC Cardiovasc Interv 2020; 13:1055-1057. [PMID: 32305397 DOI: 10.1016/j.jcin.2020.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/11/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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216
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Shivamurthy P, Vejpongsa P, Gurung S, Jacob R, Zhao Y, Anderson HV, Balan P, Nguyen TC, Estrera AL, Dougherty AH, Smalling RW, Dhoble A. Validation of scoring system predicting permanent pacemaker implantation after transcatheter aortic valve replacement. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:479-485. [DOI: 10.1111/pace.13910] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 03/13/2020] [Accepted: 03/25/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Poojita Shivamurthy
- University of Texas McGovern Medical School Houston Texas
- Memorial Hermann Heart & Vascular InstituteTexas Medical Center Houston Texas
- Mount Sinai HospitalIcahn School of Medicine New York New York
| | - Pimprapa Vejpongsa
- University of Texas McGovern Medical School Houston Texas
- Memorial Hermann Heart & Vascular InstituteTexas Medical Center Houston Texas
| | - Sidhanta Gurung
- University of Texas McGovern Medical School Houston Texas
- Memorial Hermann Heart & Vascular InstituteTexas Medical Center Houston Texas
| | - Robin Jacob
- University of Texas McGovern Medical School Houston Texas
- Memorial Hermann Heart & Vascular InstituteTexas Medical Center Houston Texas
| | - Yelin Zhao
- University of Texas McGovern Medical School Houston Texas
- Memorial Hermann Heart & Vascular InstituteTexas Medical Center Houston Texas
| | - H. Vernon Anderson
- University of Texas McGovern Medical School Houston Texas
- Memorial Hermann Heart & Vascular InstituteTexas Medical Center Houston Texas
| | - Prakash Balan
- University of Texas McGovern Medical School Houston Texas
- Memorial Hermann Heart & Vascular InstituteTexas Medical Center Houston Texas
| | - Tom C Nguyen
- University of Texas McGovern Medical School Houston Texas
- Memorial Hermann Heart & Vascular InstituteTexas Medical Center Houston Texas
| | - Anthony L Estrera
- University of Texas McGovern Medical School Houston Texas
- Memorial Hermann Heart & Vascular InstituteTexas Medical Center Houston Texas
| | - Anne H Dougherty
- University of Texas McGovern Medical School Houston Texas
- Memorial Hermann Heart & Vascular InstituteTexas Medical Center Houston Texas
| | - Richard W Smalling
- University of Texas McGovern Medical School Houston Texas
- Memorial Hermann Heart & Vascular InstituteTexas Medical Center Houston Texas
| | - Abhijeet Dhoble
- University of Texas McGovern Medical School Houston Texas
- Memorial Hermann Heart & Vascular InstituteTexas Medical Center Houston Texas
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217
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Winter JL, Healey JS, Sheth TN, Velianou JL, Schwalm JD, Smith A, Reza S, Natarajan MK. Remote Ambulatory Cardiac Monitoring Before and After Transcatheter Aortic Valve Replacement. CJC Open 2020; 2:416-419. [PMID: 32995727 PMCID: PMC7499381 DOI: 10.1016/j.cjco.2020.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/20/2020] [Indexed: 12/29/2022] Open
Abstract
Remote ambulatory cardiac monitoring (rACM) could identify high-grade atrioventricular block (AVB) before and after transcatheter aortic valve replacement (TAVR). Retrospective analysis of patients undergoing TAVR, with 14-day rACM before and after TAVR, was performed. Of 62 patients undergoing TAVR, 41 patients had rACM before TAVR. Three patients had asymptomatic AVB leading to planned pacemaker (PM) implant. After TAVR, 23 patients had rACM, with 1 patient requiring a PM implant for asymptomatic AVB. Five patients underwent unplanned PM after TAVR. Using rACM, almost half of PM implants in TAVR recipients were identified electively. High-grade AVB requiring PM was identified in nearly 10% of patients before TAVR.
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Affiliation(s)
- Jose L Winter
- Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey S Healey
- Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Tej N Sheth
- Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - James L Velianou
- Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jon-David Schwalm
- Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Amanda Smith
- Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Seleman Reza
- Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Madhu K Natarajan
- Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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218
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Nazif TM, Chen S, Codner P, Grossman PM, Menees DS, Sanchez CE, Yakubov SJ, White J, Kapadia S, Whisenant BK, Forrest JK, Krishnaswamy A, Arshi A, Orford JL, Leon MB, Dizon JM, Kodali SK, Chetcuti SJ. The initial U.S. experience with the Tempo active fixation temporary pacing lead in structural heart interventions. Catheter Cardiovasc Interv 2020; 95:1051-1056. [PMID: 31478304 DOI: 10.1002/ccd.28476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 07/30/2019] [Accepted: 08/12/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This multicenter retrospective study of the initial U.S. experience evaluated the safety and efficacy of temporary cardiac pacing with the Tempo® Temporary Pacing Lead. BACKGROUND Despite increasing use of temporary cardiac pacing with the rapid growth of structural heart procedures, temporary pacing leads have not significantly improved. The Tempo lead is a new temporary pacing lead with a soft tip intended to minimize the risk of perforation and a novel active fixation mechanism designed to enhance lead stability. METHODS Data from 269 consecutive structural heart procedures were collected. Outcomes included device safety (absence of clinically significant cardiac perforation, new pericardial effusion, or sustained ventricular arrhythmia) and efficacy (clinically acceptable pacing thresholds with successful pace capture throughout the index procedure). Postprocedure practices and sustained lead performance were also analyzed. RESULTS The Tempo lead was successfully positioned in the right ventricle and achieved pacing in 264 of 269 patients (98.1%). Two patients (0.8%) experienced loss of pace capture. Procedural mean pace capture threshold (PCT) was 0.7 ± 0.8 mA. There were no clinically significant perforations, pericardial effusions, or sustained device-related arrhythmias. The Tempo lead was left in place postprocedure in 189 patients (71.6%) for mean duration of 43.3 ± 0.7 hr (range 2.5-221.3 hr) with final PCT of 0.84 ± 1.04 mA (n = 80). Of these patients, 84.1% mobilized out of bed with no lead dislodgment. CONCLUSION The Tempo lead is safe and effective for temporary cardiac pacing for structural heart procedures, provides stable peri and postprocedural pacing and allows mobilization of patients who require temporary pacing leads.
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Affiliation(s)
- Tamim M Nazif
- Columbia University Irving Medical Center, New York, New York.,Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Shmuel Chen
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Pablo Codner
- Columbia University Irving Medical Center, New York, New York
| | - Paul M Grossman
- University of Michigan Cardiovascular Center, Ann Arbor, Michigan
| | - Daniel S Menees
- University of Michigan Cardiovascular Center, Ann Arbor, Michigan
| | | | | | - Jonathan White
- Cleveland Clinic Heart & Vascular Institute, Cleveland, Ohio
| | - Samir Kapadia
- Cleveland Clinic Heart & Vascular Institute, Cleveland, Ohio
| | | | - John K Forrest
- Yale University School of Medicine, New Haven, Connecticut
| | | | - Arash Arshi
- OhioHealth/Riverside Methodist Hospital, Columbus, Ohio
| | - James L Orford
- Intermountain Medical Center Heart Institute, Salt Lake City, Utah
| | - Martin B Leon
- Columbia University Irving Medical Center, New York, New York.,Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - José M Dizon
- Columbia University Irving Medical Center, New York, New York
| | - Susheel K Kodali
- Columbia University Irving Medical Center, New York, New York.,Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
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219
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Mas-Peiro S, Fichtlscherer S, Walther C, Vasa-Nicotera M. Current issues in transcatheter aortic valve replacement. J Thorac Dis 2020; 12:1665-1680. [PMID: 32395310 PMCID: PMC7212163 DOI: 10.21037/jtd.2020.01.10] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aortic stenosis is the most common valvular disease worldwide. With transcatheter aortic valve replacement (TAVR) being increasingly expanded to lower-risk populations, several challenging issues remain to be solved. The present review aims at discussing modern approaches to such issues as well as the current status of TAVR. TAVR has undergone several developments in the recent years: an increased use of transfemoral access, the development of prostheses in order to adapt to challenging anatomies, improved delivery systems with repositioning features, and outer skirts aiming at reducing paravalvular leak. The indication of TAVR is increasingly being expanded to patients with lower surgical risk. The main clinical trials supporting such expansion are reviewed and the latest data on low-risk patients are discussed. A number of challenges need still to be addressed and are also reviewed in this paper: the need for updated international guidelines including the latest evidence; a reduction of main complications such as permanent pacemaker implantation, paravalvular leak, and stroke (and its potential prevention by using anti-embolic protection devices); the appropriate role of TAVR in patients with concomitant cardiac ischemic disease; and durability of bio-prosthetic implanted valves. Finally, the future perspectives for TAVR use and next device developments are discussed.
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Affiliation(s)
- Silvia Mas-Peiro
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Stephan Fichtlscherer
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Claudia Walther
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Mariuca Vasa-Nicotera
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
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220
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Subramani S, Arora L, Krishnan S, Hanada S, Sharma A, Ramakrishna H. Analysis of Conduction Abnormalities and Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement. J Cardiothorac Vasc Anesth 2020; 34:1082-1093. [DOI: 10.1053/j.jvca.2019.07.132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 07/17/2019] [Indexed: 12/31/2022]
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221
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Ina Tamburino C, Barbanti M, Tamburino C. Transcatheter aortic valve implantation: how to decrease post-operative complications. Eur Heart J Suppl 2020; 22:E148-E152. [PMID: 32523460 PMCID: PMC7270891 DOI: 10.1093/eurheartj/suaa081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is a therapeutic option widely used for the treatment of severe aortic stenosis in the elderly. Careful pre-procedural screening, operator experience, and technological innovations, accounted for a safe, reliable, and standardized procedure. To further decrease post-operative complications, few steps are important: careful planning of the procedure by the Heart Team, clinical and diagnostic evaluation including electrocardiogram, echography, and computed tomography of the heart and great vessels. This approach will allow a selection of ideal candidates for the procedure, the best vascular approach, the selection of patients candidates for early discharge, and last but not least, simplification of the TAVI procedure. Although the procedure is reaching the ‘simplicity’ of coronary interventions, it should always be kept in mind the possibility, albeit remote, that life-threatening complication could ensue, requiring the prompt intervention of the cardiovascular surgeon.
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Affiliation(s)
| | - Marco Barbanti
- CAST-Ospedale Policlinico, Cardiologia, Università degli Studi di Catania, Italy
| | - Corrado Tamburino
- CAST-Ospedale Policlinico, Cardiologia, Università degli Studi di Catania, Italy
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222
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Hensey M, Sathananthan J, Alkhodair A, Landes U, Wood DA, Daniels D, Webb JG. Single‐center prospective study examining use of the Wattson temporary pacing guidewire for transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2020; 96:968-971. [DOI: 10.1002/ccd.28832] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 02/25/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Mark Hensey
- Centre for Heart Valve Innovation St Paul's Hospital, University of British Columbia Vancouver Canada
| | - Janarthanan Sathananthan
- Centre for Heart Valve Innovation St Paul's Hospital, University of British Columbia Vancouver Canada
| | - Abdullah Alkhodair
- Centre for Heart Valve Innovation St Paul's Hospital, University of British Columbia Vancouver Canada
| | - Uri Landes
- Centre for Heart Valve Innovation St Paul's Hospital, University of British Columbia Vancouver Canada
| | - David A. Wood
- Centre for Heart Valve Innovation St Paul's Hospital, University of British Columbia Vancouver Canada
| | - David Daniels
- Department of Interventional Cardiology Sutter Health San Francisco California USA
| | - John G. Webb
- Centre for Heart Valve Innovation St Paul's Hospital, University of British Columbia Vancouver Canada
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223
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Coeman M, Kayaert P, Philipsen T, Calle S, Gheeraert P, Gevaert S, Czapla J, Timmers L, Van Heuverswyn F, De Pooter J. Different dynamics of new-onset electrocardiographic changes after balloon- and self-expandable transcatheter aortic valve replacement: Implications for prolonged heart rhythm monitoring. J Electrocardiol 2020; 59:68-73. [DOI: 10.1016/j.jelectrocard.2020.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/27/2019] [Accepted: 01/14/2020] [Indexed: 12/21/2022]
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224
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Ojeda S, Hidalgo F, Romero M, Mazuelos F, Suárez de Lezo J, Martín E, Lostalo A, Luque A, González R, Fernández A, López-Aguilera J, Segura J, Guerrero N, Pan M. Impact of the repositionable Evolut R CoreValve system on the need for a permanent pacemaker after transcatheter aortic valve implantation in patients with severe aortic stenosis. Catheter Cardiovasc Interv 2020; 95:783-790. [PMID: 31062927 DOI: 10.1002/ccd.28327] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 04/15/2019] [Accepted: 04/21/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To compare the incidence of permanent pacemaker implantation (PPI) with the CoreValve and Evolut R prostheses, to evaluate the implantation depth with both types of prostheses, and to study factors predicting the need for PPI. BACKGROUND The Evolut R CoreValve can be recaptured and repositioned during deployment, allowing a more precise implantation. METHODS A total of 208 patients treated with CoreValve and 137 patients treated with Evolut R were analyzed. The depth of the prosthesis in the LVOT was measured by angiography in the annular perpendicular view projection after deploymen in all patients. RESULTS Baseline conduction abnormalities were comparable between the groups (85/208, 40.9% vs. 53/137, 38.7%; p = 0.69). The mean prosthesis depth was 10.3 ± 8.6 mm in the CoreValve group and 5.5 ± 2.7 mm in the Evolut R group; p < 0.0001. Conduction disturbances after valve implantation were more frequent with the CoreValve (new-onset left bundle branch block: 93, 44.7% vs. 16, 11.7%; p < 0.05, first-degree atrioventricular block: 23, 11.1% vs. 5, 3.6%; p < 0.05). In addition, the incidence of PPI was significantly lower with Evolut R (45, 21.6% vs. 15, 10.9%; p = 0.01). The predictors of the need for PPI were the mean depth of the prosthesis (OR: 1.13, 95% CI: 1.06-1.21; p < 0.0001) and prior right bundle branch block (OR 10.22, 95% CI: 4.62-22.63; p < 0.0001). CONCLUSIONS The recapturable capability of the Evolut R system allowed for higher and precise valve implantation. This fact had an impact on the reduction in the need for PPI.
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Affiliation(s)
- Soledad Ojeda
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Francisco Hidalgo
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Miguel Romero
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Francisco Mazuelos
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Javier Suárez de Lezo
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Ernesto Martín
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Adrián Lostalo
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Aurora Luque
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Rafael González
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Ana Fernández
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - José López-Aguilera
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - José Segura
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Noelia Guerrero
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Manuel Pan
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
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225
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Vijayaraman P, Young W, Rao S, Tung R. Managing Syncope After Transcatheter Aortic Valve Replacement: More than Meets the Eye. J Innov Card Rhythm Manag 2020; 11:4037-4040. [PMID: 32369045 PMCID: PMC7192139 DOI: 10.19102/icrm.2020.110307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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226
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Coti I, Schukro C, Drevinja F, Haberl T, Kaider A, Kocher A, Laufer G, Andreas M. Conduction disturbances following surgical aortic valve replacement with a rapid-deployment bioprosthesis. J Thorac Cardiovasc Surg 2020; 162:803-811. [PMID: 32204909 DOI: 10.1016/j.jtcvs.2020.01.083] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 01/12/2020] [Accepted: 01/19/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The implantation of rapid-deployment aortic valves may interfere with the conduction system of the heart. This study evaluates the occurrence and predictive factors of conduction anomalies in patients undergoing surgical aortic valve replacement (SAVR) with a rapid-deployment balloon-expandable bioprosthesis in a single-center, real-world experience. METHODS Between May 2010 and April 2019, 700 consecutive patients were included in a prospective, ongoing database with a longitudinal follow-up preoperatively, at discharge, and at 3 months, 1 year, 3 years, and 5 years postoperatively. Thirty-seven patients (5.3%) had a permanent pacemaker at baseline and were excluded from further analysis, leaving 663 patients for analysis. Assessment of conduction anomalies was performed by electrocardiography (ECG) monitoring and repeated 12-lead ECG during the hospital stay and at postoperative follow-ups. RESULTS Preoperatively, 126 patients (19.0%) presented with different conduction disturbances. New permanent pacemaker implantation (PPI) occurred in 61 patients during the first 14 days (cumulative incidence, 9.4%). The indication for PPI was complete atrioventricular block in 47 cases (77%). Preoperative conduction anomalies, such as right bundle branch block, as well as operative characteristics (concomitant procedures) were found to be independent predictors for new PPI. One-year survival was 98% in patients with new early PPI and 96% in those without new early PPI (P = .60). CONCLUSIONS The PPI rate was in the range of previous reports for rapid-deployment prostheses. PPI did not have a significant influence on short- to intermediate-term survival. Case selection with exclusion of patients presenting with baseline conduction disturbances may decrease the rate of new PPIs after SAVR with rapid-deployment balloon-expandable bioprostheses.
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Affiliation(s)
- Iuliana Coti
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Christoph Schukro
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Fitim Drevinja
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Haberl
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Alexandra Kaider
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Alfred Kocher
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Guenther Laufer
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Andreas
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
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227
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Giannini C, Petronio AS, Mehilli J, Sartori S, Chandrasekhar J, Faggioni M, Lefèvre T, Presbitero P, Capranzano P, Tchetche D, Iadanza A, Sardella G, Van Mieghem NM, Meliga E, Dumonteil N, Fraccaro C, Trabattoni D, Mikhail GW, Ferrer MC, Naber C, Kievit P, Sorrentino S, Morice MC, Chieffo A, Mehran R. Edwards SAPIEN Versus Medtronic Aortic Bioprosthesis in Women Undergoing Transcatheter Aortic Valve Implantation (from the Win-TAVI Registry). Am J Cardiol 2020; 125:441-448. [PMID: 31813530 DOI: 10.1016/j.amjcard.2019.10.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 10/28/2019] [Indexed: 11/27/2022]
Abstract
We sought to analyze outcomes of women receiving balloon-expandable valves (BEV) or self-expanding valves (SEV) in contemporary transcatheter aortic valve implantation (TAVI). WIN TAVI (Women's INternational Transcatheter Aortic Valve Implantation) is the first all-female TAVI registry to study the safety and performance of TAVI in women. We compared women treated with BEV (n = 408, 46.9%) versus those treated with SEV (n = 461, 53.1%). The primary efficacy end point was the Valve Academic Research Consortium-2 (VARC-2) composite of 1-year all-cause death, stroke, myocardial infarction, hospitalization for valve-related symptoms or heart failure or valve-related dysfunction. Women receiving SEV had higher surgical risk scores, higher rate of previous stroke and pulmonary hypertension whereas women receiving BEV were more frequently denied surgical valve replacement due to frailty. BEV patients were less likely to require post-dilation and had significantly lower rates of residual aortic regurgitation grade ≥2 (9.8% vs 4.7%, p = 0.007). At 1 year, the crude incidence and adjusted risk of the primary VARC-2 efficacy end point was similar between groups (17.1% with SEV and 14.3% with BEV, p = 0.25; hazards ratio 1.09, 95% confidence interval 0.68 to 1.75). Conversely the crude rate and adjusted risk of new pacemaker implantation was higher with SEV than BEV (15% vs 8.6%, p = 0.001; hazards ratio 1.97, 95% confidence interval 1.13 to 3.43). A subanalysis on new generation valves showed no difference in the need for pacemaker implantation between the 2 devices (10.1% vs 8.0%, p = 0.56). In conclusion, in contemporary TAVI, SEV are used more frequently in women with greater co-morbidities. While there were no differences in unadjusted and adjusted risk of 1-year primary efficacy end point between the valve types, there was a greater need for permanent pacemakers after SEV implantation.
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228
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Midterm outcome of aortic valve neocuspidization for aortic valve stenosis with small annulus. Gen Thorac Cardiovasc Surg 2020; 68:762-767. [DOI: 10.1007/s11748-020-01299-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 01/24/2020] [Indexed: 01/08/2023]
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Kooistra NHM, van Mourik MS, Rodríguez-Olivares R, Maass AH, Nijenhuis VJ, van der Werf R, ten Berg JM, Kraaijeveld AO, Baan Jr J, Voskuil M, Vis MM, Stella PR. Late onset of new conduction disturbances requiring permanent pacemaker implantation following TAVI. Heart 2020; 106:1244-1251. [DOI: 10.1136/heartjnl-2019-315967] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/27/2019] [Accepted: 01/08/2020] [Indexed: 12/31/2022] Open
Abstract
BackgroundThe timing of onset and associated predictors of late new conduction disturbances (CDs) leading to permanent pacemaker implantation (PPI) following transcatheter aortic valve implantation (TAVI) are still unknown, however, essential for an early and safe discharge. This study aimed to investigate the timing of onset and associated predictors of late onset CDs in patients requiring PPI (LCP) following TAVI.Methods and resultsWe performed retrospective analysis of prospectively collected data from five large volume centres in Europe. Post-TAVI electrocardiograms and telemetry data were evaluated in patients with a PPI post-TAVI to identify the onset of new advanced CDs. Early onset CDs were defined as within 48 hours after procedure, and late onset CDs as after 48 hours. A total of 2804 patients were included for analysis. The PPI rate was 12%, of which 18% was due to late onset CDs (>48 hours). Independent predictors for LCP were pre-existing non-specific intraventricular conduction delay, pre-existing right bundle branch block, self-expandable valves and predilation. At least one of these risk factors was present in 98% of patients with LCP. Patients with a balloon-expandable valve without predilation did not develop CDs requiring PPI after 48 hours.ConclusionsSafe early discharge might be feasible in patients without CDs in the first 48 hours after TAVI if no risk factors for LCP are present.
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Kefer J, Maes F, Renkin J, Kautbally S, De Meester C, Delacour M, Pouleur AC. Resheathing of self-expanding bioprosthesis: Impact on procedural results, clinical outcome and prosthetic valve durability after transcatheter aortic valve implantation. IJC HEART & VASCULATURE 2020; 26:100462. [PMID: 31921975 PMCID: PMC6948261 DOI: 10.1016/j.ijcha.2019.100462] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/20/2019] [Accepted: 12/20/2019] [Indexed: 01/08/2023]
Abstract
To resheath a SEV doesn’t increase the procedural risk of TAVI. To resheath a SEV doesn’t impair the clinical outcome of patients. The resheath has no negative impact on the acute prosthetic valve function. Resheathing manœuvre has no deleterious effect on the prosthetic valve durability at short term follow-up.
Background New transcatheter aortic valves were recently developed, enabling to resheath and reposition the prosthesis. The aim of the present study was to investigate whether the resheath manoeuvre did not impair the outcome of patients and the bioprosthesis durability after transcatheter aortic valve implantation (TAVI). Methods and results On the 346 consecutive patients (84 ± 7 yrs-old, mean STS 6.7 ± 5%) undergoing a transfemoral TAVI in our institution since January 2008, 170 patients were implanted using a self-expanding valve (SEV). Among those, 39 (Group 1) required resheathing to achieve a successful implantation, while 131 did not require it (Group 2, N = 131). A balloon-expanding valve (BEV) was used in 176 patients (Group 3). Baseline characteristics were similar between groups. Device success was 98%, the rate of in-hospital death was 2%, and the number of procedural complications was similarly low, with no significant difference between groups. The follow-up was complete in 337 of 338 patients undergoing a successful TAVI (781 patients-year). Kaplan-Meier analysis showed that overall survival was 80 ± 2% and 42 ± 3% at 1 and 5 years respectively, with no difference between groups. On multivariate analysis, acute kidney injury, post-dilatation, pulmonary hypertension, porcelain aorta and STS score, but not resheath, were independant predictors of death after TAVI. The annual event rate of structural valve deterioration was 0.6% patients-year, and similar between groups. Conclusions Our study shows that SEV resheath did not impair the procedural results, the outcome of patients nor the valve durability at short term after TAVI.
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Affiliation(s)
- Joelle Kefer
- Cliniques Universitaires Saint-Luc, Division of Cardiology and Intitut de Recherche Experimentale en Cardiologie (IREC), Brussels, Belgium
| | - Frederic Maes
- Cliniques Universitaires Saint-Luc, Division of Cardiology and Intitut de Recherche Experimentale en Cardiologie (IREC), Brussels, Belgium
| | - Jean Renkin
- Cliniques Universitaires Saint-Luc, Division of Cardiology and Intitut de Recherche Experimentale en Cardiologie (IREC), Brussels, Belgium
| | - Shakeel Kautbally
- Cliniques Universitaires Saint-Luc, Division of Cardiology and Intitut de Recherche Experimentale en Cardiologie (IREC), Brussels, Belgium
| | | | - Marine Delacour
- Cliniques Universitaires Saint-Luc, Division of Cardiology and Intitut de Recherche Experimentale en Cardiologie (IREC), Brussels, Belgium
| | - Anne-Catherine Pouleur
- Cliniques Universitaires Saint-Luc, Division of Cardiology and Intitut de Recherche Experimentale en Cardiologie (IREC), Brussels, Belgium
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Boskovski MT, Nguyen TC, McCabe JM, Kaneko T. Outcomes of Transcatheter Aortic Valve Replacement in Patients With Severe Aortic Stenosis. JAMA Surg 2020; 155:69-77. [DOI: 10.1001/jamasurg.2019.4449] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Marko T. Boskovski
- Division of Cardiac Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Tom C. Nguyen
- Department of Cardiothoracic and Vascular Surgery, University of Texas at Houston
| | | | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
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Viktorsson SA, Orrason AW, Vidisson KO, Gunnarsdottir AG, Johnsen A, Helgason D, Arnar DO, Geirsson A, Gudbjartsson T. Immediate and long-term need for permanent cardiac pacing following aortic valve replacement. SCAND CARDIOVASC J 2019; 54:186-191. [PMID: 31809597 DOI: 10.1080/14017431.2019.1698761] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction: Atrioventricular (AV) node conduction disturbances are common following surgical aortic valve replacement (SAVR), and in some cases the patient needs a permanent pacemaker (PPM) implantation before discharge from hospital. Little is known about the long-term need for PPM and the PPM dependency of these individuals. We determined the incidence of PPM implantation before and after discharge in SAVR patients. Methods: We studied 557 consecutive patients who underwent SAVR for aortic stenosis in Iceland between 2002 and 2016. Timing and indication for PPM were registered, with a new concept, ventricular pacing proportion (VPP), defined as ventricular pacing ≥90% of the time, being used to approximate pacemaker dependency. The median follow-up time was 73 months. We plotted the cumulative incidence of pacemaker implantation, treating death as a competing risk. Results: Of the 557 patients, 22 (3.9%) received PPM in the first 30 days after surgery, most commonly for complete AV block (n = 14) or symptomatic bradycardia (n = 8); Thirty-eight other patients (6.8%) had a PPM implanted >30 days postoperatively, at a median of 43 months after surgery (range 0‒181), most often for AV block (n = 13) or sick-sinus syndrome (n = 10). The cumulative incidence of PPM implantation at 1, 5, and 10 years postoperatively was 5.0%, 9.2%, and 12.3%, respectively. During follow-up, 45.0% of the 60 patients had VPP ≥90%. Conclusion: The cumulative incidence of permanent pacemaker implantation following SAVR was about 12% at 10 years, with every other patient having VPP ≥90% during follow-up. This suggests that AV node conduction disturbances extend significantly beyond the perioperative period.
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Affiliation(s)
- Sindri A Viktorsson
- Division of Cardiothoracic Surgery, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - Andri W Orrason
- Division of Cardiothoracic Surgery, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - Kristjan O Vidisson
- Division of Cardiothoracic Surgery, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - Anna G Gunnarsdottir
- Division of Cardiothoracic Surgery, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - Arni Johnsen
- Division of Cardiothoracic Surgery, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - Dadi Helgason
- Internal Medicine Services, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - David O Arnar
- Division of Cardiology, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Tomas Gudbjartsson
- Division of Cardiothoracic Surgery, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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233
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Tian Y, Padmanabhan D, McLeod CJ, Zhang P, Xiao P, Sandhu GS, Greason KL, Gulati R, Nkomo VT, Rihal CS, Polk LE, Sanvick C, Liu XP, Friedman PA, Cha YM. Utility of 30-Day Continuous Ambulatory Monitoring to Identify Patients With Delayed Occurrence of Atrioventricular Block After Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2019; 12:e007635. [DOI: 10.1161/circinterventions.118.007635] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Mechanical injury in the conduction system requiring permanent pacemaker (PPM) associated with transcatheter aortic valve replacement (TAVR) procedure is a common complication. The objective of this study was to use ambulatory monitor BodyGuardian to assess late occurrence of atrioventricular block (AVB) after TAVR.
Methods:
This prospective study evaluated 365 patients who underwent TAVR at Mayo Clinic, Rochester, Minnesota between June 2016 and August 2017. Patients who received PPM for bradycardia after TAVR before discharge were considered as the PPM group. Those not requiring PPM received a BodyGuardian system (BodyGuardian group) for 30 days of continuous monitoring. Primary end point was Mobitz II or third-degree atrioventricular block (II/III AVB) at 30-day follow-up.
Results:
Of 365 patients, 74 who had a PPM or an implantable cardioverter-defibrillator before TAVR and 94 who were enrolled in other studies were excluded. Of 197 patients enrolled in the study, 70 (35.5%) received PPM and 127 had BodyGuardian before the hospital dismissal. Eleven of 127 (8.6%) BodyGuardian group required PPM within 30 days after TAVR for late occurrence of symptomatic bradycardia. In total, 33 of 197 (16.7%) patients developed II/III AVB (24 before and 9 after discharge). Thirty-four patients had preexisting right bundle branch block. Of them, 16 (47%) developed II/III AVB. Of 53 patients who developed new left bundle branch block after TAVR, 14% progressed to II/III AVB within 30 days.
Conclusions:
In patients without a standard post-TAVR pacing indication, yet a potential risk to develop AVB, a strategy of 30-day monitoring identifies additional patients who require permanent pacing.
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Affiliation(s)
- Ying Tian
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
- Department of Cardiovascular Diseases, Beijing Chaoyang Hospital, China (Y.T., X.-P.L.)
| | - Deepak Padmanabhan
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
| | | | - Pei Zhang
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
| | - Peilin Xiao
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
| | - Gurpreet S. Sandhu
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
| | - Kevin L. Greason
- Department of Cardiovascular Surgery (K.L.G.), Mayo Clinic, Rochester, MN
| | - Rajiv Gulati
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
| | - Vuyisile T. Nkomo
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
| | - Charanjit S. Rihal
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
| | - Lynn E. Polk
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
| | - Carrie Sanvick
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
| | - Xing-Peng Liu
- Department of Cardiovascular Diseases, Beijing Chaoyang Hospital, China (Y.T., X.-P.L.)
| | - Paul A. Friedman
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
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Left Ventricular Rapid Pacing Via the Valve Delivery Guidewire in Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2019; 12:2449-2459. [DOI: 10.1016/j.jcin.2019.09.029] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 09/17/2019] [Accepted: 09/18/2019] [Indexed: 11/17/2022]
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235
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Xi Z, Liu T, Liang J, Zhou YJ, Liu W. Impact of postprocedural permanent pacemaker implantation on clinical outcomes after transcatheter aortic valve replacement: a systematic review and meta-analysis. J Thorac Dis 2019; 11:5130-5139. [PMID: 32030230 DOI: 10.21037/jtd.2019.12.02] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background The incidence of conduction disturbances requiring permanent pacemaker (PPM) implantation following transcatheter aortic valve replacement (TAVR) have remained a common concern. The purpose of this study was to evaluate the impact of postprocedural PPM implantation following TAVR on clinical outcomes. Methods We performed a systematic search in PubMed and EMBASE databases for studies that reported raw data on clinical outcomes of patients with and without PPM implantation after TAVR and followed up patients for 10 months or longer. The primary endpoint was all-cause death. The secondary endpoints were cardiovascular death, heart failure and a composite of stroke and myocardial infarction (MI). Results Data from 20 studies with a total of 21,666 patients undergoing TAVR, of whom 12.5% required PPM implantation after intervention, were analysed and the mean duration follow-up was 16.9 months. The rate of PPM ranged from 6.2% to 32.8% among different studies. A total of 6,753 (31.2%) patients underwent TAVR with self-expandable prosthesis and 14,913 (68.8%) with balloon-expandable prosthesis. The incidence of postprocedural PPM implantation was higher with the self-expandable prosthesis (n=1,717, 25.4%) compared with the balloon-expandable prosthesis (n=996, 6.7%). PPM after TAVR was associated with a higher risk of all-cause death (RR: 1.13; 95% CI: 1.01-1.25; P=0.03) but not incidence of stroke and MI (RR: 0.85; 95% CI: 0.64-1.13; P=0.27). Conclusions In patients undergoing TAVR, the PPM implantation after intervention was associated higher all-cause mortality but not cardiovascular mortality, heart failure and stroke or MI, which remain an unsolved issue of TAVR.
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Affiliation(s)
- Ziwei Xi
- Department of Cardiology, Beijing Anzhen hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Tong Liu
- Department of Cardiology, Beijing Anzhen hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Jing Liang
- Department of Cardiology, Beijing Anzhen hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Yu-Jie Zhou
- Department of Cardiology, Beijing Anzhen hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Wei Liu
- Department of Cardiology, Beijing Anzhen hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
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236
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Zhan Y, Saadat S, Soin A, Kawabori M, Chen FY. A meta-analysis comparing transaxillary and transfemoral transcatheter aortic valve replacement. J Thorac Dis 2019; 11:5140-5151. [PMID: 32030231 DOI: 10.21037/jtd.2019.12.07] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background While transfemoral (TF) approach is considered as the default access for transcatheter aortic valve replacement (TAVR), the alternative access route of choice remains to be elucidated. Transaxillary (TAx) approach has shown promise as an excellent option. We performed a meta-analysis of the studies comparing the TF and TAx approaches using one type of self-expandable transcatheter valve to avoid device-related bias. Methods We searched PubMed/MEDLINE, EMBASE, and the Cochrane Library from inception to December 2018 to identify articles comparing TAx-TAVR and TF-TAVR. The studies included in this meta-analysis contain data related to the use of the CoreValve device. Patients' baseline characteristics, procedural outcomes, and clinical outcomes were extracted from the articles and pooled for analysis. Results The meta-analysis included five studies comprising 1,414 patients in the TF group and 489 patients in the TAx group. The average EuroScores of the TF and TAx groups were 20.04±13.89 and 22.73±14.73, respectively. The TAx group has higher rates of major comorbidities. No difference was found between the two groups with regard to vascular complications (P=0.71; OR 1.08; 95% CI, 0.71-1.65), aortic regurgitation (P=0.90; OR 1.03; 95% CI, 0.71-1.49), and permanent pacemaker (PPM) implantation (P=0.42; OR 1.12; 95% CI, 0.86-1.46). The TAx group has a lower incidence of acute kidney injury (AKI) (P=0.05; OR 1.63; 95% CI, 1.01-2.62). No difference was observed in 30-day mortality (P=0.32; OR 1.30; 95% CI, 0.78-2.17) or 1-year mortality (P=0.21; OR 0.76; 95% CI, 0.50-1.16). Conclusions TAx-TAVR is associated with overall comparable outcomes to TF TAVR in high-risk patient cohorts, despite higher incidences of major comorbidities in the TAx-TAVR patient population. The rate of AKI appears to be lower after TAx-TAVR.
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Affiliation(s)
- Yong Zhan
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Siavash Saadat
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Avneet Soin
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Masashi Kawabori
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Frederick Y Chen
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
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Should All Low-risk Patients Now Be Considered for TAVR? Operative Risk, Clinical, and Anatomic Considerations. Curr Cardiol Rep 2019; 21:161. [PMID: 31781976 DOI: 10.1007/s11886-019-1250-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW This article reviews the current data on TAVR in low-risk patients with severe, symptomatic aortic stenosis, highlights the results of the recently published Medtronic Low Risk Randomized Study and PARTNER 3 trials, and describes specific clinical, anatomic, and procedural considerations regarding the optimal treatment choice in this population. RECENT FINDINGS In low-risk patients, the Medtronic Low Risk Randomized Study demonstrated TAVR to be non-inferior to surgery with respect to the composite endpoint of death or disabling stroke while PARTNER 3 trial proved TAVR to be superior to surgery with regard to the composite endpoint of death, stroke, or rehospitalization. Recent trials demonstrate the safety and efficacy of TAVR in low-risk patients and have led to an FDA indication for the use of TAVR in these patients. However, the lack of long-term data on the rate of transcatheter valve deterioration in the younger population, higher incidence of paravalvular leak and pacemaker implantation following TAVR, along with certain intrinsic anatomic factors remain potential challenges to generalize TAVR in all low surgical risk patients. We describe specific clinical, anatomic, and procedural considerations regarding the optimal treatment choice for low-risk patients with severe, symptomatic AS.
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238
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Kotronias RA, Scarsini R, De Maria GL, Rajasundaram S, Sayeed R, Krasopoulos G, Grebenik C, Keiralla A, Newton JD, Banning AP, Kharbanda RK. Ultrasound guided vascular access site management and left ventricular pacing are associated with improved outcomes in contemporary transcatheter aortic valve replacement: Insights from the OxTAVI registry. Catheter Cardiovasc Interv 2019; 96:432-439. [DOI: 10.1002/ccd.28578] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/22/2019] [Accepted: 10/25/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Rafail A. Kotronias
- Oxford Heart Centre Oxford University Hospitals, NHS Trust Oxford UK
- Department of Cardiovascular Medicine University of Oxford Oxford UK
| | - Roberto Scarsini
- Oxford Heart Centre Oxford University Hospitals, NHS Trust Oxford UK
- Department of Medicine, Division of Cardiology University of Verona Verona Italy
| | | | | | - Rana Sayeed
- Oxford Heart Centre Oxford University Hospitals, NHS Trust Oxford UK
| | | | | | - Amar Keiralla
- Oxford Heart Centre Oxford University Hospitals, NHS Trust Oxford UK
| | - James D. Newton
- Oxford Heart Centre Oxford University Hospitals, NHS Trust Oxford UK
| | - Adrian P. Banning
- Oxford Heart Centre Oxford University Hospitals, NHS Trust Oxford UK
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Du F, Zhu Q, Jiang J, Chen H, Liu X, Wang J. Incidence and Predictors of Permanent Pacemaker Implantation in Patients Who Underwent Transcatheter Aortic Valve Replacement: Observation of a Chinese Population. Cardiology 2019; 145:27-34. [DOI: 10.1159/000502792] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 08/18/2019] [Indexed: 11/19/2022]
Abstract
Aims: Permanent pacemaker (PPM) implantation is one of the most common complications after transcatheter aortic valve replacement (TAVR). We studied the incidence of PPM implantation and identified the predictors in patients who underwent TAVR in a Chinese population. Methods and Results: A total of 256 patients who underwent TAVR with self-expandable valves were included. The incidence of PPM implantation in our study population was 14.8%. In patients who received PPM implantation, the proportion of bicuspid aortic valve (BAV) patients was much lower compared to tricuspid aortic valve (TAV) patients (18.4 vs. 81.6%, p < 0.05). Patients with BAV were associated with a significantly lower PPM implantation rate and shallower implantation depth compared to patients with TAV (6.4 vs. 21.7% and 4.2 ± 4.4 vs. 6.2 ± 5.0 mm, respectively, p < 0.05 for both). In the multivariable logistic regression analysis, prior right bundle branch block (RBBB; OR 8.3, 95% CI 2.2–32.1, p < 0.05), implantation depth (OR 1.3, 95% CI 1.1–1.5, p = 0.01), and TAV (OR 4.7, 95% CI 1.5–14.4, p < 0.05) were independent predictors of PPM implantation after TAVR. There was no difference in 30-day and 1-year all-cause mortality between the 2 groups. Conclusions: The incidence of PPM implantation in patients with self-expandable valves after TAVR was 14.8% in our cohort study. Independent predictors of PPM implantation included prior RBBB, TAV, and implantation depth at the noncoronary sinus side. TAVR in BAV with a supra-annular structure-based sizing strategy might decrease the risk of PPM implantation.
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240
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Toggweiler S, Brinkert M. Can Risk Scores Help to Further Improve Transcatheter Aortic Valve Replacement? JACC Cardiovasc Interv 2019; 12:2143-2144. [PMID: 31699375 DOI: 10.1016/j.jcin.2019.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/20/2019] [Indexed: 10/25/2022]
Affiliation(s)
| | - Miriam Brinkert
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
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241
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Ait Said M, Coquard C, Horvilleur J, Manenti V, Fiorina L, Lacotte J, Salerno F. [Transcatheter aortic valve implantation and conduction disturbances]. Ann Cardiol Angeiol (Paris) 2019; 68:443-449. [PMID: 31668339 DOI: 10.1016/j.ancard.2019.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is currently becoming the treatment of choice for patients with calcific aortic stenosis. Despite several technical improvements, the incidence of conduction disturbances has not diminished and remains TAVI's major complication. These disturbances include the occurrence of left bundle branch block and/or high-grade atrioventricular block often requiring pacemaker implantation. The proximity of the aortic valve to the conduction system (conduction pathways) accounts for the occurrence of these complications. Several factors have been identified as carrying a high risk of conduction disturbances like the presence of pre-existing right bundle branch block, the type of valve implanted, the volume of aortic and mitral calcifications, the size of the annulus and the depth of valve implantation. Left bundle branch block is the most frequent post TAVI conduction disturbance. Whereas the therapeutic strategy for persistent complete atrioventricular block is simple, it becomes complex in the presence of fluctuating changes in PR interval and left bundle branch block duration. The QRS width threshold value (150-160 ms) indicative of the need for pacemaker implantation is still being debated. Although there are currently no recommendations regarding the management of these conduction disturbances, the extension of TAVI indications to patient at low surgical risk calls for a standardization of our practice. However, a decision algorithm was recently proposed by a group of experts composed of interventional cardiologists, electrophysiologists and cardiac surgeons. There are still uncertainties about the appropriate timing of pacemaker implantation and the management of new onset left bundle branch block.
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Affiliation(s)
- M Ait Said
- ICPS Jacques Cartier, groupe Ramsay Générale de Santé, 6, avenue du Noyer Lambert, 91300 Massy, France.
| | - C Coquard
- ICPS Jacques Cartier, groupe Ramsay Générale de Santé, 6, avenue du Noyer Lambert, 91300 Massy, France
| | - J Horvilleur
- ICPS Jacques Cartier, groupe Ramsay Générale de Santé, 6, avenue du Noyer Lambert, 91300 Massy, France
| | - V Manenti
- ICPS Jacques Cartier, groupe Ramsay Générale de Santé, 6, avenue du Noyer Lambert, 91300 Massy, France
| | - L Fiorina
- ICPS Jacques Cartier, groupe Ramsay Générale de Santé, 6, avenue du Noyer Lambert, 91300 Massy, France
| | - J Lacotte
- ICPS Jacques Cartier, groupe Ramsay Générale de Santé, 6, avenue du Noyer Lambert, 91300 Massy, France
| | - F Salerno
- ICPS Jacques Cartier, groupe Ramsay Générale de Santé, 6, avenue du Noyer Lambert, 91300 Massy, France
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Costa G, Zappulla P, Barbanti M, Cirasa A, Todaro D, Rapisarda G, Picci A, Platania F, Tosto A, Di Grazia A, Sgroi C, Tamburino C, Calvi V. Pacemaker dependency after transcatheter aortic valve implantation: incidence, predictors and long-term outcomes. EUROINTERVENTION 2019; 15:875-883. [DOI: 10.4244/eij-d-18-01060] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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243
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Kiani S, Kamioka N, Black GB, Lu MLR, Lisko JC, Rao B, Mengistu A, Gleason PT, Stewart JP, Caughron H, Dong A, Patel H, Grubb KJ, Greenbaum AB, Devireddy CM, Guyton RA, Leshnower B, Merchant FM, El-Chami M, Westerman SB, Lloyd MS, Babaliaros VC, Hoskins MH. Development of a Risk Score to Predict New Pacemaker Implantation After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2019; 12:2133-2142. [DOI: 10.1016/j.jcin.2019.07.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/05/2019] [Accepted: 07/11/2019] [Indexed: 11/29/2022]
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244
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Goldsweig AM, Al-Ani A, Almomani A. Pacemaker Requirements following Self-Expanding Transcatheter Aortic Valve Replacement. Cardiology 2019; 145:35-37. [PMID: 31645042 DOI: 10.1159/000503380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Andrew M Goldsweig
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA,
| | - Ahmed Al-Ani
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Ahmed Almomani
- Division of Cardiovascular Medicine, University of Texas Health Sciences Center, San Antonio, Texas, USA
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245
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Meduri CU, Kereiakes DJ, Rajagopal V, Makkar RR, O'Hair D, Linke A, Waksman R, Babliaros V, Stoler RC, Mishkel GJ, Rizik DG, Iyer VS, Schindler J, Allocco DJ, Meredith IT, Feldman TE, Reardon MJ. Pacemaker Implantation and Dependency After Transcatheter Aortic Valve Replacement in the REPRISE III Trial. J Am Heart Assoc 2019; 8:e012594. [PMID: 31640455 PMCID: PMC6898843 DOI: 10.1161/jaha.119.012594] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background As transcatheter aortic valve replacement expands to younger and/or lower risk patients, the long‐term consequences of permanent pacemaker implantation are a concern. Pacemaker dependency and impact have not been methodically assessed in transcatheter aortic valve replacement trials. We report the incidence and predictors of pacemaker implantation and pacemaker dependency after transcatheter aortic valve replacement with the Lotus valve. Methods and Results A total of 912 patients with high/extreme surgical risk and symptomatic aortic stenosis were randomized 2:1 (Lotus:CoreValve) in REPRISE III (The Repositionable Percutaneous Replacement of Stenotic Aortic Valve through Implantation of Lotus Valve System—Randomized Clinical Evaluation) trial. Systematic assessment of pacemaker dependency was pre‐specified in the trial design. Pacemaker implantation within 30 days was more frequent with Lotus than CoreValve. By multivariable analysis, predictors of pacemaker implantation included baseline right bundle branch block and depth of implantation; diabetes mellitus was also a predictor with Lotus. No association between new pacemaker implantation and clinical outcomes was found. Pacemaker dependency was dynamic (30 days: 43%; 1 year: 50%) and not consistent for individual patients over time. Predictors of pacemaker dependency at 30 days included baseline right bundle branch block, female sex, and depth of implantation. No differences in mortality or stroke were found between patients who were pacemaker dependent or not at 30 days. Rehospitalization was higher in patients who were not pacemaker dependent versus patients without a pacemaker or those who were dependent. Conclusions Pacemaker implantation was not associated with adverse clinical outcomes. Most patients with a new pacemaker at 30 days were not dependent at 1 year. Mortality and stroke were similar between patients with or without pacemaker dependency and patients without a pacemaker. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier NCT02202434.
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Affiliation(s)
| | - Dean J Kereiakes
- The Christ Hospital Heart and Vascular Center The Lindner Research Center Cincinnati OH
| | | | | | | | - Axel Linke
- Dresden University Hospital, Heart Center Dresden Germany
| | | | | | | | | | - David G Rizik
- HonorHealth and the Scottsdale-Lincoln Health Network Scottsdale AZ
| | - Vijay S Iyer
- University at Buffalo/Gates Vascular Institute Buffalo NY
| | | | | | | | - Ted E Feldman
- Edwards Lifesciences Irvine California.,Northshore University Health System Evanston Hospital Evanston Illinois
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246
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Schoechlin S, Jalil F, Blum T, Ruile P, Hein M, Nührenberg TG, Arentz T, Neumann FJ. Need for pacemaker implantation in patients with normal QRS duration immediately after transcatheter aortic valve implantation. Europace 2019; 21:1851-1856. [DOI: 10.1093/europace/euz261] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 08/29/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
We sought to assess the need for permanent pacemaker implantation (PPI) in patients with QRS <120 ms in electrocardiogram (ECG) after transcatheter aortic valve implantation (TAVI).
Methods and results
We retrospectively analysed 1139 consecutive patients who underwent transfemoral TAVI between 2008 and 2016, receiving different valve types. All patients were surveyed by continuous ECG monitoring for 48 h, 12-lead ECGs starting immediately after procedure, as well as 24-h Holter recording the day before discharge. Indication for PPI was at the discretion of the attending physician. Among 760 patients with QRS <120 ms prior to the TAVI procedure, 400 patients showed QRS <120 ms immediately after procedure, whereas 360 patients had QRS ≥120 ms. In the group with QRS <120 ms, PPI was performed in 34 patients [8.5%; 95% confidence interval (CI) 5.6–11.2%] during the first week. Eight of the PPIs in the group with QRS <120 ms (2%; CI 0.8–3.5%) fulfilled Class I indications for PPI after TAVI, whereas 26 PPIs had different indications [left bundle branch block, sick sinus, low-grade atrioventricular (AV) block]. Complete AV block developed in three patients of the group of QRS <120 ms (0.75%; CI 0.0–1.7%), which in all cases occurred after the 48 h-surveillance period. During 1-year follow-up, 11 PPIs were performed (2.8%; CI 1.2–4.5%), thereof three PPI for Class I indications including one complete AV block.
Conclusion
In patients with QRS duration <120 ms immediately after TAVI, the risk for complete AV block was low during the first week after TAVI and 1-year follow-up.
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Affiliation(s)
- Simon Schoechlin
- Division of Cardiology and Angiology II, University Heart Centre Freiburg-Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany
| | - Fares Jalil
- Division of Cardiology and Angiology II, University Heart Centre Freiburg-Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany
| | - Thomas Blum
- Division of Cardiology and Angiology II, University Heart Centre Freiburg-Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany
| | - Philipp Ruile
- Division of Cardiology and Angiology II, University Heart Centre Freiburg-Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany
| | - Manuel Hein
- Division of Cardiology and Angiology II, University Heart Centre Freiburg-Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany
| | - Thomas G Nührenberg
- Division of Cardiology and Angiology II, University Heart Centre Freiburg-Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany
| | - Thomas Arentz
- Division of Cardiology and Angiology II, University Heart Centre Freiburg-Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Division of Cardiology and Angiology II, University Heart Centre Freiburg-Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany
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247
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Lader JM, Barbhaiya CR, Subnani K, Park D, Aizer A, Holmes D, Staniloae C, Williams MR, Chinitz LA. Factors predicting persistence of AV nodal block in post‐TAVR patients following permanent pacemaker implantation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1347-1354. [DOI: 10.1111/pace.13789] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/26/2019] [Accepted: 08/18/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Joshua M. Lader
- Departments of MedicineNew York University School of Medicine New York New York
| | - Chirag R. Barbhaiya
- Cardiothoracic SurgeryNew York University School of Medicine New York New York
| | - Kishore Subnani
- Departments of MedicineNew York University School of Medicine New York New York
| | - David Park
- Departments of MedicineNew York University School of Medicine New York New York
| | - Anthony Aizer
- Departments of MedicineNew York University School of Medicine New York New York
| | - Douglas Holmes
- Departments of MedicineNew York University School of Medicine New York New York
| | - Cezar Staniloae
- Departments of MedicineNew York University School of Medicine New York New York
| | - Mathew R. Williams
- Cardiothoracic SurgeryNew York University School of Medicine New York New York
| | - Larry A. Chinitz
- Departments of MedicineNew York University School of Medicine New York New York
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248
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay. Heart Rhythm 2019; 16:e128-e226. [DOI: 10.1016/j.hrthm.2018.10.037] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Indexed: 12/13/2022]
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249
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Prevalence of and Risk Factors for Permanent Pacemaker Implantation After Aortic Valve Replacement. Ann Thorac Surg 2019; 108:700-707. [DOI: 10.1016/j.athoracsur.2019.03.056] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/26/2019] [Accepted: 03/14/2019] [Indexed: 11/20/2022]
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250
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Husser O, Pellegrini C, Kim WK, Holzamer A, Pilgrim T, Toggweiler S, Schäfer U, Blumenstein J, Deuschl F, Rheude T, Joner M, Hilker M, Hengstenberg C, Möllmann H. Transcatheter Valve SELECTion in Patients With Right Bundle Branch Block and Impact on Pacemaker Implantations. JACC Cardiovasc Interv 2019; 12:1781-1793. [DOI: 10.1016/j.jcin.2019.05.055] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/06/2019] [Accepted: 05/14/2019] [Indexed: 10/26/2022]
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