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Aldea GS, Burke CR, Fischlein T, Heimansohn DA, Haverich A, Suri RM, Ad N. Does valve size impact hemodynamic, left ventricular mass regression, and prosthetic valve deterioration with a sutureless aortic valve? J Thorac Cardiovasc Surg 2024; 168:502-509.e9. [PMID: 36858846 DOI: 10.1016/j.jtcvs.2023.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/22/2022] [Accepted: 01/16/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To assess the mid-term clinical outcomes, hemodynamics, left ventricular (LV) mass regression, and structural valve deterioration (SVD) in patients implanted with the Perceval aortic sutureless valve across valve sizes. METHODS Data were obtained from a multicenter European trial and a US Investigational Device Exemption trial. Echocardiography data were analyzed by an echocardiography core lab. A mixed-effects regression model was used to assess relationships between hemodynamic outcomes, time from the procedure, and valve sizes. The Valve Academic Research Consortium (VARC)-3 definition for bioprosthetic valve failure was applied. RESULTS A Perceval sutureless valve was implanted in 970 patients. The median patient age was 77.8 years, 57.2% were female, the median Society of Thoracic Surgeons predicated risk of mortality was 3.3% (range, 2.1%-6.2%), and 33.4% had a concomitant procedure. The median clinical follow-up was 45.7 months (range, 28.2-76.1 months). Small and medium valves were implanted more commonly in women than in men (16.9% vs 1.9% for small and 55.1% vs 19.5% for medium; P < .001). The mean aortic valve gradients decreased significantly postimplantation and remained stable across all valve sizes throughout the follow-up period. All patients were free from severe patient-prosthesis mismatch (with an effective orifice area/m2 of >0.8). Significant LV mass regression was documented regardless valve sizes, plateaued at -9.1% at 5 years. Freedom from SVD and reintervention were 95.2% and 96.3%, respectively, at 5 years and were independent of implanted valve size (P = .22). The VARC-3 stage 3 bioprosthetic valve failure rate was low, 2.8% at 5 years. CONCLUSIONS The Perceval valve demonstrated low and stable mean gradients, significant LV mass regression, and low SVD and reintervention rates across all valve sizes.
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Affiliation(s)
- Gabriel S Aldea
- Division of Cardiothoracic Surgery, University of Washington, Seattle, Wash.
| | | | - Theodor Fischlein
- Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nürnberg, Germany
| | | | - Axel Haverich
- Clinic for Cardiac, Thoracic, Transplantation and Vascular Surgery, Medizinische Hochschule Hannover, Hannover, Germany
| | - Rakesh M Suri
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi and Cleveland Clinic Foundation, Cleveland, Ohio
| | - Niv Ad
- Cardiothoracic Surgery, Adventist White Oak Medical Center and Johns Hopkins University, Silver Spring, Md
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Harvey JE, Puri R, Grubb KJ, Yakubov SJ, Mahoney PD, Gada H, Coylewright M, Poulin MF, Chetcuti SJ, Sorajja P, Rovin JD, Eisenberg R, Reardon MJ. Decreasing pacemaker implantation rates with Evolut supra-annular transcatheter aortic valves in a large real-world registry. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00493-7. [PMID: 38871537 DOI: 10.1016/j.carrev.2024.05.024] [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: 11/30/2023] [Revised: 04/29/2024] [Accepted: 05/17/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Permanent pacemaker implantation (PPI) rates following transcatheter aortic valve replacement (TAVR) remain a concern. We assessed the PPI rates over time in patients implanted with an Evolut supra-annular, self-expanding transcatheter valve from the US STS/ACC TVT Registry. METHODS Patients who underwent TAVR with an Evolut R, Evolut PRO or Evolut PRO+ valve between July 2018 (Q3) and June 2021 (Q2) were included. PPI rates were reported by calendar quarter. In-hospital PPI rates were reported as proportions and 30-day rates as Kaplan-Meier estimates. A Cox regression model was used to determine potential predictors of a new PPI within 30 days of the TAVR procedure. RESULTS From July 2018 to June 2021, 54,014 TAVR procedures were performed using Evolut valves. Mean age was 79.3 ± 8.8 years and 49.2 % were male. The 30-day PPI rate was 16.6 % in 2018 (Q3) and 10.8 % in 2021 (Q2, 34.9 % decrease, p < 0.001 for trend across all quarters). The in-hospital PPI rate decreased by 40.1 %; from 14.7 % in 2018 (Q3) to 8.8 % in 2021 (Q2) (p < 0.001 for trend across all quarters). Significant predictors of a new PPI within 30 days included a baseline conduction defect, history of atrial fibrillation, home oxygen, and diabetes mellitus. CONCLUSION From 2018 to 2021, TAVR with an Evolut transcatheter heart valve in over 50,000 patients showed a significant decreasing trend in the rates of in-hospital and 30-day PPI, representing the lowest rate of PPI in any large real-world registry of Evolut. During the same evaluated period, high device success and shorter length of stay was also observed.
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Affiliation(s)
- James E Harvey
- WellSpan York Hospital, 1001 S George Street, York, PA 17403, USA.
| | - Rishi Puri
- Cleveland Clinic, 2049 East 100(th) Street, Cleveland, OH 44195, USA.
| | - Kendra J Grubb
- Emory University, 100 Woodruff Circle, Atlanta, GA 30322, USA.
| | - Steven J Yakubov
- Riverside Methodist-Ohio Health, 3535 Olentangy River Road, Columbus, OH 43214, USA
| | - Paul D Mahoney
- Sentara Healthcare, 600 Gresham Drive, Suite 8630A, Norfolk, VA 23507, USA
| | - Hemal Gada
- University of Pittsburgh-Pinnacle, 1000 N Front Street, Wormleysburg, PA 17043, USA
| | - Megan Coylewright
- Erlanger Heart and Lung Institute, 979 E 3rd Street, C-520, Chattanooga, TN 37403, USA.
| | - Marie-France Poulin
- Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
| | - Stanley J Chetcuti
- University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Paul Sorajja
- Minneapolis Heart Institute-Abbott-Northwestern Hospital, 920 E 28th Street, Suite 100, Minneapolis, MN 55404, USA.
| | - Joshua D Rovin
- Morton Plant Hospital, 55 Pinellas St #320, Clearwater, FL 33756, USA.
| | - Ruth Eisenberg
- Medtronic, 8200 Coral Sea Street, Mounds View, MN 55112, USA.
| | - Michael J Reardon
- Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St #1401, Houston, TX, USA.
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Kikuchi S, Minamimoto Y, Matsushita K, Cho T, Terasaka K, Hanajima Y, Nakahashi H, Gohbara M, Kimura Y, Yasuda S, Okada K, Matsuzawa Y, Iwahashi N, Kosuge M, Ebina T, Morel O, Ohlmann P, Uchida K, Hibi K. Impact of New-Onset Right Bundle-Branch Block After Transcatheter Aortic Valve Replacement on Permanent Pacemaker Implantation. J Am Heart Assoc 2024; 13:e032777. [PMID: 38639357 PMCID: PMC11179913 DOI: 10.1161/jaha.123.032777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/15/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND A delayed and recurrent complete atrioventricular block (CAVB) is a life-threatening complication of transcatheter aortic valve replacement (TAVR). Post-TAVR evaluation may be important in predicting delayed and recurrent CAVB requiring permanent pacemaker implantation (PPI). The impact of new-onset right bundle-branch block (RBBB) after TAVR on PPI remains unknown. METHODS AND RESULTS In total, 407 patients with aortic stenosis who underwent TAVR were included in this analysis. Intraprocedural CAVB was defined as CAVB that occurred during TAVR. A 12-lead ECG was evaluated at baseline, immediately after TAVR, on postoperative days 1 and 5, and according to the need to identify new-onset bundle-branch block (BBB) and CAVB after TAVR. Forty patients (9.8%) required PPI, 17 patients (4.2%) had persistent intraprocedural CAVB, and 23 (5.7%) had delayed or recurrent CAVB after TAVR. The rates of no new-onset BBB, new-onset left BBB, and new-onset RBBB were 65.1%, 26.8%, and 4.7%, respectively. Compared with patients without new-onset BBB and those with new-onset left BBB, the rate of PPI was higher in patients with new-onset RBBB (3.4% versus 5.6% versus 44.4%, P<0.0001). On post-TAVR evaluation in patients without persistent intraprocedural CAVB, the multivariate logistic regression analysis showed that new-onset RBBB was a statistically significant predictor of PPI compared with no new-onset BBB (odds ratio [OR], 18.0 [95% CI, 5.94-54.4]) in addition to the use of a self-expanding valve (OR, 2.97 [95% CI, 1.09-8.10]). CONCLUSIONS Patients with new-onset RBBB after TAVR are at high risk for PPI.
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Affiliation(s)
- Shinnosuke Kikuchi
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Yugo Minamimoto
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Kensuke Matsushita
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Tomoki Cho
- Cardiovascular CenterYokohama City University Medical CenterYokohamaJapan
| | - Kengo Terasaka
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Yohei Hanajima
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Hidefumi Nakahashi
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Masaomi Gohbara
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Yuichiro Kimura
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Shota Yasuda
- Cardiovascular CenterYokohama City University Medical CenterYokohamaJapan
| | - Kozo Okada
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Yasushi Matsuzawa
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Noriaki Iwahashi
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Masami Kosuge
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Toshiaki Ebina
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Olivier Morel
- Université de Strasbourg, Pôle d’Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier UniversitaireStrasbourgFrance
| | - Patrick Ohlmann
- Université de Strasbourg, Pôle d’Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier UniversitaireStrasbourgFrance
| | - Keiji Uchida
- Cardiovascular CenterYokohama City University Medical CenterYokohamaJapan
| | - Kiyoshi Hibi
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
- Department of CardiologyYokohama City University Graduate School of MedicineYokohamaJapan
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Ahmad S, Yousaf A, Ghumman GM, Dvalishvili M, Ahsan MJ, Dilibe A, Reis HL, Qavi AH, Szerlip M, Goldsweig AM. Outcomes of transcatheter aortic valve replacement in patients with mitral annular calcification and concomitant mitral valve dysfunction: A systematic review and meta-analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 61:99-109. [PMID: 37867120 DOI: 10.1016/j.carrev.2023.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/07/2023] [Accepted: 10/12/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Calcific aortic stenosis is the principal indication for transcatheter aortic valve replacement (TAVR). Comorbid mitral annular calcification (MAC) is often present in patients undergoing TAVR. Limited data exist on the impact of MAC on TAVR outcomes. We conducted a systematic review and meta-analysis to explore the effects of MAC and concomitant mitral valve dysfunction (MVD) on TAVR outcomes. METHODS A comprehensive literature review was conducted using PubMed, Embase, Google Scholar, ClinicalTrials.gov, Scopus, and OVID for studies until March 20, 2023. Using the random-effects Mantel-Haenszel method, we calculated pooled risk ratios (RRs) and their corresponding 95 % confidence intervals (CIs) for all dichotomous variables. RESULTS Six studies comprising 5822 patients (2541 with MAC [severe MAC (>4 mm thickness) 583; non-severe MAC 1958; 400 with MVD; and 1071 without MVD], 3281 without MAC) met inclusion criteria. At 30 days and 1 year, no significant differences were observed between the overall MAC and no MAC groups in terms of mortality, stroke, and permanent pacemaker implantation. However, MAC with MVD was associated with a higher risk of all-cause mortality compared to MAC without MVD at 30 days (RR = 3.43, 95 % CI 2.04-5.76, P < 0.00001) and at 1 year (RR = 2.44, 95 % CI 1.85-3.20, P < 0.00001). Moreover, the risk of cardiovascular mortality was higher in patients with MAC and MVD compared to those with MAC alone (RR = 2.77, 95 % CI 1.89-4.06, P < 0.00001). Additionally, patients with severe MAC had a higher risk of major bleeding at 30 days compared to the non-severe MAC group (RR = 1.33, 95 % CI 1.04-1.69, P = 0.02). CONCLUSION TAVR appears to be safe in patients with non-severe MAC, but severe MAC is associated with a higher risk of major bleeding and concomitant MVD increases the mortality risk in patients undergoing TAVR.
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Affiliation(s)
- Soban Ahmad
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA; Department of Medicine, East Carolina University, Greenville, NC, USA.
| | - Amman Yousaf
- Department of Medicine, McLaren Flint-Michigan State University, Flint, MI, USA
| | | | | | | | - Arthur Dilibe
- Department of Medicine, East Carolina University, Greenville, NC, USA
| | - Heidi Lynn Reis
- William E Laupus Health Sciences Library, East Carolina University, Greenville, NC, USA
| | - Ahmed Hassaan Qavi
- Division of Cardiovascular Medicine, East Carolina Heart Institute, Greenville, NC, USA
| | - Molly Szerlip
- Department of Cardiology, Baylor Scott and White, The Heart Hospital Plano, Plano, TX, USA
| | - Andrew Michael Goldsweig
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA; Department of Cardiology, Baystate Medical Center/UMass Chan Medical School, Springfield, MA, USA
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Ghazal R, Garabedian H, Sawaya F, Refaat MM. Post-TAVR conduction abnormalities leading to permanent pacemaker implantation: Risk factors, prevention, and management. J Cardiovasc Electrophysiol 2024; 35:488-497. [PMID: 38254339 DOI: 10.1111/jce.16185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/26/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024]
Abstract
Transcatheter aortic valve replacement (TAVR) often leads to conduction abnormalities, necessitating pacemaker implantation. This review of 38 meta-analyses identified preexisting right bundle branch block (RBBB), LAHB, and new-onset left bundle branch block as key risk factors, with a higher PPM risk in male and older patients. Procedural factors like transfemoral access and self-expandable valves also increase this risk. Prevention focuses on tailoring TAVR to individual electrophysiological and anatomical profiles. However, there's a lack of consensus in managing these conduction disturbances post-TAVR, highlighting the need for further research and standardized treatment strategies.
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Affiliation(s)
- Rachad Ghazal
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Fadi Sawaya
- Structural Heart and Valve Division, American University of Beirut Medical Center, Beirut, Lebanon
- Internal Medicine Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwan M Refaat
- Internal Medicine Department, American University of Beirut Medical Center, Beirut, Lebanon
- Cardiac Electrophysiology Division, American University of Beirut Medical Center, Beirut, Lebanon
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Batta A, Hatwal J. Risk of permanent pacemaker implantation following transcatheter aortic valve replacement: Which factors are most relevant? World J Cardiol 2024; 16:49-53. [PMID: 38456072 PMCID: PMC10915891 DOI: 10.4330/wjc.v16.i2.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/30/2023] [Accepted: 01/11/2024] [Indexed: 02/21/2024] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as a formidable treatment option for severe symptomatic aortic stenosis ahead of surgical aortic valve replacement. The encouraging results from large randomized controlled trials has resulted in an exponential rise in the use of TAVR even in the low-risk patients. However, this is not without challenges. Need for permanent pacemaker (PPM) post-TAVR remains the most frequent and clinically relevant challenge. Naturally, identifying risk factors which predispose an individual to develop high grade conduction block post-TAVR is important. Various demographic factors, electrocardiographic features, anatomic factors and procedural characteristics have all been linked to the development of advanced conduction block and need for PPM following TAVR. Amongst these electrophysiological variables, most notably a prolonged QRS > 120 ms regardless of the type of conduction block seems to be one of the strongest predictors on logistic regression models. The index study by Nwaedozie et al highlights that patients requiring PPM post-TAVR had higher odds of having a baseline QRS > 120 ms and were more likely to be having diabetes mellitus that those who did not require PPM.
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Affiliation(s)
- Akash Batta
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India.
| | - Juniali Hatwal
- Department of Internal Medicine, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
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Kikuchi S, Minamimoto Y, Matsushita K, Cho T, Terasaka K, Hanajima Y, Nakahashi H, Gohbara M, Kimura Y, Yasuda S, Okada K, Matsuzawa Y, Iwahashi N, Kosuge M, Ebina T, Morel O, Ohlmann P, Uchida K, Hibi K. Ratio of left ventricular outflow tract area to aortic annulus area and complete atrioventricular block after transcatheter aortic valve replacement for aortic stenosis. Int J Cardiol 2024; 397:131608. [PMID: 38030042 DOI: 10.1016/j.ijcard.2023.131608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/29/2023] [Accepted: 11/23/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Mechanical compression of cardiac conduction system by transcatheter heart valves leads to complete atrioventricular block (CAVB) after transcatheter aortic valve replacement (TAVR). Bulging of ventricular septum in the left ventricular outflow tract (LVOT) may be associated with greater compression of conduction system, leading to irreversible CAVB. OBJECTIVE This study aimed to investigate the association of ventricular septal bulging with TAVR-related CAVB and permanent pacemaker implantation (PPI). METHODS Among 294 consecutive patients with severe aortic stenosis who underwent TAVR between July 2017 and February 2023, 271 were included in the analysis. As a quantitative evaluation of bulging of the ventricular septum, the ratio of LVOT area to aortic annulus area (L/A ratio) was measured at the systolic phase of computed tomography images. RESULTS TAVR-related CAVB occurred in 64 patients (23.6%). Twenty-eight patients (10.3%) required PPI. The optimal thresholds of L/A ratio for predicting TAVR-related CAVB and PPI were 1.0181 and 0.985, respectively. Patients with less than the cut-off values had higher rate of TAVR-related CAVB and PPI than those above (28.3% vs 13.1%, p = 0.0063; 14.7% vs 4.4%, p = 0.0077, respectively). A multivariate analysis showed that L/A ratio < 1.0181 was an independent predictor of TAVR-related CAVB (odds ratio [OR] 2.65, p = 0.011), in addition to prior right bundle branch block (OR 3.76, p = 0.0005), use of a self-expanding valve (OR 1.99, p = 0.030), and short membranous septum length (OR 0.96, p = 0.037). Only L/A ratio < 0.985 was independently associated with PPI (OR 3.70, p = 0.011). CONCLUSION Low L/A ratio is a predictor of TAVR-related CAVB and PPI.
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Affiliation(s)
- Shinnosuke Kikuchi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yugo Minamimoto
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kensuke Matsushita
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Tomoki Cho
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Kengo Terasaka
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yohei Hanajima
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Hidefumi Nakahashi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Masaomi Gohbara
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yuichiro Kimura
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Shota Yasuda
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Kozo Okada
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yasushi Matsuzawa
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Noriaki Iwahashi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Toshiaki Ebina
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Olivier Morel
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 1 Place de L'Hôpital, 67091 Strasbourg, France
| | - Patrick Ohlmann
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 1 Place de L'Hôpital, 67091 Strasbourg, France
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan; Department of Cardiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
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Benjamin MM, Rabbat MG. Artificial Intelligence in Transcatheter Aortic Valve Replacement: Its Current Role and Ongoing Challenges. Diagnostics (Basel) 2024; 14:261. [PMID: 38337777 PMCID: PMC10855497 DOI: 10.3390/diagnostics14030261] [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: 12/15/2023] [Revised: 01/18/2024] [Accepted: 01/20/2024] [Indexed: 02/12/2024] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as a viable alternative to surgical aortic valve replacement, as accumulating clinical evidence has demonstrated its safety and efficacy. TAVR indications have expanded beyond high-risk or inoperable patients to include intermediate and low-risk patients with severe aortic stenosis. Artificial intelligence (AI) is revolutionizing the field of cardiology, aiding in the interpretation of medical imaging and developing risk models for at-risk individuals and those with cardiac disease. This article explores the growing role of AI in TAVR procedures and assesses its potential impact, with particular focus on its ability to improve patient selection, procedural planning, post-implantation monitoring and contribute to optimized patient outcomes. In addition, current challenges and future directions in AI implementation are highlighted.
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Affiliation(s)
- Mina M. Benjamin
- Division of Cardiovascular Medicine, SSM—Saint Louis University Hospital, Saint Louis University, Saint Louis, MO 63104, USA
| | - Mark G. Rabbat
- Department of Cardiovascular Medicine, Loyola University Medical Center, Maywood, IL 60153, USA;
- Department of Cardiology, Edward Hines Jr. VA Hospital, Hines, IL 60141, USA
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Takaseya T, Itaya N, Sasaki KI, Sasaki M, Yokomizo M, Honda A, Oshita K, Azuma J, Fukumoto Y, Tayama E. Cusp overlap technique decreases paravalvular leakage in self-expandable transcatheter aortic valve replacement. Heart Vessels 2024; 39:48-56. [PMID: 37606754 DOI: 10.1007/s00380-023-02307-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/16/2023] [Indexed: 08/23/2023]
Abstract
The cusp overlap technique allows greater visual separation between the basal annular plane and the conduction system and decreases the permanent pacemaker implantation rate. We assessed the impact of the cusp overlap technique on conduction disturbance and paravalvular leakage after transcatheter aortic valve replacement. A total of 97 patients underwent transfemoral transcatheter aortic valve replacement with self-expandable valves at our institution from November 2018 to January 2023. The mean age of the patients was 85 years, and 23% were male. The patients were divided into two groups: the cusp overlap technique group and the non-cusp overlap technique group. We compared the clinical results between the two groups. The 30-day permanent pacemaker implantation rate was similar between the two groups (cusp overlap technique: 6.3% vs. non-cusp overlap technique: 10.2%, p = 0.48). The rate of new-onset conduction disturbance was slightly lower in the cusp overlap than non-cusp overlap technique group (18.8% vs. 34.7%, respectively; p = 0.08). The implanted valve function was similar between the two groups, but the rate of trivial or less paravalvular leakage (PVL) was significantly higher in the cusp overlap technique group on echocardiography (69% vs. 45%, p = 0.02). On multidetector computed tomography, the implantation depth at the membranous septum was significantly shorter in the cusp overlap technique group (2.0 ± 2.3 vs. 2.9 ± 1.5 mm, p = 0.02). The degree of canting was slightly smaller in the cusp overlap technique group (1.0 ± 2.2 vs. 1.7 ± 1.9 mm, p = 0.07). The relative risk of PVL equal to or greater than mild was 1.76 times higher for valve implantation without the cusp overlap technique (adjusted odds ratio, 3.74; 95% confidence interval, 1.45-9.69; p < 0.01). Transcatheter aortic valve replacement using the cusp overlap technique is associated with an optimized implantation depth, leading to fewer conduction disturbances. Optimal deployment may also maximize the radial force of self-expanding valves to reduce paravalvular leakage.
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Affiliation(s)
- Tohru Takaseya
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-Machi, Kurume-Shi, Fukuoka, 830-0011, Japan.
| | - Naoki Itaya
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Ken-Ichiro Sasaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Masahiro Sasaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Michiko Yokomizo
- Department of Anesthesiology, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Akihiro Honda
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Kensuke Oshita
- Department of Anesthesiology, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Junpei Azuma
- Division of Radiology, Kurume University Hospital, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-Machi, Kurume-Shi, Fukuoka, 830-0011, Japan
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10
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Flores-Umanzor E, Keshvara R, Reza S, Asghar A, Rashidul Anwar M, Cepas-Guillen PL, Osten M, Halankar J, Abrahamyan L, Horlick E. A systematic review of contrast-enhanced computed tomography calcium scoring methodologies and impact of aortic valve calcium burden on TAVI clinical outcomes. J Cardiovasc Comput Tomogr 2023; 17:373-383. [PMID: 37635033 DOI: 10.1016/j.jcct.2023.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/25/2023] [Accepted: 08/19/2023] [Indexed: 08/29/2023]
Abstract
Different methodologies have been used to assess the role of AV calcification (AVC) on TAVI outcomes. This systematic review aims to describe the burden of AVC, synthesize the different methods of calcium score quantification, and evaluate the impact of AVC on outcomes after TAVI. We included studies of TAVI patients who had reported AV calcium scoring by contrast-enhanced multidetector CT and the Agatston method. The impact of calcification on TAVI outcomes without restrictions on follow-up time or outcome type was evaluated. Results were reported descriptively, and a meta-analysis was conducted when feasible. Sixty-eight articles were included, with sample sizes ranging from 23 to 1425 patients. Contrast-enhanced calcium scoring was reported in 30 studies, calcium volume score in 28 studies, and unique scoring methods in two. All studies with calcium volume scores had variable protocols, but most utilized a modified Agatston method with variable attenuation threshold values of 300-850 HU. Eight studies used the Agatston method, with the overall mean AV calcium score in studies published from 2010 to 2012 of 3342.9 AU [95%CI: 3150.4; 3535.4, I2 = 0%]. The overall mean score was lower and heterogenous in studies published from 2014 to 2020 (2658.9 AU [95% CI: 2517.3; 2800.5, I2 = 79%]. Most studies reported a positive association between calcium burden and increased risk of adverse outcomes, including implantation of permanent pacemaker (7/8 studies), paravalvular leak (13/13 studies), and risk of aortic rupture (2/2 studies). AVC quantification methodology with contrast-enhanced CT is still variable. AVC negatively impacts TAVI outcomes independently of the quantification method.
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Affiliation(s)
- Eduardo Flores-Umanzor
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Rajesh Keshvara
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Seleman Reza
- Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, ON, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, ON, Canada
| | - Areeba Asghar
- Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, ON, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, ON, Canada
| | - Mohammed Rashidul Anwar
- Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, ON, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, ON, Canada
| | - Pedro L Cepas-Guillen
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Spain
| | - Mark Osten
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Jaydeep Halankar
- Joint Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network, University of Toronto, ON, Canada
| | - Lusine Abrahamyan
- Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, ON, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, ON, Canada
| | - Eric Horlick
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
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11
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Tan BEX, Hashem A, Boppana LKT, Mohamed MS, Abbas SF, Faisaluddin M, Thakkar S, Ahmed AK, Hall C, Abtahian F, Rao M, Bhatt DL, Depta JP. Utility of rapid atrial pacing before and after TAVR with balloon-expandable valve in predicting permanent pacemaker implantation. Catheter Cardiovasc Interv 2023; 102:919-928. [PMID: 37698294 DOI: 10.1002/ccd.30817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/28/2023] [Accepted: 08/19/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND High-grade or complete atrioventricular block (AVB) requiring permanent pacemaker (PPM) implantation is a known complication of transcatheter aortic valve replacement (TAVR). Wenckebach AVB induced by rapid atrial pacing (RAP) after TAVR was previously demonstrated in an observational analysis to be an independent predictor for PPM. We sought to investigate the utility of both pre- and post-TAVR RAP in predicting PPM implantation. METHODS In a single-center, prospective study, 421 patients underwent TAVR with balloon-expandable valves (BEV) between April 2020 and August 2021. Intraprocedural RAP was performed in patients without a pre-existing pacemaker, atrial fibrillation/flutter, or intraprocedural complete AVB to assess for RAP-induced Wenckebach AVB. The primary outcome was PPM within 30 days after TAVR. RESULTS RAP was performed in 253 patients, of whom 91.3% underwent post-TAVR RAP and 61.2% underwent pre-TAVR RAP. The overall PPM implantation rate at 30 days was 9.9%. Although there was a numerically higher rate of PPM at 30 days in patients with RAP-induced Wenckebach AVB, it did not reach statistical significance (13.3% vs. 8.4%, p = 0.23). In a multivariable analysis, RAP-induced Wenckebach was not an independent predictor for PPM implantation at 30 days after TAVR. PPM rates at 30 days were comparable in patients with or without pre-TAVR pacing-induced Wenckebach AVB (11.8% vs. 8.2%, p = 0.51) and post-TAVR pacing-induced Wenckebach AVB (10.2% vs. 5.8%, p = 0.25). CONCLUSION In patients who underwent TAVR with BEV, there were no statistically significant differences in PPM implantation rates at 30 days regardless of the presence or absence of RAP-induced Wenckebach AVB. Due to conflicting results between the present study and the prior observational analysis, future studies with larger sample sizes are warranted to determine the role of RAP during TAVR as a risk-stratification tool for significant AVB requiring PPM after TAVR.
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Affiliation(s)
- Bryan E-Xin Tan
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Anas Hashem
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Leela K T Boppana
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Mohamed S Mohamed
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Syed Faiz Abbas
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Mohammed Faisaluddin
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Samarthkumar Thakkar
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Akbar K Ahmed
- Sands-Constellation Heart Institute, Rochester Regional Health, Rochester, New York, USA
| | - Cameron Hall
- Sands-Constellation Heart Institute, Rochester Regional Health, Rochester, New York, USA
| | - Farhad Abtahian
- Sands-Constellation Heart Institute, Rochester Regional Health, Rochester, New York, USA
| | - Mohan Rao
- Sands-Constellation Heart Institute, Rochester Regional Health, Rochester, New York, USA
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jeremiah P Depta
- Sands-Constellation Heart Institute, Rochester Regional Health, Rochester, New York, USA
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12
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Dykun I, Mahabadi AA, Jehn S, Kalra A, Isogai T, Wazni OM, Kanj M, Krishnaswamy A, Reed GW, Yun JJ, Totzeck M, Jánosi RA, Lind AY, Kapadia SR, Rassaf T, Puri R. The degree of permanent pacemaker dependence and clinical outcomes following transcatheter aortic valve implantation: implications for procedural technique. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead127. [PMID: 38105920 PMCID: PMC10721444 DOI: 10.1093/ehjopen/oead127] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 10/27/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023]
Abstract
Aims Conduction abnormalities necessitating permanent pacemaker (PPM) implantation remain the most frequent complication post-transcatheter aortic valve implantation (TAVI), yet reliance on PPM function varies. We evaluated the association of right-ventricular (RV)-stimulation rate post-TAVI with 1-year major adverse cardiovascular events (MACE) (all-cause mortality and heart failure hospitalization). Methods and results This retrospective cohort study of patients undergoing TAVI in two high-volume centers included patients with existing PPM pre-TAVI or new PPM post-TAVI. There was a bimodal distribution of RV-stimulation rates stratifying patients into two groups of either low [≤10%: 1.0 (0.0, 3.6)] or high [>10%: 96.0 (54.0, 99.9)] RV-stimulation rate post-TAVI. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated comparing MACE in patients with high vs. low RV-stimulation rates post-TAVI. Of 4659 patients, 408 patients (8.6%) had an existing PPM pre-TAVI and 361 patients (7.7%) underwent PPM implantation post-TAVI. Mean age was 82.3 ± 8.1 years, 39% were women. A high RV-stimulation rate (>10%) development post-TAVI is associated with a two-fold increased risk for MACE [1.97 (1.20, 3.25), P = 0.008]. Valve implantation depth was an independent predictor of high RV-stimulation rate [odds ratio (95% CI): 1.58 (1.21, 2.06), P=<0.001] and itself associated with MACE [1.27 (1.00, 1.59), P = 0.047]. Conclusion Greater RV-stimulation rates post-TAVI correlate with increased 1-year MACE in patients with new PPM post-TAVI or in those with existing PPM but low RV-stimulation rates pre-TAVI. A shallower valve implantation depth reduces the risk of greater RV-stimulation rates post-TAVI, correlating with improved patient outcomes. These data highlight the importance of a meticulous implant technique even in TAVI recipients with pre-existing PPMs.
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Affiliation(s)
- Iryna Dykun
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Amir Abbas Mahabadi
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Stefanie Jehn
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Ankur Kalra
- Krannert Cardiovascular Research Center, Division of Cardiovascular Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Oussama M Wazni
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Mohamad Kanj
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Grant W Reed
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - James J Yun
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Matthias Totzeck
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - R Alexander Jánosi
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Alexander Y Lind
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
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13
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Gupta R, Mahmoudi E, Behnoush AH, Malik AH, Mahajan P, Lin M, Bandyopadhyay D, Goel A, Chakraborty S, Aedma SK, Gupta HB, Vyas AV, Combs WG, Mathur M, Yakubov SJ, Patel NC. Clinical outcomes and the impact of valve morphology for transcatheter aortic valve replacement in bicuspid aortic valves: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2023; 102:721-730. [PMID: 37605512 DOI: 10.1002/ccd.30808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 05/16/2023] [Accepted: 08/13/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Bicuspid aortic valve (BAV) is present in approximately 0.5%-2% of the general population, causing significant aortic stenosis (AS) in 12%-37% of affected individuals. Transcatheter aortic valve replacement (TAVR) is being considered the treatment of choice in patients with symptomatic AS across all risk spectra. AIM Aim Our study aims to compare TAVR outcomes in patients with BAV versus tricuspid aortic valves (TAV). METHODS A comprehensive literature search was performed in PubMed, Web of Science, and Cochrane trials. Studies were included if they included BAV and TAV patients undergoing TAVR with quantitative data available for at least one of our predefined outcomes. Meta-analysis was performed by the random-effects model using Stata software. RESULTS Fifty studies of 203,288 patients were included. BAV patients had increased 30-day all-cause mortality (odds ratio [OR] = 1.23 [1.00-1.50], p = 0.05), in-hospital stroke (OR = 1.39 [1.01-1.93], p = 0.05), in-hospital and 30-day PPI (OR = 1.13 [1.00-1.27], p = 0.04; OR = 1.16 [1.04-1.13], p = 0.01) and in-hospital, 30-day and 1-year aortic regurgitation (AR) (OR = 1.48 [1.19-1.83], p < 0.01; OR = 1.79 [1.26-2.52], p < 0.01; OR = 1.64 [1.03-2.60], p = 0.04). Subgroup analysis on new-generation valves showed a reduced 1-year all-cause mortality (OR = 0.86 [CI = 0.75-0.98], p = 0.03), despite higher in-hospital and 30-day PPI (OR = 0.1.21 [1.04-1.41], p = 0.01; OR = 1.17 [1.05-1.31], p = 0.01) and in-hospital AR (OR = 1.62 [1.14-2.31], p = 0.01) in the BAV group. The quality of included studies was moderate-to-high, and only three analyses presented high heterogeneity. CONCLUSION TAVR is associated with comparable outcomes in patients with BAV and TAV. Careful selection of BAV cases by preprocedural assessment of valve anatomy and burden of calcification, pre- and post-procedural dilation, and implementing newer generations of valves may improve the safety and efficacy of TAVR in BAV patients.
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Affiliation(s)
- Rahul Gupta
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Elham Mahmoudi
- Universal Scientific Education and Research Network, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Aaqib H Malik
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Pranav Mahajan
- Department of Medicine, Carle Foundation Hospital, Urbana, Illinois, USA
| | - Muling Lin
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Dhrubajyoti Bandyopadhyay
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Akshay Goel
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Sandipan Chakraborty
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Surya K Aedma
- Department of Medicine, Carle Foundation Hospital, Urbana, Illinois, USA
| | - Harsh Bala Gupta
- Guru Nanak Dev Hospital, Department of medicine, Government Medical College, Amritsar, Punjab, India
| | - Apurva V Vyas
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - William G Combs
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Moses Mathur
- Heart & Vascular Institute, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Steven J Yakubov
- Department of Interventional Cardiology, Riverside Methodist-Ohio Health, Columbus, Ohio, USA
| | - Nainesh C Patel
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
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14
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Zheng HJ, Yan CJ, Lin DQ, Cheng YB, Yu SJ, Li J, Zhang XP, Cheng W. Prognostic impact of new permanent pacemaker implantation following transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2023; 102:743-750. [PMID: 37493466 DOI: 10.1002/ccd.30788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/26/2023] [Accepted: 07/19/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Conduction disturbances requiring permanent pacemaker implantation (PPI) are common following transcatheter aortic valve replacement (TAVR). There were conflicting data regarding the impact of new PPI on clinical outcomes after TAVR. OBJECTIVES The study sought to evaluate the impact of new PPI on clinical outcomes in patients undergoing TAVR. METHODS This study was a retrospective analysis of prospectively collected data. Data were from 210 consecutive patients without prior PPI who underwent TAVR due to severe symptomatic aortic stenosis at our center between June 2018 and July 2020. Clinical, echocardiographic, and pacing data were assessed at 30-day, 1- and 2-year follow-up. RESULTS New PPI was required in 35 (16.7%) patients within 30 days after TAVR. The median time from TAVR to PPI was 3 days. The most common indication for PPI was high-degree or complete atrioventricular block. The median follow-up was 798.0 (interquartile range, 669.0-1115.0) days. There were no differences in all-cause mortality (adjusted hazard ratio [HR]: 1.18; 95% confidence interval [CI]: 0.85-2.36; p = 0.415) and cardiovascular mortality (adjusted HR: 0.92; 95% CI: 0.57-1.89; p = 0.609) between groups. However, PPI group had a higher risk of heart failure (HF) rehospitalization (adjusted HR: 1.53; 95% CI: 1.26-2.28; p = 0.027). Echocardiography showed no significant improvement of LVEF over time in patients with PPI. At the latest follow-up, 31.3% of patients exhibited low (≤10%) pacing burdens, whereas 28.1% of patients had near constant (>90%) right ventricular pacing. CONCLUSIONS New PPI within 30 days following TAVR was not associated with an increased risk of all-cause or cardiovascular mortality. However, patients with PPI had a higher risk of HF rehospitalization and lack of LVEF improvement.
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Affiliation(s)
- Hua-Jie Zheng
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Chao-Jun Yan
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - De-Qing Lin
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yong-Bo Cheng
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - San-Jiu Yu
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jun Li
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xian-Pu Zhang
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Wei Cheng
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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15
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Rivard L, Nault I, Krahn AD, Daneault B, Roux JF, Natarajan M, Healey JS, Quadros K, Sandhu RK, Kouz R, Greiss I, Leong-Sit P, Gourraud JB, Ben Ali W, Asgar A, Aguilar M, Bonan R, Cadrin-Tourigny J, Cartier R, Dorval JF, Dubuc M, Dürrleman N, Dyrda K, Guerra P, Ibrahim M, Ibrahim R, Macle L, Mondesert B, Moss E, Raymond-Paquin A, Roy D, Tadros R, Thibault B, Talajic M, Nozza A, Guertin MC, Khairy P. Rationale and Design of the Randomized Bayesian Multicenter COME-TAVI Trial in Patients With a New Onset Left Bundle Branch Block. CJC Open 2023; 5:611-618. [PMID: 37720184 PMCID: PMC10502429 DOI: 10.1016/j.cjco.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/22/2023] [Indexed: 09/19/2023] Open
Abstract
Patients with new-onset left bundle branch block (LBBB) after transcatheter aortic valve implantation (TAVI) are at risk of developing delayed high-degree atrioventricular block. Management of new-onset LBBB post-TAVI remains controversial. In the Comparison of a Clinical Monitoring Strategy Versus Electrophysiology-Guided Algorithmic Approach in Patients With a New LBBB After TAVI (COME-TAVI) trial, consenting patients with new-onset LBBB that persists on day 2 after TAVI, meeting exclusion/inclusion criteria, are randomized to an electrophysiological study (EPS)-guided approach or 30-day electrocardiographic monitoring. In the EPS-guided approach, patients with a His to ventricle (HV) interval ≥ 65 ms undergo permanent pacemaker implantation. Patients randomized to noninvasive monitoring receive a wearable continuous electrocardiographic recording and transmitting device for 30 days. Follow-up will be performed at 3, 6, and 12 months. The primary endpoint is a composite outcome designed to capture net clinical benefit. The endpoint incorporates major consequences of both strategies in patients with new-onset LBBB after TAVI, as follows: (i) sudden cardiac death; (ii) syncope; (iii) atrioventricular conduction disorder requiring a pacemaker (for a class I or IIa indication); and (iv) complications related to the pacemaker or EPS. The trial incorporates a Bayesian design with a noninformative prior, outcome-adaptive randomization (initially 1:1), and 2 prespecified interim analyses once 25% and 50% of the anticipated number of primary endpoints are reached. The trial is event-driven, with an anticipated upper limit of 452 patients required to reach 77 primary outcome events over 12 months of follow-up. In summary, the aim of this Bayesian multicentre randomized trial is to compare 2 management strategies in patients with new-onset LBBB post-TAVI-an EPS-guided approach vs noninvasive 30-day monitoring. Trial registration number: NCT03303612.
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Affiliation(s)
- Lena Rivard
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Isabelle Nault
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - Andrew D. Krahn
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Benoit Daneault
- Department of Cardiology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Jean-Francois Roux
- Department of Cardiology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Madhu Natarajan
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey S. Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Kenneth Quadros
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Roopinder K. Sandhu
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Remi Kouz
- Department of Cardiology, Hopital Sacre-Coeur de Montreal, Montreal, Quebec, Canada
| | - Isabelle Greiss
- Department of Cardiology, Centre Hospitalier de Université de Montréal, Montreal, Quebec, Canada
| | - Peter Leong-Sit
- Department of Cardiology, Western University, London, Ontario, Canada
| | | | - Walid Ben Ali
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Anita Asgar
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Martin Aguilar
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Raoul Bonan
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Julia Cadrin-Tourigny
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Raymond Cartier
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Francois Dorval
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Marc Dubuc
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Nicolas Dürrleman
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Katia Dyrda
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Peter Guerra
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Marina Ibrahim
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Reda Ibrahim
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Laurent Macle
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Blandine Mondesert
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Emmanuel Moss
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Alexandre Raymond-Paquin
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Denis Roy
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Rafik Tadros
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Bernard Thibault
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Mario Talajic
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Anna Nozza
- Montreal Health Innovations Coordinating Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Paul Khairy
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
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16
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Wienemann H, Maier O, Beyer M, Portratz M, Tanaka T, Mauri V, Ernst A, Waldschmidt L, Kuhn E, Bleiziffer S, Wilde N, Schaefer A, Zeus T, Baldus S, Zimmer S, Veulemans V, Rudolph TK, Adam M. Cusp overlap versus standard three-cusp technique for self-expanding Evolut transcatheter aortic valves. EUROINTERVENTION 2023; 19:e176-e187. [PMID: 37013922 PMCID: PMC10240731 DOI: 10.4244/eij-d-22-01030] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/14/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Reducing rates of permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) is important for achieving the best procedural outcomes. The cusp overlap technique (COT) implements procedural steps including an overlap angulation of the right and left coronary cusp to mitigate this complication. AIMS We investigated the incidence of PPI and complication rates following the COT compared to the standard three-cusp implantation technique (3CT) in an all-comers cohort. METHODS A total of 2,209 patients underwent TAVI with the self-expanding Evolut platform from January 2016 to April 2022 at five sites. Baseline, procedural and in-hospital outcome characteristics were compared for both techniques before and after one-to-one propensity score matching. RESULTS A total of 1,151 patients were implanted using the 3CT and 1,058 using the COT. At discharge, the rates of PPI (17.0 vs 12.3%; p=0.002) and moderate/severe paravalvular regurgitation (4.6% vs 2.4%; p=0.006) were significantly reduced with the COT compared with 3CT within the unmatched cohort. Overall procedural success and complication rates were similar; major bleeding was less common in the COT group (7.0% vs 4.6%; p=0.020). These results remained consistent after propensity score matching. In multivariable logistic regression analysis, right bundle branch block (odds ratio [OR] 7.19, 95% confidence interval [CI]: 5.18-10.0; p<0.001) and diabetes mellitus (OR 1.38, 95% CI: 1.05-1.80; p=0.021) emerged as predictors of PPI, whereas the COT (OR 0.63, 95% CI: 0.49-0.82; p<0.001) was protective. CONCLUSIONS The introduction of the COT was associated with a significant and relevant reduction of PPI and paravalvular regurgitation rates without an increase in complication rates.
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Affiliation(s)
- Hendrik Wienemann
- Clinic III for Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Oliver Maier
- Department of Cardiology, Pneumology, and Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Martin Beyer
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Max Portratz
- Clinic for General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Tetsu Tanaka
- Clinic II for Internal Medicine, University Hospital Bonn, Bonn, Germany
| | - Victor Mauri
- Clinic III for Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Angela Ernst
- Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany
| | - Lara Waldschmidt
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Elmar Kuhn
- Department of Cardiovascular Surgery, University Hospital Cologne, Cologne, Germany
| | - Sabine Bleiziffer
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Nihal Wilde
- Clinic II for Internal Medicine, University Hospital Bonn, Bonn, Germany
| | - Andreas Schaefer
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Tobias Zeus
- Department of Cardiology, Pneumology, and Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Stephan Baldus
- Clinic III for Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Sebastian Zimmer
- Clinic II for Internal Medicine, University Hospital Bonn, Bonn, Germany
| | - Verena Veulemans
- Department of Cardiology, Pneumology, and Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Tanja Katharina Rudolph
- Clinic for General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Matti Adam
- Clinic III for Internal Medicine, University Hospital Cologne, Cologne, Germany
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17
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Sá MP, Van den Eynde J, Jacquemyn X, Erten O, Rodriguez R, Goldman S, Coady PM, Gnall E, Gray WA, Jarrett H, Abramson SV, Clavel MA, Pibarot P, Ramlawi B. Computed tomography-derived membranous septum length as predictor of conduction abnormalities and permanent pacemaker implantation after TAVI: A meta-analysis of observational studies. Catheter Cardiovasc Interv 2023; 101:1203-1213. [PMID: 37070459 DOI: 10.1002/ccd.30666] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/13/2023] [Accepted: 04/08/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) is associated with higher risk of mortality and rehospitalization for heart failure. Efforts to prevent conduction abnormalities (CA) requiring PPI after TAVI should be made. The membranous septum (MS) length and its interaction with implantation depth (ID-ΔMSID) could provide useful information about the risk of CA/PPI following TAVI. OBJECTIVES To identify MS length and ΔMSID as predictors of CA/PPI following TAVI. METHODS Study-level meta-analysis of studies published by September 30, 2022. RESULTS Eighteen studies met our eligibility including 5740 patients. Shorter MS length was associated with a significantly higher risk of CA/PPI (per 1 mm decrease: odds ratio [OR] 1.60, 95% confidence interval [CI] 1.28-1.99, p < 0.001). Similarly, lower ΔMSID was associated with a significantly higher risk of CA/PPI (per 1 mm decrease: OR 1.75, 95% CI 1.32-2.31, p < 0.001). Meta-regression analyses revealed a statistically significant modulation of the effect of shorter MS length and lower ΔMSID on the outcome (CA/PPI) by balloon postdilatation (positive regression coefficients with p < 0.001); with increasing use of balloon postdilatation, the effect of shorter MS length and lower ΔMSID on the outcome increased. MS length and ΔMSID demonstrated excellent discriminative abilities, with diagnostic ORs equaling 9.49 (95% CI 4.73-19.06), and 7.19 (95% CI 3.31-15.60), respectively. CONCLUSION Considering that short MS length and low ΔMSID are associated with higher risk of CA and PPI, we should include measurement of MS length in the pre-TAVI planning with MDCT and try to establish optimal ID values before the procedure to avoid CA/PPI.
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Affiliation(s)
- Michel Pompeu Sá
- Department of Cardiothoracic Surgery, Lankenau Medical Center, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | | | - Xander Jacquemyn
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Ozgun Erten
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Roberto Rodriguez
- Department of Cardiothoracic Surgery, Lankenau Medical Center, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Scott Goldman
- Department of Cardiothoracic Surgery, Lankenau Medical Center, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Paul M Coady
- Department of Interventional Cardiology, Lankenau Medical Center, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Eric Gnall
- Department of Interventional Cardiology, Lankenau Medical Center, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
| | - William A Gray
- Department of Interventional Cardiology, Lankenau Medical Center, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Harish Jarrett
- Department of Cardiovascular Imaging, Lankenau Medical Center, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Sandra V Abramson
- Department of Cardiovascular Imaging, Lankenau Medical Center, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Marie-Annick Clavel
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada
- Department of Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Philippe Pibarot
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada
- Department of Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Basel Ramlawi
- Department of Cardiothoracic Surgery, Lankenau Medical Center, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
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18
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Rudolph T, Droppa M, Baan J, Nielsen NE, Baranowski J, Hachaturyan V, Kurucova J, Hack L, Bramlage P, Geisler T. Modifiable risk factors for permanent pacemaker after transcatheter aortic valve implantation: CONDUCT registry. Open Heart 2023; 10:openhrt-2022-002191. [PMID: 36750275 PMCID: PMC9906394 DOI: 10.1136/openhrt-2022-002191] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/14/2022] [Indexed: 02/09/2023] Open
Abstract
OBJECTIVE The onset of new conduction abnormalities requiring permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) is still a relevant adverse event. The main objective of this registry was to identify modifiable procedural risk factors for an improved outcome (lower rate of PPI) after TAVI in patients at high risk of PPI. METHODS Patients from four European centres receiving a balloon-expandable TAVI (Edwards SAPIEN 3/3 Ultra) and considered at high risk of PPI (pre-existing conduction disturbance, heavily calcified left ventricular outflow tract or short membranous septum) were prospectively enrolled into registry. RESULTS A total of 300 patients were included: 42 (14.0%) required PPI after TAVI and 258 (86.0%) did not. Patients with PPI had a longer intensive care unit plus intermediate care stay (65.7 vs 16.3 hours, p<0.001), general ward care stay (6.9 vs 5.3 days, p=0.004) and later discharge (8.6 vs 5.0 days, p<0.001). Of the baseline variables, only pre-existing right bundle branch block at baseline (OR 6.8, 95% CI 2.5 to 18.1) was significantly associated with PPI in the multivariable analysis. Among procedure-related variables, oversizing had the highest impact on the rate of PPI: higher than manufacturer-recommended sizing, mean area oversizing as well as the use of the 29 mm valve (OR 3.4, 95% CI 1.4 to 8.5, p=0.008) all were significantly associated with PPI. Rates were higher with the SAPIEN 3 (16.1%) vs SAPIEN 3 Ultra (8.5%), although not statistically significant but potentially associated with valve sizing. Implantation depth and postdelivery balloon dilatation also tended to affect PPI rates but without a statistical significance. CONCLUSION Valve oversizing is a strong procedure-related risk factor for PPI following TAVI. The clinical impact of the valve type (SAPIEN 3), implantation depth, and postdelivery balloon dilatation did not reach significance and may reflect already refined procedures in the participating centres, giving attention to these avoidable risk factors. TRIAL REGISTRATION NUMBER NCT03497611.
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Affiliation(s)
- Tanja Rudolph
- Department of Cardiology, Cologne University, Cologne, Germany,Clinic for General and Interventional Cardiology/Angiology, Ruhr University Bochum, Bochum, Germany
| | - Michal Droppa
- Department of Cardiology and Angiology, University Hospital Tübingen, Tubingen, Baden-Württemberg, Germany
| | - Jan Baan
- Heart Center, University of Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Niels-Erik Nielsen
- Department of Cardiology, Linköping University Hospital, Linköping, Sweden
| | - Jacek Baranowski
- Department of Cardiology, Linköping University Hospital, Linköping, Sweden
| | | | | | - Luis Hack
- Department of Cardiology, Cologne University, Cologne, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Tobias Geisler
- Department of Cardiology and Angiology, University Hospital Tübingen, Tubingen, Baden-Württemberg, Germany
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19
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Chang S, Liu X, Lu ZN, Yao J, Yin C, Wu W, Yuan F, Luo T, Liu R, Yan Y, Zhang Q, Pu J, Modine T, Piazza N, Jilaihawi H, Jiang Z, Song G. Feasibility study of temporary permanent pacemaker in patients with conduction block after TAVR. Front Cardiovasc Med 2023; 10:978394. [PMID: 36760563 PMCID: PMC9905124 DOI: 10.3389/fcvm.2023.978394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 01/06/2023] [Indexed: 01/26/2023] Open
Abstract
Background Limited data exist on the use of temporary permanent pacemaker (TPPM) to reduce unnecessary PPM in patients with high-degree atrioventricular block (HAVB) after transcatheter aortic valve replacement (TAVR). Objectives This study aims to determine the feasibility of TPPM in patients with HAVB after TAVR to provide prolonged pacing as a bridge. Materials and methods One hundred and eleven consecutive patients undergoing TAVR were screened from August 2021 to June 2022. Patients with HAVB eligible for PPM were included. TPPM were used in these patients instead of conventional temporary pacing or early PPM. Patients were followed up for 1 month. Holter and pacemaker interrogation were used to determine whether to implant PPM. Results Twenty one patients met the inclusion criteria for TPPM, of which 14 patients were third-degree AVB, 1 patient was second-degree AVB, 6 patients were first degree AVB with PR interval > 240 ms and LBBB with QRS duration > 150 ms. TPPM were placed on the 21 patients for 35 ± 7 days. Among 15 patients with HAVB, 26.7% of them (n = 4) recovered to sinus rhythm; 46.7% (n = 7) recovered to sinus rhythm with bundle branch block. The remains of 26.7% patients (n = 4) still had third-degree AVB and received PPM. For patients with first-degree AVB and LBBB, PR interval shortened to < 200 ms in all 6 patients and LBBB recovered in 2 patients. TPPM were successfully removed from all patients and no procedure-related adverse events occurred. Conclusion TPPM is reliable and safe in the small sample of patients with conduction block after TAVR to provide certain buffer time to distinguish whether a PPM is necessary. Future studies with larger sample are needed for further validation of the current results.
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Affiliation(s)
- Sanshuai Chang
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Capital Medical University, Beijing, China
| | - Xinmin Liu
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Capital Medical University, Beijing, China
| | - Zhi-Nan Lu
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Capital Medical University, Beijing, China
| | - Jing Yao
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Capital Medical University, Beijing, China
| | - Chengqian Yin
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Capital Medical University, Beijing, China
| | - Wenhui Wu
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Capital Medical University, Beijing, China
| | - Fei Yuan
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Capital Medical University, Beijing, China
| | - Taiyang Luo
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Capital Medical University, Beijing, China
| | - Ran Liu
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Capital Medical University, Beijing, China
| | - Yunfeng Yan
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Capital Medical University, Beijing, China
| | - Qian Zhang
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Capital Medical University, Beijing, China
| | - Junzhou Pu
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Capital Medical University, Beijing, China
| | - Thomas Modine
- UMCV, Hôpital Haut Leveque, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Nicolo Piazza
- Montreal and German Heart Centre, McGill University Health Center, Munich, Germany
| | | | - Zhengming Jiang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China,*Correspondence: Zhengming Jiang,
| | - Guangyuan Song
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Capital Medical University, Beijing, China,Guangyuan Song,
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20
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Prediction of conduction disturbances in patients undergoing transcatheter aortic valve replacement. Clin Res Cardiol 2023; 112:677-690. [PMID: 36680617 PMCID: PMC10160192 DOI: 10.1007/s00392-023-02160-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/12/2023] [Indexed: 01/22/2023]
Abstract
AIM Transcatheter aortic valve replacement (TAVR) can cause intraventricular conduction disturbances (ICA), particularly left bundle branch block (BBB) and high-degree atrioventricular block (HAVB). The aim of this study was to investigate clinical, anatomical, procedural, and electrophysiological parameters predicting ICA after TAVR. METHODS Patients with severe aortic stenosis (n = 203) without pacing devices undergoing TAVR with a self-expanding (n = 103) or balloon-expanding (n = 100) valve were enrolled. Clinical and anatomical parameters, such as length of the membranous septum (MS) and implantation depth, were assessed. His-ventricular interval (HVi) before and after implantation was determined. 12-lead-electrocardiograms (ECG) before, during and after 3 and 30 days after TAVR were analyzed for detection of any ICA. RESULTS Among 203 consecutive patients (aortic valve area 0.78 ± 0.18 cm2, age 80 ± 6 years, 54% male, left ventricular ejection fraction 52 ± 10%), TAVR led to a significant prolongation of infranodal conduction in all patients from 49 ± 10 ms to 59 ± 16 ms (p = 0.01). The HVi prolongation was independent of valve types, occurrence of HAVB or ICA. Fifteen patients (7%) developed HAVB requiring permanent pacemaker (PPM) implantation and 63 patients (31%) developed ICA within 30 days. Pre-existing BBB (OR 11.64; 95% CI 2.87-47.20; p = 0.001), new-onset left BBB (OR 15.72; 95% CI 3.05-81.03; p = 0.001), and diabetes mellitus (OR 3.88; 95% CI 1.30-15.99; p = 0.02) independently predicted HAVB requiring PPM. Neither pre-existing right BBB, a prolonged postHVi, increases in PR duration, any of the TAVR implantation procedural and anatomic nor echocardiographic characteristics were predictive for later HAVB. CONCLUSIONS New-onset left BBB and diabetes mellitus independently predicted HAVB requiring PPM after TAVR and helped to identify patients at risk. Electrophysiologic study (EPS) of atrioventricular conduction was neither specific nor predictive of HAVB and can be skipped. TRIAL REGISTRATION NUMBER NCT04128384 ( https://www. CLINICALTRIALS gov ).
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21
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Reduction of permanent pacemaker implantation by using the cusp overlap technique in transcatheter aortic valve replacement: a meta-analysis. Clin Res Cardiol 2023; 112:633-644. [PMID: 36656375 PMCID: PMC10160159 DOI: 10.1007/s00392-022-02150-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/23/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND The need for permanent pacemaker (PPM) implantation is a common complication after transcatheter aortic valve replacement (TAVR). Deep implantation position is a risk factor for PPM implantation. Thus, in the field of self-expandable (SE) transcatheter heart valves (THV) cusp overlap projection (COP) technique was implemented to reduce parallax, allowing a more precise guidance of implantation depth. AIMS This meta-analysis aims to report the outcome of patients undergoing TAVR with SE THV using COP versus conventional implantation technique (CIT). METHODS Systematical search in MEDLINE and EMBASE yielded five observational controlled studies comparing both implantation techniques for the SE Evolut prosthesis (Medtronic Intern. Ltd., CA, USA) and fulfilling the inclusion criteria for meta-analysis. RESULTS Totally, 1227 patients were included, comprising 641 who underwent COP and 586 CIT TAVR. Incidence of post-procedural need for PPM implantation was significantly lower in COP group (9.8% vs 20.6%; OR = 0.43; p < 0.00001). This was accompanied by significantly higher implantation position in COP group (mean difference distance from distal end of the intraventricular portion of the THV to the non-coronary cusp (NCC): - 1.03 mm; p = 0.00001). Incidence of new-onset left bundle branch block did not differ. Regarding procedural and 30-day mortality, technical success, post-procedural aortic regurgitation, and rates of multiple device implantation, no difference between COP and CIT was found. CONCLUSION COP is an effective and safe implantation technique to reduce the need for a permanent pacemaker implantation during TAVR with SE Evolut prosthesis.
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Costa G, Reddavid C, Dipietro E, Barbanti M. Managing complications after transcatheter aortic valve implantation. Expert Rev Med Devices 2022; 19:599-612. [PMID: 36150162 DOI: 10.1080/17434440.2022.2129009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Although transcatheter aortic valve implantation (TAVI) has become a streamlined and standardized procedure, different complications still remain and need the operators to be properly trained about their management. AREAS COVERED This review article aims at offering a practical overview of the most impactful TAVI complications, analyzing, and discussing the potential risk factors, and focusing on the available strategies for their management. EXPERT OPINION Complications following TAVI have been decreasing thanks to technical advancements and operators experience. The thorough knowledge of potential complications and their prevention played a key role in the decreasing of complications rates. Pre-procedural, computed tomography angiography assessment of patient's anatomical characteristics, allows to properly choose and tailor the best strategy for managing complications in most of cases. Nevertheless, further research is required to shed lights about the optimal strategies to adopt for managing TAVI complications.
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Affiliation(s)
- Giuliano Costa
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Claudia Reddavid
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Elena Dipietro
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Marco Barbanti
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
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Ma Y, Mao Y, Zhu G, Yang J. Application of cardiovascular 3-dimensional printing in Transcatheter aortic valve replacement. CELL REGENERATION 2022; 11:35. [PMID: 36121512 PMCID: PMC9485371 DOI: 10.1186/s13619-022-00129-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/05/2022] [Indexed: 11/10/2022]
Abstract
AbstractTranscatheter aortic valve replacement (TAVR) has been performed for nearly 20 years, with reliable safety and efficacy in moderate- to high-risk patients with aortic stenosis or regurgitation, with the advantage of less trauma and better prognosis than traditional open surgery. However, because surgeons have not been able to obtain a full view of the aortic root, 3-dimensional printing has been used to reconstruct the aortic root so that they could clearly and intuitively understand the specific anatomical structure. In addition, the 3D printed model has been used for the in vitro simulation of the planned procedures to predict the potential complications of TAVR, the goal being to provide guidance to reasonably plan the procedure to achieve the best outcome. Postprocedural 3D printing can be used to understand the depth, shape, and distribution of the stent. Cardiovascular 3D printing has achieved remarkable results in TAVR and has a great potential.
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(Permanent pacemaker implantation in patients undergoing TAVR - single center study between years 2009 and 2021). COR ET VASA 2022. [DOI: 10.33678/cor.2022.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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25
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Comparison of In-Hospital Outcomes and Readmission Rates of Transcatheter Aortic Valve Implantation in Mixed Aortic Valve Disease Versus Pure Aortic Stenosis. Am J Cardiol 2022; 175:72-79. [PMID: 35562299 DOI: 10.1016/j.amjcard.2022.03.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 11/22/2022]
Abstract
Recently, transcatheter aortic valve implantation (TAVI) has been performed in patients with combined aortic stenosis (AS) and aortic regurgitation. We sought to evaluate in-hospital outcomes and readmission rates after TAVI in patients with mixed aortic valve disease (MAVD). A total of 100,573 TAVI procedures were identified between 2011 and 2017 using International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision procedure codes the from Nationwide Readmissions Database. We separated patients into 2 cohorts, those with MAVD and those with pure AS. The primary outcome was all-cause inpatient mortality after TAVI, and secondary outcomes included rates of 30- and 90-day readmissions and postprocedural complications. A total of 3,260 patients had MAVD (median age 83 years, 43.5% women). In-hospital mortality (2.5% vs 2.6%, p = 0.531) and rates of paravalvular leak (1.0% vs 1.3%, p = 0.056) were similar between the MAVD and pure AS groups. Major bleeding (7.4% vs 9.6%, p <0.001), 30-day readmission (0.5% vs 8.8%, p <0.001) and 90-day readmission rates (0.8% vs 16.0%, p <0.001), acute kidney injury (12.9% vs 15.1%, p <0.001), postoperative ischemic stroke (2.0% vs 5.7%, p <0.001), and mechanic circulatory support use (1.9% vs 4.5%, p <0.001) were less prevalent in the MAVD cohort. Using a multivariate logistic regression model to adjust for confounding factors, MAVD was not predictive of mortality in patients who underwent TAVI (adjusted odds ratio [adjOR] 1.25, 95% confidence interval [CI] 0.99 to 1.57, p = 0.056); however, MAVD was associated with: decreased odds of 30-day readmission (adjOR 0.05, 95% CI 0.03 to 0.08, p <0.001), 90-day readmission rates (adjOR 0.04, 95% CI 0.03 to 0.06, p <0.001), and higher odds of pacemaker implantation (adjOR 1.46, 95% CI 1.29 to 1.65, p <0.001). In conclusion, despite differences in the aortic valve and left ventricular anatomy (pressure vs volume-related adaptive changes) in patients with MAVD and pure AS, TAVI appears safe and feasible. However, patients with MAVD were more likely to have permanent pacemakers implanted. The results of our study warrant further randomized controlled studies to confirm these findings.
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Hokken TW, Muhemin M, Okuno T, Veulemans V, Lopes BB, Beneduce A, Vittorio R, Ooms JF, Adrichem R, Neleman T, Kardys I, Daemen J, Chieffo A, Montorfano M, Cavalcante J, Zeus T, Pilgrim T, Toggweiler S, Van Mieghem NM. Impact of membranous septum length on pacemaker need with different transcatheter aortic valve replacement systems: The INTERSECT registry. J Cardiovasc Comput Tomogr 2022; 16:524-530. [PMID: 35872136 DOI: 10.1016/j.jcct.2022.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/09/2022] [Accepted: 07/10/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND New permanent pacemaker implantation (new-PPI) remains a compelling issue after Transcatheter Aortic Valve Replacement (TAVR). Previous studies reported the relationship between a short MS length and the new-PPI post-TAVR with a self-expanding THV. However, this relationship has not been investigated in different currently available THV. Therefore, the aim of this study was to investigate the association between membranous septum (MS)-length and new-PPI after TAVR with different Transcatheter Heart Valve (THV)-platforms. METHODS We included patients with a successful TAVR-procedure and an analyzable pre-procedural multi-slice computed tomography. MS-length was measured using a standardized methodology. The primary endpoint was the need for new-PPI within 30 days after TAVR. RESULTS In total, 1811 patients were enrolled (median age 81.9 years [IQR 77.2-85.4], 54% male). PPI was required in 275 patients (15.2%) and included respectively 14.2%, 20.7% and 6.3% for Sapien3, Evolut and ACURATE-THV(p < 0.01). Median MS-length was significantly shorter in patients with a new-PPI (3.7 mm [IQR 2.2-5.1] vs. 4.1 mm [IQR 2.8-6.0], p = <0.01). Shorter MS-length was a predictor for PPI in patients receiving a Sapien3 (OR 0.87 [95% CI 0.79-0.96], p = <0.01) and an Evolut-THV (OR 0.91 [95% CI 0.84-0.98], p = 0.03), but not for an ACURATE-THV (OR 0.99 [95% CI 0.79-1.21], p = 0.91). By multivariable analysis, first-degree atrioventricular-block (OR 2.01 [95% CI 1.35-3.00], p = <0.01), right bundle branch block (OR 8.33 [95% CI 5.21-13.33], p = <0.01), short MS-length (OR 0.89 [95% CI 0.83-0.97], p < 0.01), annulus area (OR 1.003 [95% CI 1.001-1.005], p = 0.04), NCC implantation depth (OR 1.13 [95% CI 1.07-1.19] and use of Evolut-THV(OR 1.54 [95% CI 1.03-2.27], p = 0.04) were associated with new-PPI. CONCLUSION MS length was an independent predictor for PPI across different THV platforms, except for the ACURATE-THV. Based on our study observations within the total cohort, we identified 3 risk groups by MS length: MS length ≤3 mm defined a high-risk group for PPI (>20%), MS length 3-7 mm intermediate risk for PPI (10-20%) and MS length > 7 mm defined a low risk for PPI (<10%). Anatomy-tailored-THV-selection may mitigate the need for new-PPI in patients undergoing TAVR.
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Affiliation(s)
- Thijmen W Hokken
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Mohammed Muhemin
- Heart Center Lucerne, Lucerner Kantonsspital, Lucerne, Switzerland
| | - Taishi Okuno
- Department of Cardiology, Inselspital Bern, University Hospital, University of Bern, Bern, Switzerland
| | - Verena Veulemans
- Department of Cardiology, Pulmonology and Vascular Diseases, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Bernardo B Lopes
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Alessandro Beneduce
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Romano Vittorio
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Joris F Ooms
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Rik Adrichem
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Tara Neleman
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Joost Daemen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Joao Cavalcante
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Tobias Zeus
- Department of Cardiology, Pulmonology and Vascular Diseases, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital Bern, University Hospital, University of Bern, Bern, Switzerland
| | | | - Nicolas M Van Mieghem
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands. https://twitter.com/drnvanmieghem
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Hameed I, Khan MO, Ul-Haque I, Siddiqui OM, Samad SA, Malik S, Mahmood S. Transaxillary Versus Transaortic Transcatheter Aortic Valve Implantation in the Treatment of Aortic Stenosis: An Updated Systematic Review and Meta-Analysis. Cureus 2022; 14:e24054. [PMID: 35573526 PMCID: PMC9097931 DOI: 10.7759/cureus.24054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 11/05/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is a technique that can be performed through multiple approaches, and the benefits of one approach over another are still being evaluated to make sure patients receive the best possible care. Our meta-analysis aims to compare clinical and procedural outcomes of the transaxillary (TAx) and transaortic (TAo) approaches to validate the more optimal procedure. The systematic literature search was done via PubMed/MEDLINE, Embase, and the Cochrane Central databases from inception to December 2021, to identify articles reporting data on both TAx TAVR and TAo TAVR. In addition, we checked ClinicalTrials.gov for more published or unpublished trials. Baseline patient characteristics, procedure results, and clinical results were extracted from the article and pooled for analysis. A quantitative meta-analysis was conducted using Review Manager (RevMan) version 5.3 (Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). The outcomes extracted included blood transfusion, conversion to sternotomy, tamponade, contrast amount, procedure time, bleeding incidents (minor, major, or life-threatening), length of stay (LOS), vascular complications (minor or major), acute kidney injury (AKI), paravalvular leak (PVL), permanent pacemaker (PPM) implantation, 30-day mortality, one-year mortality, 30-day stroke, and device success. The final analysis included 11 articles, consisting of 10 observational studies and a pivotal trial. Cumulative results revealed that the TAo approach had a significantly lower incidence of vascular complications (RR = 2.30; 95% CI = 1.22 to 4.35), and the need for implantation of a permanent pacemaker (RR = 1.82; 95% CI = 1.30 to 2.54) along with a lower amount of contrast (mean difference (MD) = 27.40; 95% CI = 3.73 to 51.08) needed to be used. The TAx group was associated with a significantly lower 30-day mortality (RR = 0.46; 95% CI = 0.31 to 0.69), AKI (RR = 0.47; 95% CI = 0.33 to 0.67), and length of hospital stay (MD = −1.95; 95% CI = −2.51 to −1.38). No significant difference was observed between the outcomes of 30-day stroke (RR = 1.38; 95% CI = 0.81 to 2.33), PVL (RR = 1.05; 95% CI = 0.50 to 2.18), tamponade (RR = 0.71; 95% CI = 0.12 to 4.03), conversion to sternotomy (RR = 0.51; 95% CI = 0.06 to 4.30), device success (RR = 0.97; 95% CI = 0.88 to 1.07), the incidence of bleeding (RR = 0.75; 95% CI = 0.51 to 1.10), and procedure time (MD = 4.44; 95% CI = −96.30 to 105.17). Both the procedures were associated with their benefits and risks. Although most of the outcomes favored TAx transcatheter aortic valve implantation (TAVI), it is too early to say if it would be better than TAo TAVI. To authenticate the findings concluded in this meta-analysis and further improve our understanding of the efficacy, safety, and risk profile between TAx and TAo approaches for TAVI, large sample randomized clinical trials are required on a wide scale.
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Doldi PM, Stolz L, Escher F, Steffen J, Gmeiner J, Roden D, Linnemann M, Löw K, Deseive S, Stocker TJ, Orban M, Theiss H, Rizas K, Curta A, Sadoni S, Buech J, Joskowiak D, Peterss S, Hagl C, Massberg S, Hausleiter J, Braun D. Transcatheter Aortic Valve Replacement with the Self-Expandable Core Valve Evolut Prosthesis Using the Cusp-Overlap vs. Tricusp-View. J Clin Med 2022; 11:jcm11061561. [PMID: 35329887 PMCID: PMC8953752 DOI: 10.3390/jcm11061561] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/31/2022] [Accepted: 03/10/2022] [Indexed: 01/27/2023] Open
Abstract
Despite the rapid increase in experience and technological improvement, the incidence of conduction disturbances in patients undergoing transcatheter aortic valve replacement (TAVR) with the self-expandable CoreValve Evolut valve remains high. Recently, a cusp-overlap view (COP) implantation technique has been proposed for TAVR with self-expandable valves offering an improved visualization during valve expansion compared to the three-cusp view (TCV). This study aims to systematically analyze procedural outcomes of TAVR patients treated with the CoreValve Evolut valve using a COP compared to TCV in a high-volume center. The primary endpoint was technical success according the 2021 VARC-3 criteria. A total of 122 consecutive patients (61 pts. TCV: April 2019 to November 2020; 61 pts. COP: December 2020 to October 2021) that underwent TAVR with the CoreValve Evolut prosthesis were included in this analysis. Although there was no difference in the primary endpoint technical success between TCV and COP patients (93.4% vs. 90.2%, OR 0.65, 95% CI 0.16, 2.4, p = 0.51), we observed a significantly lower risk for permanent pacemaker implantation (PPI) among COP patients (TCV: 27.9% vs. COP: 13.1%, OR 0.39, 95% CI 0.15, 0.97, p = 0.047). Implantation of the CoreValve Evolut prosthesis using the COP might help to reduce the rate of PPI following TAVR.
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Affiliation(s)
- Philipp Maximilian Doldi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; (L.S.); (J.S.); (J.G.); (D.R.); (M.L.); (K.L.); (S.D.); (T.J.S.); (M.O.); (H.T.); (K.R.); (S.M.); (J.H.); (D.B.)
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, 80539 Munich, Germany
- Correspondence:
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; (L.S.); (J.S.); (J.G.); (D.R.); (M.L.); (K.L.); (S.D.); (T.J.S.); (M.O.); (H.T.); (K.R.); (S.M.); (J.H.); (D.B.)
| | - Felix Escher
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, 81377 Munich, Germany; (F.E.); (A.C.)
| | - Julius Steffen
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; (L.S.); (J.S.); (J.G.); (D.R.); (M.L.); (K.L.); (S.D.); (T.J.S.); (M.O.); (H.T.); (K.R.); (S.M.); (J.H.); (D.B.)
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, 80539 Munich, Germany
| | - Jonas Gmeiner
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; (L.S.); (J.S.); (J.G.); (D.R.); (M.L.); (K.L.); (S.D.); (T.J.S.); (M.O.); (H.T.); (K.R.); (S.M.); (J.H.); (D.B.)
| | - Daniel Roden
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; (L.S.); (J.S.); (J.G.); (D.R.); (M.L.); (K.L.); (S.D.); (T.J.S.); (M.O.); (H.T.); (K.R.); (S.M.); (J.H.); (D.B.)
| | - Marie Linnemann
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; (L.S.); (J.S.); (J.G.); (D.R.); (M.L.); (K.L.); (S.D.); (T.J.S.); (M.O.); (H.T.); (K.R.); (S.M.); (J.H.); (D.B.)
| | - Kornelia Löw
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; (L.S.); (J.S.); (J.G.); (D.R.); (M.L.); (K.L.); (S.D.); (T.J.S.); (M.O.); (H.T.); (K.R.); (S.M.); (J.H.); (D.B.)
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; (L.S.); (J.S.); (J.G.); (D.R.); (M.L.); (K.L.); (S.D.); (T.J.S.); (M.O.); (H.T.); (K.R.); (S.M.); (J.H.); (D.B.)
| | - Thomas J. Stocker
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; (L.S.); (J.S.); (J.G.); (D.R.); (M.L.); (K.L.); (S.D.); (T.J.S.); (M.O.); (H.T.); (K.R.); (S.M.); (J.H.); (D.B.)
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, 80539 Munich, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; (L.S.); (J.S.); (J.G.); (D.R.); (M.L.); (K.L.); (S.D.); (T.J.S.); (M.O.); (H.T.); (K.R.); (S.M.); (J.H.); (D.B.)
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, 80539 Munich, Germany
| | - Hans Theiss
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; (L.S.); (J.S.); (J.G.); (D.R.); (M.L.); (K.L.); (S.D.); (T.J.S.); (M.O.); (H.T.); (K.R.); (S.M.); (J.H.); (D.B.)
| | - Konstantinos Rizas
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; (L.S.); (J.S.); (J.G.); (D.R.); (M.L.); (K.L.); (S.D.); (T.J.S.); (M.O.); (H.T.); (K.R.); (S.M.); (J.H.); (D.B.)
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, 80539 Munich, Germany
| | - Adrian Curta
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, 81377 Munich, Germany; (F.E.); (A.C.)
| | - Sebastian Sadoni
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, 81377 Munich, Germany; (S.S.); (J.B.); (D.J.); (S.P.); (C.H.)
| | - Joscha Buech
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, 81377 Munich, Germany; (S.S.); (J.B.); (D.J.); (S.P.); (C.H.)
| | - Dominik Joskowiak
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, 81377 Munich, Germany; (S.S.); (J.B.); (D.J.); (S.P.); (C.H.)
| | - Sven Peterss
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, 81377 Munich, Germany; (S.S.); (J.B.); (D.J.); (S.P.); (C.H.)
| | - Christian Hagl
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, 81377 Munich, Germany; (S.S.); (J.B.); (D.J.); (S.P.); (C.H.)
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; (L.S.); (J.S.); (J.G.); (D.R.); (M.L.); (K.L.); (S.D.); (T.J.S.); (M.O.); (H.T.); (K.R.); (S.M.); (J.H.); (D.B.)
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, 80539 Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; (L.S.); (J.S.); (J.G.); (D.R.); (M.L.); (K.L.); (S.D.); (T.J.S.); (M.O.); (H.T.); (K.R.); (S.M.); (J.H.); (D.B.)
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, 80539 Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; (L.S.); (J.S.); (J.G.); (D.R.); (M.L.); (K.L.); (S.D.); (T.J.S.); (M.O.); (H.T.); (K.R.); (S.M.); (J.H.); (D.B.)
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, 80539 Munich, Germany
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Permanent Pacemaker Reduction Using Cusp-Overlapping Projection in TAVR: A Propensity Score Analysis. JACC Cardiovasc Interv 2022; 15:150-161. [PMID: 35057985 DOI: 10.1016/j.jcin.2021.10.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/27/2021] [Accepted: 10/05/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The aim of this study was to determine if modifying the classical implantation technique for self-expanding (SE) transcatheter aortic valve replacement to a novel cusp-overlapping projection (COP) technique results in a higher implantation depth (ID) and subsequently reduces the rate of permanent pacemaker implantation (PPMI). BACKGROUND The COP technique presents the potential benefit of an optimized ID to reduce the rate of PPMI. However, only a few studies have compared clinical outcomes with those achieved using the standard technique. This is the first study to systematically evaluate this approach for SE transcatheter heart valves (THVs) in different populations METHODS: Beginning in February 2015, 444 patients were consecutively included. Propensity score matching was used to control baseline characteristics because of the observational nature of the study. In total, 161 pairs of patients were analyzed. Three methods were used to measure ID (noncoronary cusp [NCC] to the THV, mean of the NCC and the left coronary cusp [LCC] to the THV, and the deepest edge from the LCC and the NCC to the THV). RESULTS ID was significantly higher in COP cases when measuring from the NCC (4.2 mm vs 5.3 mm; P < 0.001) and the mean from the NCC and the LCC (5.3 mm vs 5.9 mm; P = 0.04), but not from the deepest edge. The PPMI rate was lower in the COP group: 19 (11.8%) vs 35 (21.7%) (P = 0.03; relative risk: 0.54; 95% CI: 0.32-0.91). CONCLUSIONS The present study showed that the COP technique significantly reduces PPMI in SE THV implantation compared with the classical implantation technique, with similar rates of complications.
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Carey J, Buckley A, O'Connor S, Hensey M. The Wattson temporary pacing guidewire for transcatheter heart valve implantation. Future Cardiol 2021; 18:275-283. [PMID: 34875868 DOI: 10.2217/fca-2021-0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Transcatheter aortic valve implantation and implantation of other transcatheter heart valves, generally requires insertion of a temporary venous pacemaker. Implantation of a temporary venous pacemaker adds complexity, time and risk to the procedure. Guidewire modification to allow pacing is increasingly popular, however it requires technical expertise and provides unipolar pacing resulting in high thresholds and potential capture loss. The Wattson temporary pacing guidewire is a novel device which offers guidewire support for valve delivery and concomitant bipolar pacing. It may offer a safe and effective solution to guidewire pacing for transcatheter aortic valve implantation and other transcatheter heart valve implantations. Herein, we review the literature surrounding left ventricular guidewire pacing along with the features and clinical data of the Wattson wire.
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Affiliation(s)
- James Carey
- St James's Hospital, James St, Dublin 8, Ireland
| | | | | | - Mark Hensey
- St James's Hospital, James St, Dublin 8, Ireland
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Hokken TW, de Ronde M, Wolff Q, Schermers T, Ooms JF, van Wiechen MP, Kardys I, Daemen J, de Jaegere PP, Van Mieghem NM. Insights in a restricted temporary pacemaker strategy in a lean transcatheter aortic valve implantation program. Catheter Cardiovasc Interv 2021; 99:1197-1205. [PMID: 34837467 PMCID: PMC9539864 DOI: 10.1002/ccd.30026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/05/2021] [Accepted: 11/17/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To study the safety and feasibility of a restrictive temporary-RV-pacemaker use and to evaluate the need for temporary pacemaker insertion for failed left ventricular (LV) pacing ability (no ventricular capture) or occurrence of high-degree AV-blocks mandating continuous pacing. BACKGROUND Ventricular pacing remains an essential part of contemporary transcatheter aortic valve implantation (TAVI). A temporary-right-ventricle (RV)-pacemaker lead is the standard approach for transient pacing during TAVI but requires central venous access. METHODS An observational registry including 672 patients who underwent TAVI between June 2018 and December 2020. Patients received pacing on the wire when necessary, unless there was a high-anticipated risk for conduction disturbances post-TAVI, based on the baseline-ECG. The follow-up period was 30 days. RESULTS A temporary-RV-pacemaker lead (RVP-cohort) was inserted in 45 patients, pacing on the wire (LVP-cohort) in 488 patients, and no pacing (NoP-cohort) in 139 patients. A bailout temporary pacemaker was implanted in 14 patients (10.1%) in the NoP-cohort and in 24 patients (4.9%) in the LVP-cohort. One patient in the LVP-cohort needed an RV-pacemaker for incomplete ventricular capture. Procedure time was significantly longer in the RVP-cohort (68 min [IQR 52-88.] vs. 55 min [IQR 44-72] in NoP-cohort and 55 min [IQR 43-71] in the LVP-cohort [p < 0.005]). Procedural high-degree AV-block occurred most often in the RVP-cohort (45% vs. 14% in the LVP and 16% in the NoP-cohort [p ≤ 0.001]). Need for new PPI occurred in 47% in the RVP-cohort, versus 20% in the NoP-cohort and 11% in the LVP-cohort (p ≤ 0.001). CONCLUSION A restricted RV-pacemaker strategy is safe and shortens procedure time. The majority of TAVI-procedures do not require a temporary-RV-pacemaker.
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Affiliation(s)
- Thijmen W Hokken
- Department of Cardiology, Thoraxcenter. Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marjo de Ronde
- Department of Cardiology, Thoraxcenter. Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Quinten Wolff
- Department of Cardiology, Thoraxcenter. Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Thom Schermers
- Department of Cardiology, Thoraxcenter. Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joris F Ooms
- Department of Cardiology, Thoraxcenter. Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maarten P van Wiechen
- Department of Cardiology, Thoraxcenter. Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Isabella Kardys
- Department of Cardiology, Thoraxcenter. Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joost Daemen
- Department of Cardiology, Thoraxcenter. Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Peter P de Jaegere
- Department of Cardiology, Thoraxcenter. Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter. Erasmus University Medical Center, Rotterdam, The Netherlands
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Nakashima M, Jilaihawi H. Conduction Disturbances and Pacing in Transcatheter Aortic Valve Replacement. Interv Cardiol Clin 2021; 10:455-463. [PMID: 34593109 DOI: 10.1016/j.iccl.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Conduction disturbances (CDs) after transcatheter artic replacement remain a clinical concern and relatively common complication. A recent meta-analysis showed both new-onset persistent left bundle branch block and new permanent pacemaker implantation were related to all-cause death with risk ratio 1.32 (95% confidence interval [CI] 1.17 to 1.49; P<.001) and 1.17 (95% CI 1.11-1.25; P<.001) at 1 year, respectively. Preprocedural computed tomography imaging can highlight potential risk factors for CDs, such as membranous septum length, device landing zone calcium, and the annulus size/degree of device oversizing.
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Affiliation(s)
- Makoto Nakashima
- Heart Valve Center, NYU Langone Health, 530 1st Avenue, Suite 9V, New York, NY 10016, USA
| | - Hasan Jilaihawi
- Heart Valve Center, NYU Langone Health, 530 1st Avenue, Suite 9V, New York, NY 10016, USA.
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Next-Day Discharge vs Early Discharge After Transcatheter Aortic Valve Replacement: Systematic Review and Meta-Analysis. Curr Probl Cardiol 2021; 47:100998. [PMID: 34571105 DOI: 10.1016/j.cpcardiol.2021.100998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/14/2021] [Indexed: 11/23/2022]
Abstract
With the growing utilization of transcatheter aortic valve replacement (TAVR) as an alternative option to surgical valve replacement (SAVR) in patients considered to be suboptimal for surgery, there is a need to explore the possibility of next day discharge (NDD) and its potential outcomes. The aim of our study is to compare outcomes and complications following NDD vs the standard early discharge (ED) (less than 3 days). A comprehensive literature search was performed in PubMed, Embase, and Cochrane to identify relevant trials. Summary effects were calculated using a DerSimonian and Laird random effects model as odds ratio with 95% confidence intervals for all the clinical endpoints. Studies comparing same-day or next-day discharge vs discharge within the next three days were included in our analysis. 6 studies with 2,672 patients were identified. The risk of bleeding and vascular complications was significantly lower in patients with NDD compared to ED (OR 0.10, P < 0.00001 and OR 0.22, P = 0.002 respectively). The incidence of permanent pacemaker (PPM) implants was significantly lower in patients who had NDD compared to ED (OR 0.21, P = 0.0005). The incidence of 30 day mortality, stroke, AKI and readmission rates was not different between the two groups. NDD after TAVR allows for reduction in hospital stay and can mitigate hospital costs without an increased risk of complications. Our analysis shows that complication rate is comparable to ED, NDD is a reasonable option for certain patients with severe aortic stenosis who undergo TAVR. Further studies are needed to elucidate whether higher risk patients who would benefit from an extended inpatient monitoring post TAVR.
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