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Verhemel S, Nuis RJ, van den Dorpel M, Adrichem R, de Sá Marchi MF, Hirsch A, Daemen J, Budde RPJ, Van Mieghem NM. Computed tomography to predict pacemaker need after transcatheter aortic valve replacement. J Cardiovasc Comput Tomogr 2024:S1934-5925(24)00434-9. [PMID: 39299898 DOI: 10.1016/j.jcct.2024.08.009] [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: 04/18/2024] [Revised: 08/30/2024] [Accepted: 08/31/2024] [Indexed: 09/22/2024]
Abstract
Transcatheter aortic valve replacement (TAVR) is preferred therapy for elderly patients with severe aortic stenosis (AS) and increasingly used in younger patient populations with good safety and efficacy outcomes. However, cardiac conduction abnormalities remain a frequent complication after TAVR ranging from relative benign interventriculair conduction delays to prognostically relevant left bundle branch block and complete atrio-ventricular (AV) block requiring permanent pacemaker implantation (PPI). Although clinical, procedural and electrocardiographic factors have been identified as predictors of this complication, there is a need for advanced strategies to control the burden of conduction defects particularly as TAVR shifts towards younger populations. This state of the art review highlights the value of ECG-synchronized computed tomographic angiography (CTA) evaluation of the aortic root to better understand and manage conduction problems post-TAVR. An update on CTA derived anatomic features related to conduction issues is provided and complemented with computational framework modelling. This CTA-derived 3-dimensional anatomical reconstruction tool generates patient-specific TAVR simulations enabling operators to adapt procedural strategy and implantation technique to mitigate conduction abnormality risks.
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Affiliation(s)
- Sarah Verhemel
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Rutger-Jan Nuis
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Mark van den Dorpel
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Rik Adrichem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Alexander Hirsch
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Joost Daemen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ricardo P J Budde
- Department of Radiology, 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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Kroon HG, Hokken T, van Wiechen M, Ooms JFW, van Gils L, Kardys I, Daemen J, De Jaegere PPT, Nuis RJ, Van Mieghem NM. Conduction dynamics over time after transcatheter aortic valve replacement: An expert review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00625-0. [PMID: 39299841 DOI: 10.1016/j.carrev.2024.08.005] [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: 04/15/2024] [Revised: 07/27/2024] [Accepted: 08/13/2024] [Indexed: 09/22/2024]
Abstract
New conduction disorders remain a frequent complication in current transcatheter aortic valve replacement (TAVR) era. Left bundle branch block (LBBB) occurs early in about 20-30 % of TAVR-patients, persists at 1 month in about 35-45 % of cases and will likely remain thereafter. Third-degree atrioventricular block (AV3B) affects approximately 15 % of patients. Pacemaker dependency gradually decreases throughout follow-up and approximately 25-35 % of patients remain pacemaker dependent at one year. We aimed to review what is currently known about the dynamics of acquired conduction disorders, including extraction of predictors, and how to interpret these dynamics in light of an early discharge policy.
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Affiliation(s)
- Herbert G Kroon
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Thijmen Hokken
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Maarten van Wiechen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Joris F W Ooms
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Lennart van Gils
- 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
| | - Peter P T De Jaegere
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Rutger-Jan Nuis
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
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3
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Ueyama HA, Miyamoto Y, Hashimoto K, Watanabe A, Kolte D, Latib A, Kuno T, Tsugawa Y. Comparison of Patient Outcomes Between Leadless vs Transvenous Pacemakers Following Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2024; 17:1779-1791. [PMID: 39023453 DOI: 10.1016/j.jcin.2024.05.030] [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: 02/13/2024] [Revised: 04/23/2024] [Accepted: 05/21/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Evidence is limited regarding the effectiveness of leadless pacemaker implantation for conduction disturbance following transcatheter aortic valve replacement (TAVR). OBJECTIVES This study sought to examine the national trends in the use of leadless pacemaker implantation following TAVR and compare its performance with transvenous pacemakers. METHODS Medicare fee-for-service beneficiaries aged ≥65 years who underwent leadless or transvenous pacemakers following TAVR between 2017 and 2020 were included. Outcomes included in-hospital overall complications as well as midterm (up to 2 years) all-cause death, heart failure hospitalization, infective endocarditis, and device-related complications. Propensity score overlap weighting analysis was used. RESULTS A total of 10,338 patients (730 leadless vs 9,608 transvenous) were included. Between 2017 and 2020, there was a 3.5-fold increase in the proportion of leadless pacemakers implanted following TAVR. Leadless pacemaker recipients had more comorbidities, including atrial fibrillation and end-stage renal disease. After adjusting for potential confounders, patients with leadless pacemakers experienced a lower rate of in-hospital overall complications compared with patients who received transvenous pacemakers (7.2% vs 10.1%; P = 0.014). In the midterm, we found no significant differences in all-cause death (adjusted HR: 1.13; 95% CI: 0.96-1.32; P = 0.15), heart failure hospitalization (subdistribution HR: 0.89; 95% CI: 0.74-1.08; P = 0.24), or infective endocarditis (subdistribution HR: 0.98; 95% CI: 0.44-2.17; P = 0.95) between the 2 groups, but leadless pacemakers were associated with a lower risk of device-related complications (subdistribution HR: 0.37; 95% CI: 0.21-0.64; P < 0.001). CONCLUSIONS Leadless pacemakers are increasingly being used for conduction disturbance following TAVR and were associated with a lower rate of in-hospital complications and midterm device-related complications compared to transvenous pacemakers without a difference in midterm mortality.
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Affiliation(s)
- Hiroki A Ueyama
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Yoshihisa Miyamoto
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan
| | - Kenji Hashimoto
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Atsuyuki Watanabe
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside and West, New York, New York, USA
| | - Dhaval Kolte
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA; Division of Cardiology, Jacobi Medical Center, Albert Einstein College of Medicine, New York, New York, USA.
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California, USA; Department of Health Policy and Management, University of California-Los Angeles Fielding School of Public Health, Los Angeles, California, USA
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Pinnacchio G, Ruscio E, Rocco E, Trani C, Burzotta F, Aurigemma C, Romagnoli E, Scacciavillani R, Narducci ML, Bencardino G, Perna F, Spera FR, Comerci G, Bisignani A, Pelargonio G. Short-Term Atrioventricular Dysfunction Recovery after Post-TAVI Pacemaker Implantation. J Cardiovasc Dev Dis 2022; 9:jcdd9100324. [PMID: 36286276 PMCID: PMC9604573 DOI: 10.3390/jcdd9100324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/04/2022] [Accepted: 09/09/2022] [Indexed: 11/24/2022] Open
Abstract
Permanent pacemaker implantation (PPI) represents a frequent complication after transcatheter aortic valve implantation (TAVI) due to atrio-ventricular (AV) node injury. Predictors of early AV function recovery were investigated. We analyzed 50 consecutive patients (82 ± 6 years, 58% males, EuroSCORE: 7.8 ± 3.3%, STS mortality score: 5 ± 2.8%). Pacemaker interrogations within 4−6 weeks from PPI were performed to collect data on AV conduction. The most common indication of PPI was persistent third-degree (44%)/high-degree (20%) AV block/atrial fibrillation (AF) with slow ventricular conduction (16%) after TAVI. At follow-up, 13 patients (26%) recovered AV conduction (i.e., sinus rhythm with stable 1:1 AV conduction/AF with a mean ventricular response >50 bpm, associated with a long-term ventricular pacing percentage < 5%). At multivariate analysis, complete atrio-ventricular block independently predicted pacemaker dependency at follow-up (p = 0.019). Patients with persistent AV dysfunction showed a significant AV conduction time prolongation after TAVI (PR interval from 207 ± 50 to 230 ± 51, p = 0.02; QRS interval from 124 ± 23 to 147 ± 16, p < 0.01) compared to patients with recovery, in whom AV conduction parameters remained unchanged. Several patients receiving PPI after TAVI have recovery of AV conduction within a few weeks. Longer observation periods prior to PPI might be justified, and algorithms to minimize ventricular pacing should be utilized whenever possible.
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Affiliation(s)
- Gaetano Pinnacchio
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
- Correspondence:
| | - Eleonora Ruscio
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Erica Rocco
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
- Cardiology Institute, Catholic University of Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
- Cardiology Institute, Catholic University of Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Roberto Scacciavillani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Maria Lucia Narducci
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Gianluigi Bencardino
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Francesco Perna
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Francesco Raffaele Spera
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Gianluca Comerci
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Antonio Bisignani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Gemma Pelargonio
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
- Cardiology Institute, Catholic University of Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
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Sá MP, Jacquemyn X, Sun T, Van den Eynde J, Tasoudis P, Erten O, Sicouri S, Torregrossa G, Clavel MA, Pibarot P, Ramlawi B. Late Outcomes of Permanent Pacemaker Implantation After TAVR: Meta-analysis of Reconstructed Time-to-Event Data. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100434. [PMID: 39131484 PMCID: PMC11308092 DOI: 10.1016/j.jscai.2022.100434] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/12/2022] [Accepted: 07/20/2022] [Indexed: 08/13/2024]
Abstract
Background Permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR) is relatively frequent, and its impact on outcomes during follow-up remains a matter of discussion. Previous meta-analyses have yielded conflicting results. Methods To compare late outcomes in patients after TAVR with and without PPI, PubMed/MEDLINE, Embase, and Google Scholar were searched for studies that reported rates of mortality/survival, rehospitalization for heart failure (HF), stroke, and/or endocarditis accompanied by at least 1 Kaplan-Meier curve for any of these outcomes. We adopted a 2-stage approach to reconstruct individual patient data on the basis of the published Kaplan-Meier graphs. Results Twenty-eight studies with Kaplan-Meier curves met our eligibility criteria and included a total of 50,282 patients (7232 who underwent PPI and 42,959 who did not undergo PPI). Patients who underwent PPI after TAVR had a significantly higher risk of mortality (hazard ratio [HR], 1.21; 95% CI, 1.14-1.28; P < .001) and HF-related rehospitalization (HR, 1.30; 95% CI, 1.17-1.45; P < .001) over time. We did not observe statistically significant differences in the incidence of stroke (HR, 1.07; 95% CI, 0.55-2.08; P = .849) and endocarditis (HR, 0.98; 95% CI, 0.61-1.57; P = .925) during follow-up. Conclusions Patients who undergo PPI after TAVR experience higher risk of mortality and HF-related rehospitalization over time. These findings provide support for the implementation of procedural strategies to prevent heart conduction disorder and, thus, avoid PPI at the time of TAVR.
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Affiliation(s)
- Michel Pompeu Sá
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania
| | - Xander Jacquemyn
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Tian Sun
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania
| | | | - Panagiotis Tasoudis
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania
| | - Ozgun Erten
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania
| | - Serge Sicouri
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania
| | - Gianluca Torregrossa
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania
| | - 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 Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania
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Zito A, Princi G, Lombardi M, D’Amario D, Vergallo R, Aurigemma C, Romagnoli E, Pelargonio G, Bruno P, Trani C, Burzotta F, Crea F. Long-term clinical impact of permanent pacemaker implantation in patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis. Europace 2022; 24:1127-1136. [PMID: 35138367 PMCID: PMC9460982 DOI: 10.1093/europace/euac008] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/27/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS The aims of this study is to assess by an updated meta-analysis the clinical outcomes related to permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) at long-term (≥12 months) follow-up (LTF). METHODS AND RESULTS A comprehensive literature research was performed on PubMed and EMBASE. The primary endpoint was all-cause death. Secondary endpoints were rehospitalization for heart failure, stroke, and myocardial infarction. A subgroup analysis was performed according to the Society of Thoracic Surgeon-Predicted Risk of Mortality (STS-PROM) score. This study is registered with PROSPERO (CRD42021243301). A total of 51 069 patients undergoing TAVI from 31 observational studies were included. The mean duration of follow-up was 22 months. At LTF, PPI post-TAVI was associated with a higher risk of all-cause death [risk ratio (RR) 1.18, 95% confidence interval (CI) 1.10-1.25; P < 0.001] and rehospitalization for heart failure (RR 1.32, 95% CI 1.13-1.52; P < 0.001). In contrast, the risks of stroke and myocardial infarction were not affected. Among the 20 studies that reported procedural risk, the association between PPI and all-cause death risk at LTF was statistically significant only in studies enrolling patients with high STS-PROM score (RR 1.25, 95% CI 1.12-1.40), although there was a similar tendency of the results in those at medium and low risk. CONCLUSION Patients necessitating PPI after TAVI have a higher long-term risk of all-cause death and rehospitalization for heart failure as compared to those who do not receive PPI.
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Affiliation(s)
- Andrea Zito
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy
| | - Giuseppe Princi
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy
| | - Marco Lombardi
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy
| | - Domenico D’Amario
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rocco Vergallo
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gemma Pelargonio
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piergiorgio Bruno
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Xu S, Zhang E, Qian Z, Sun J, Zou F, Wang Y, Hou X, Zou J. Mid- to Long-Term Clinical and Echocardiographic Effects of Post-procedural Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:911234. [PMID: 35837611 PMCID: PMC9275565 DOI: 10.3389/fcvm.2022.911234] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 05/30/2022] [Indexed: 01/14/2023] Open
Abstract
Aims To date, the prognostic effects of permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR) remain controversial. The purpose of this meta-analysis was to investigate the mid- (1 year) to long-term (> 1 year) clinical and echocardiographic effects of post-procedural PPI in patients after TAVR. Methods PubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched from the establishment of databases up to 1 December 2021. Studies comparing clinical and echocardiographic outcomes between patients with and without post-TAVR PPI of ≥ 1-year follow-up were collected for further meta-analysis. Results A total of 39 studies comprising of 83,082 patients were included in this meta-analysis. At mid-term follow-up (1 year), the pooled results demonstrated a higher risk of all-cause mortality in patients with post-procedural PPI than those without following TAVR (relative risk (RR), 1.17; 95% CI, 1.10–1.24; P < 0.00001). No significant differences were observed in cardiovascular mortality (RR, 0.86; 95% CI, 0.71–1.03; P = 0.10) or heart failure rehospitalization (RR, 0.91; 95% CI, 0.58–1.44; P = 0.69) at 1-year follow-up. At long-term follow-up (> 1 year), post-TAVR PPI had negative effects on all-cause mortality (RR, 1.18; 95% CI, 1.09–1.28; P < 0.0001) and heart failure rehospitalization (RR, 1.42; 95% CI, 1.18–1.71; P = 0.0002). There was no difference in long-term cardiovascular mortality between the two groups (RR, 1.15; 95% CI, 0.97–1.36; P = 0.11). Left ventricular ejection fraction (LVEF) was not significantly different at baseline (mean difference, 1.40; 95% CI, –0.13–2.93; P = 0.07), but was significantly lower in the PPI group at 1-year follow-up (mean difference, –3.57; 95% CI, –4.88 to –2.26; P < 0.00001). Conclusion Our meta-analysis provides evidence that post-TAVR PPI has negative clinical and echocardiographic effects on patients at mid- to long-term follow-up. Further studies are urgently needed to explore the cause of these complications and optimize the treatment and management of patients requiring permanent pacing after TAVR. Systematic Review Registration [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021289935], identifier [CRD42021289935].
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Affiliation(s)
- Shun Xu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Enrui Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhiyong Qian
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jinyu Sun
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fengwei Zou
- Montefiore Medical Center, Bronx, NY, United States
| | - Yao Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaofeng Hou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiangang Zou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Boonyakiatwattana W, Maneesai A, Chaithiraphan V, Jakrapanichakul D, Sakiyalak P, Chunhamaneewat N, Slisatkorn W, Chotinaiwattarakul C, Pongakasira R, Wongpraparut N. Preprocedural and procedural variables that predict new-onset conduction disturbances after transcatheter aortic valve replacement. BMC Cardiovasc Disord 2022; 22:135. [PMID: 35361124 PMCID: PMC8974214 DOI: 10.1186/s12872-022-02576-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 03/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background Conduction disturbances are a common complication after transcatheter aortic valve replacement (TAVR). The aim of this study was to investigate the preprocedural and procedural variables that predict new-onset conduction disturbances post-TAVR (hereafter CD/CDs). Methods Consecutive patients who underwent TAVR during December 2009–March 2021 at the Faculty of Medicine Siriraj Hospital, Mahidol University—Thailand’s largest national tertiary referral center—were enrolled. Patients with prior implantation of a cardiac device, periprocedural death, or unsuccessful procedure were excluded. Clinical and electrocardiographic data, preprocedural imaging, including membranous septum (MS) length, and procedural variables, including implantation depth (ID), were analyzed. CD was defined as new left or right bundle branch block, significant intraventricular conduction disturbance with QRS interval ≥ 120 ms, new high-grade atrioventricular block, or complete heart block. Multivariate binary logistic analysis and receiver operating characteristic (ROC) curve analysis were used to identify independent predictors and the optimal ∆MSID (difference between the MS length and ID) cutoff value, respectively. Results A total of 124 TAVR patients (mean age: 84.3 ± 6.3 years, 62.1% female) were included. The mean Society of Thoracic Surgeons score was 7.3%, and 85% of patients received a balloon expandable transcatheter heart valve. Thirty-five patients (28.2%) experienced a CD, and one-third of those required pacemaker implantation. The significant preprocedural and procedural factors identified from univariate analysis included intraventricular conduction delay, mitral annular calcification, MS length ≤ 6.43 mm, self-expanding device, small left ventricular cavity, and ID ≥ 6 mm. Multivariate analysis revealed MS length ≤ 6.43 mm (adjusted odds ratio [aOR] 9.54; 95% CI 2.56–35.47; p = 0.001) and ∆MSID < 0 mm (adjusted odds ratio [aOR] 10.77; 95% CI 2.86–40.62; p = < 0.001) to be independent predictors of CD. The optimal ∆MSID cutoff value for predicting conduction disturbances was less than 0 mm (area under the receiver operating characteristic curve [AuROC]: 0.896). Conclusion This study identified MS length ≤ 6.43 mm and ∆MSID < 0 mm as independent predictors of CDs. ∆MSID < 0 was the strongest and only modifiable predictor. Importantly, we expanded the CD criteria to cover all spectrum of TAVR-related conduction injury to lower the threshold of this sole modifiable risk. The optimal ∆MSID cutoff value was < 0 mm. Trial registration: TCTR, TCTR20210818002. Registered 17 August 2021—Retrospectively registered, http://www.thaiclinicaltrials.org/show/TCTR 20210818002.
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Affiliation(s)
- Wongsaput Boonyakiatwattana
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Adisak Maneesai
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Vithaya Chaithiraphan
- Faculty of Medicine Siriraj Hospital, Her Majesty's Cardiac Center, Mahidol University, Bangkok, Thailand
| | - Decho Jakrapanichakul
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Pranya Sakiyalak
- Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Narathip Chunhamaneewat
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Worawong Slisatkorn
- Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Rungtiwa Pongakasira
- Faculty of Medicine Siriraj Hospital, Her Majesty's Cardiac Center, Mahidol University, Bangkok, Thailand
| | - Nattawut Wongpraparut
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
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9
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Lee KH, Yagishita A, Ohno Y, Sakai T, Sakai K, Miyamoto J, Horinouchi H, Sakama S, Kamioka N, Murakami T, Ayabe K, Amino M, Yoshioka K, Ikari Y. Late-onset atrioventricular block after transcatheter aortic valve replacement. Heart Rhythm O2 2022; 2:607-613. [PMID: 34988505 PMCID: PMC8703188 DOI: 10.1016/j.hroo.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Conduction disturbances leading to permanent pacemaker implantation (PPI) rarely occur late after transcatheter aortic valve replacement (TAVR). The clinical features of this phenomenon and its association with periprocedural conduction disturbances remain uncertain. Objectives We aimed to determine the incidence and characteristics of late-onset atrioventricular block (AVB) after TAVR. Methods This single-center study included 246 patients undergoing TAVR. Late-onset AVB was defined as AVB ≥1 month after the TAVR. Results Periprocedural AVB (periAVB) occurred in 43 patients (17%). Patients with periAVB had a higher rate of right bundle branch block (47% vs 7%, P < .0001). Of the 43 patients with periAVB, 15 underwent PPI (35%) at a median duration of 6 days, whereas 1 of the remaining 203 patients without periAVB underwent PPI within 1 month (0.5%). During a median follow-up duration of 365 days, late-onset AVB occurred in 10 of 230 patients without PPI within 1 month (4%) at a median duration of 76 days. All 10 patients presented transient periprocedural atrioventricular conduction disturbances, including 8 patients with periAVB (80%), all of whom recovered within 1 month, and 9 patients underwent self-expanding valve implantation (90%). The mortality rate in patients with PPI within 1 month was higher than in those without, although the difference was not statistically significant (hazard ratio 2.68, 95% confidence interval 0.97–9.05, log-rank P = .09). Conclusion Late-onset AVB occurred in a minority of patients undergoing TAVR. Greater vigilance is warranted, particularly in patients with transient conduction disturbances during the periprocedural period following self-expanding valve implantation.
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Affiliation(s)
| | - Atsuhiko Yagishita
- Address reprint requests and correspondence: Dr Atsuhiko Yagishita, Department of Cardiology, Tokai University, Shimokasuya 143, Isehara, Kanagawa, Japan.
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10
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The incidence and predictors of high-degree atrioventricular block in patients with bicuspid aortic valve receiving self-expandable transcatheter aortic valve implantation. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2021; 18:825-835. [PMID: 34754294 PMCID: PMC8558740 DOI: 10.11909/j.issn.1671-5411.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The high-degree atrioventricular block (HAVB) in patients with bicuspid aortic valve (BAV) treated with transcatheter aortic valve implantation (TAVI) remains high. The study aims to explore this poorly understood subject of mechanisms and predictors for HAVB in BAV self-expandable TAVI patients. METHODS We retrospectively included 181 BAV patients for analysis. Using computed tomography data, the curvature of ascending aorta (AAo) was quantified by the angle (AAo angle) between annulus and the cross-section at 35 mm above annulus (where the stent interacts with AAo the most). The valvular anatomy and leaflet calcification were also characterized. RESULTS The 30-day HAVB rate was 16.0% (median time to HAVB was three days). Type-1 morphology was found in 79 patients (43.6%) (left- and right-coronary cusps fusion comprised 79.7%). Besides implantation below membrane septum, large AAo angle [odds ratio (OR) = 1.08, P = 0.016] and type-1 morphology (OR = 4.97, P = 0.001) were found as the independent predictors for HAVB. Together with baseline right bundle branch block, these predictors showed strong predictability for HAVB with area under the cure of 0.84 (sensitivity = 62.1%, specificity = 92.8%). Bent AAo and calcified raphe had a synergistic effect in facilitating high implantation, though the former is associated with at-risk deployment (device implanted above annulus + prothesis pop-out, versus straight AAo: 9.9% vs. 2.2%, P = 0.031).
CONCLUSIONS AAo curvature and type-1 morphology are novel predictors for HAVB in BAV patients following self-expandable TAVI. For patients with bent AAo or calcified raphe, a progressive approach to implant the device above the lower edge of membrane septum is favored, though should be done cautiously to avoid pop-out.
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11
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Hwang YM, Kim J, Nam GB, Choi KJ, Park DW, Kang DY, Park SJ, Park SY. Pacemaker dependency after transcatheter aortic valve replacement compared to surgical aortic valve replacement. Medicine (Baltimore) 2021; 100:e26123. [PMID: 34087862 PMCID: PMC8183801 DOI: 10.1097/md.0000000000026123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/10/2021] [Indexed: 01/04/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is a standard treatment indicated for severe aortic stenosis in high-risk patients. The objective of this study was to evaluate the incidence of pacemaker dependency after permanent pacemaker implantation (PPI) following TAVR or surgical aortic valve replacement (SAVR) and the risk of mortality at a tertiary center in Korea.In this retrospective study conducted at a single tertiary center, clinical outcomes related to pacemaker dependency were evaluated for patients implanted with pacemakers after TAVR from January 2012 to November 2018 and post-SAVR from January 2005 to May 2015. Investigators reviewed patients' electrocardiograms and baseline rhythms as well as conduction abnormalities. Pacemaker dependency was defined as a ventricular pacing rate > 90% with an intrinsic rate of <40 bpm during interrogation.Of 511 patients who underwent TAVR for severe AS, 37(7.3%) underwent PPI after a median duration of 6 (3-7) days, whereas pacemakers were implanted after a median interval of 13 (8-28) days post-SAVR in 10 of 663 patients (P < .001). Pacemaker dependency was observed in 36 (97.3%) patients during 7 days immediately post-TAVR and in 25 (64.9%) patients between 8 and 180 days post-TAVR. Pacemaker dependency occurred after 180 days in 17 (50%) patients with TAVR and in 4 (44.4%) patients with SAVR. Twelve (41.4%) patients were pacemaker-dependent after 365 days post-TAVR.Pacemaker dependency did not differ at 6 months after TAVR vs SAVR. In patients undergoing post-TAVR PPI, 58.6% were not pacemaker-dependent at 1 year after the TAVR procedure.
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Affiliation(s)
- You Mi Hwang
- Department of Cardiology, St. Vincent's Hospital, The Catholic University of Korea
| | | | | | | | | | | | | | - Seo Young Park
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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12
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Ravaux JM, Di Mauro M, Vernooy K, Van't Hof AW, Veenstra L, Kats S, Maessen JG, Lorusso R. One-year pacing dependency after pacemaker implantation in patients undergoing transcatheter aortic valve implantation: Systematic review and meta-analysis. JTCVS OPEN 2021; 6:41-55.e15. [PMID: 36003550 PMCID: PMC9390410 DOI: 10.1016/j.xjon.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/09/2021] [Indexed: 12/04/2022]
Abstract
Objectives Atrioventricular conductions disturbances, requiring permanent pacemaker implantation (PPI), represent a potential complication after transcatheter aortic valve implantation (TAVI), However, little is known about the pacemaker dependency after PPI in this patient setting. This systematic review analyses the incidence of PPI, the short-term (1-year) pacing dependency, and predictors for such a state after TAVI. Methods We performed a systematic search in PUBMED, EMBASE, and MEDLINE to identify potentially relevant literature investigating PPI requirement and dependency after TAVI. Study data, patients, and procedural characteristics were extracted. Odds ratio (OR) with 95% confidence intervals were extracted. Results Data from 23 studies were obtained that included 18,610 patients. The crude incidence of PPI after TAVI was 17% (range, 8.8%-32%). PPI occurred at a median time of 3.2 days (range, 0-30 days). Pacing dependency at 1-year was 47.5% (range, 7%-89%). Self-expandable prosthesis (pooled OR was 2.14 [1.15-3.96]) and baseline right bundle branch block (pooled OR was 2.01 [1.06-3.83]) showed 2-fold greater risk to maintain PPI dependency at 1 year after TAVI. Conclusions Although PPI represents a rather frequent event after TAVI, conduction disorders have a temporary nature in almost 50% of the cases with recovery and stabilization after discharge. Preoperative conduction abnormality and type of TAVI are associated with higher PPI dependency at short term.
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Affiliation(s)
- Justine M. Ravaux
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Address for reprints: Justine M. Ravaux, MD, Department of Cardio-Thoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC+), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands.
| | - Michele Di Mauro
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Department of Cardiology, Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands
| | - Arnoud W. Van't Hof
- Department of Cardiology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Leo Veenstra
- Department of Cardiology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Suzanne Kats
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Jos G. Maessen
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
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13
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Nai Fovino L, Cipriani A, Fabris T, Massussi M, Scotti A, Lorenzoni G, Guerra MC, Cardaioli F, Rodinò G, Matsuda Y, Masiero G, Leoni L, Zorzi A, Fraccaro C, Tarantini G. Anatomical Predictors of Pacemaker Dependency After Transcatheter Aortic Valve Replacement. Circ Arrhythm Electrophysiol 2020; 14:e009028. [PMID: 33306415 DOI: 10.1161/circep.120.009028] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Conduction disturbances after transcatheter aortic valve replacement (TAVR) are often transient. Limited data exist on anatomic factors predisposing to pacemaker dependency after TAVR. We sought to assess the rate and the possible predictors of pacemaker dependency after TAVR. METHODS Consecutive patients undergoing pacemaker implantation up to 30 days after TAVR between May 2014 and September 2019 were included. Baseline electrocardiographic, computed tomography, and procedural characteristics were collected, including valve implantation depth and membranous septum length, an anatomic surrogate of the distance between the aortic annulus and the His bundle. Pacemaker dependency at 30 days and 1 year and all-cause mortality during follow-up were evaluated. RESULTS Of 728 TAVR patients, 112 (53.5% men; median age, 81 years) underwent pacemaker implantation after TAVR. Of these, 44.6% (50 of 112) were pacemaker dependent at 30 days and 46.7% (36 of 77) at 1 year. By multivariate analysis, independent predictors of 30-day pacemaker dependency included left ventricular outflow tract calcifications under the left coronary cusp (odds ratio, 5.69 [95% CI, 1.45-22.31]; P=0.013) and a difference between membranous septum length and implantation depth (ΔMSID) ≥3 mm (odds ratio, 7.58 [95% CI, 2.07-27.78]; P=0.002). Conversely, membranous septum length and implantation depth alone were not associated with pacemaker dependency (odds ratio, 0.79 [95% CI, 0.60-1.05]; P=0.11 and odds ratio, 1.11 [95% CI, 0.99-1.24]; P=0.08). At a median follow-up of 28.1 (11.7-48.6) months, pacemaker-dependent patients did not show a worse survival (P=0.26). CONCLUSIONS Less than half of the patients undergoing pacemaker implantation after TAVR are pacemaker-dependent at midterm follow-up. ΔMSID ≥3 mm and the presence of left ventricular outflow tract calcifications under the left coronary cusp, but not membranous septum length nor implantation depth alone, are predictive of long-term pacemaker dependency after TAVR, thus influencing device selection and programming.
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Affiliation(s)
- Luca Nai Fovino
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Tommaso Fabris
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Mauro Massussi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Andrea Scotti
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Giulia Lorenzoni
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Maria Chiara Guerra
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Francesco Cardaioli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Giulio Rodinò
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Yuji Matsuda
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Giulia Masiero
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Loira Leoni
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
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14
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Hochstadt A, Merdler I, Meridor Y, Schwartz AL, Ingbir M, Ghantous E, Havakuk O, Mazo A, Steinvil A, Finkelstein A, Viskin S, Rosso R. Effect of pacemaker implantation after transcatheter aortic valve replacement on long- and mid-term mortality. Heart Rhythm 2020; 18:199-206. [PMID: 33091603 DOI: 10.1016/j.hrthm.2020.10.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/06/2020] [Accepted: 10/12/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has become quite common. Atrioventricular conduction defects remain a frequent complication resulting with permanent pacemaker (PPM) implantation. Past studies showed conflicting results regarding PPM effect on mortality. OBJECTIVE The purpose of this study was to assess the influence of PPM implantation on mid- and long-term mortality in a large cohort of patients who underwent TAVR. METHODS Patients undergoing TAVR between 2009 and 2019 were categorized into groups: no PPM implanted (no-PPM), PPM implanted before the procedure (pre-PPM), and PPM implanted postprocedure (post-PPM). All-cause mortality up to 6 years was compared. Subanalyses were performed according to pacing burden. Proportion of patients who had decreased left ventricular ejection fraction within 1 year of the procedure after TAVR was also recorded. RESULTS A total of 1489 patients were followed. Unadjusted mortality was similar for patients regardless of PPM status within 12 months (P > .187), yet within 72 months, mortality was similar for the post-PPM (P = .257) and higher for pre-PPM (hazard ratio 1.53; P = .002) groups. Analysis adjusted by clinical characteristics did not show any independent long- or mid-term survival effects of PPM (P > .563). Analysis according to pacing burden showed no significant mortality difference (P > .8). Analysis of post-PPM patients with "high" or "near constant" (>40%) pacing burden vs no-PPM patients showed similar mortality for both mid- and long-term mortality (P = .055 and P = .513). Left ventricular ejection fraction decrease within 1 year was more common in both PPM groups, with a higher proportion with higher pacing burden (P < .001). CONCLUSION This cohort of consecutive patients undergoing TAVR showed that postprocedure PPM was not associated with increased long-term mortality. This conclusion was not altered by ventricular pacing burden.
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Affiliation(s)
- Aviram Hochstadt
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ilan Merdler
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Meridor
- Department of Internal Medicine J, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arie L Schwartz
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Merav Ingbir
- Department of Internal Medicine J, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eihab Ghantous
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Havakuk
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anna Mazo
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arie Steinvil
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Finkelstein
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sami Viskin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raphael Rosso
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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15
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Mas-Peiro S, Fichtlscherer S, Walther C, Vasa-Nicotera M. Current issues in transcatheter aortic valve replacement. J Thorac Dis 2020; 12:1665-1680. [PMID: 32395310 PMCID: PMC7212163 DOI: 10.21037/jtd.2020.01.10] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aortic stenosis is the most common valvular disease worldwide. With transcatheter aortic valve replacement (TAVR) being increasingly expanded to lower-risk populations, several challenging issues remain to be solved. The present review aims at discussing modern approaches to such issues as well as the current status of TAVR. TAVR has undergone several developments in the recent years: an increased use of transfemoral access, the development of prostheses in order to adapt to challenging anatomies, improved delivery systems with repositioning features, and outer skirts aiming at reducing paravalvular leak. The indication of TAVR is increasingly being expanded to patients with lower surgical risk. The main clinical trials supporting such expansion are reviewed and the latest data on low-risk patients are discussed. A number of challenges need still to be addressed and are also reviewed in this paper: the need for updated international guidelines including the latest evidence; a reduction of main complications such as permanent pacemaker implantation, paravalvular leak, and stroke (and its potential prevention by using anti-embolic protection devices); the appropriate role of TAVR in patients with concomitant cardiac ischemic disease; and durability of bio-prosthetic implanted valves. Finally, the future perspectives for TAVR use and next device developments are discussed.
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Affiliation(s)
- Silvia Mas-Peiro
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Stephan Fichtlscherer
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Claudia Walther
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Mariuca Vasa-Nicotera
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
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16
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Alperi Garcia A, Muntané-Carol G, Junquera L, del Val D, Faroux L, Philippon F, Rodés-Cabau J. Can we reduce conduction disturbances following transcatheter aortic valve replacement? Expert Rev Med Devices 2020; 17:309-322. [DOI: 10.1080/17434440.2020.1741349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
| | | | - Lucia Junquera
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - David del Val
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - Laurent Faroux
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - François Philippon
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
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17
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Faroux L, Chen S, Muntané-Carol G, Regueiro A, Philippon F, Sondergaard L, Jørgensen TH, Lopez-Aguilera J, Kodali S, Leon M, Nazif T, Rodés-Cabau J. Clinical impact of conduction disturbances in transcatheter aortic valve replacement recipients: a systematic review and meta-analysis. Eur Heart J 2020; 41:2771-2781. [DOI: 10.1093/eurheartj/ehz924] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/26/2019] [Accepted: 12/11/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
The clinical impact of new-onset persistent left bundle branch block (NOP-LBBB) and permanent pacemaker implantation (PPI) on transcatheter aortic valve replacement (TAVR) recipients remains controversial. We aimed to evaluate the impact of (i) periprocedural NOP-LBBB and PPI post-TAVR on 1-year all-cause death, cardiac death, and heart failure hospitalization and (ii) NOP-LBBB on the need for PPI at 1-year follow-up.
Methods and results
We performed a systematic search from PubMed and EMBASE databases for studies reporting raw data on 1-year clinical impact of NOP-LBBB or periprocedural PPI post-TAVR. Data from 30 studies, including 7792 patients (12 studies) and 42 927 patients (21 studies) for the evaluation of the impact of NOP-LBBB and PPI after TAVR were sourced, respectively. NOP-LBBB was associated with an increased risk of all-cause death [risk ratio (RR) 1.32, 95% confidence interval (CI) 1.17–1.49; P < 0.001], cardiac death (RR 1.46, 95% CI 1.20–1.78; P < 0.001), heart failure hospitalization (RR 1.35, 95% CI 1.05–1.72; P = 0.02), and PPI (RR 1.89, 95% CI 1.58–2.27; P < 0.001) at 1-year follow-up. Periprocedural PPI after TAVR was associated with a higher risk of all-cause death (RR 1.17, 95% CI 1.11–1.25; P < 0.001) and heart failure hospitalization (RR 1.18, 95% CI 1.03–1.36; P = 0.02). Permanent pacemaker implantation was not associated with an increased risk of cardiac death (RR 0.84, 95% CI 0.67–1.05; P = 0.13).
Conclusion
NOP-LBBB and PPI after TAVR are associated with an increased risk of all-cause death and heart failure hospitalization at 1-year follow-up. Periprocedural NOP-LBBB also increased the risk of cardiac death and PPI within the year following the procedure. Further studies are urgently warranted to enhance preventive measures and optimize the management of conduction disturbances post-TAVR.
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Affiliation(s)
- Laurent Faroux
- Quebec Heart and Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Quebec G1V4G5, Canada
| | - Shmuel Chen
- Columbia University Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, New York, NY 10032, USA
| | - Guillem Muntané-Carol
- Quebec Heart and Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Quebec G1V4G5, Canada
| | - Ander Regueiro
- Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Carrer de Villaroel, 170, 08036 Barcelona, Spain
| | - Francois Philippon
- Quebec Heart and Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Quebec G1V4G5, Canada
| | - Lars Sondergaard
- Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Troels H Jørgensen
- Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - José Lopez-Aguilera
- Hospital Reina Sofia of Cordoba, Avenida Menendez Pidal, 14004 Cordoba, Spain
| | - Susheel Kodali
- Columbia University Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, New York, NY 10032, USA
| | - Martin Leon
- Columbia University Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, New York, NY 10032, USA
| | - Tamim Nazif
- Columbia University Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, New York, NY 10032, USA
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Quebec G1V4G5, Canada
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Tian Y, Padmanabhan D, McLeod CJ, Zhang P, Xiao P, Sandhu GS, Greason KL, Gulati R, Nkomo VT, Rihal CS, Polk LE, Sanvick C, Liu XP, Friedman PA, Cha YM. Utility of 30-Day Continuous Ambulatory Monitoring to Identify Patients With Delayed Occurrence of Atrioventricular Block After Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2019; 12:e007635. [DOI: 10.1161/circinterventions.118.007635] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Mechanical injury in the conduction system requiring permanent pacemaker (PPM) associated with transcatheter aortic valve replacement (TAVR) procedure is a common complication. The objective of this study was to use ambulatory monitor BodyGuardian to assess late occurrence of atrioventricular block (AVB) after TAVR.
Methods:
This prospective study evaluated 365 patients who underwent TAVR at Mayo Clinic, Rochester, Minnesota between June 2016 and August 2017. Patients who received PPM for bradycardia after TAVR before discharge were considered as the PPM group. Those not requiring PPM received a BodyGuardian system (BodyGuardian group) for 30 days of continuous monitoring. Primary end point was Mobitz II or third-degree atrioventricular block (II/III AVB) at 30-day follow-up.
Results:
Of 365 patients, 74 who had a PPM or an implantable cardioverter-defibrillator before TAVR and 94 who were enrolled in other studies were excluded. Of 197 patients enrolled in the study, 70 (35.5%) received PPM and 127 had BodyGuardian before the hospital dismissal. Eleven of 127 (8.6%) BodyGuardian group required PPM within 30 days after TAVR for late occurrence of symptomatic bradycardia. In total, 33 of 197 (16.7%) patients developed II/III AVB (24 before and 9 after discharge). Thirty-four patients had preexisting right bundle branch block. Of them, 16 (47%) developed II/III AVB. Of 53 patients who developed new left bundle branch block after TAVR, 14% progressed to II/III AVB within 30 days.
Conclusions:
In patients without a standard post-TAVR pacing indication, yet a potential risk to develop AVB, a strategy of 30-day monitoring identifies additional patients who require permanent pacing.
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Affiliation(s)
- Ying Tian
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
- Department of Cardiovascular Diseases, Beijing Chaoyang Hospital, China (Y.T., X.-P.L.)
| | - Deepak Padmanabhan
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
| | | | - Pei Zhang
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
| | - Peilin Xiao
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
| | - Gurpreet S. Sandhu
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
| | - Kevin L. Greason
- Department of Cardiovascular Surgery (K.L.G.), Mayo Clinic, Rochester, MN
| | - Rajiv Gulati
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
| | - Vuyisile T. Nkomo
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
| | - Charanjit S. Rihal
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
| | - Lynn E. Polk
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
| | - Carrie Sanvick
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
| | - Xing-Peng Liu
- Department of Cardiovascular Diseases, Beijing Chaoyang Hospital, China (Y.T., X.-P.L.)
| | - Paul A. Friedman
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
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19
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Xi Z, Liu T, Liang J, Zhou YJ, Liu W. Impact of postprocedural permanent pacemaker implantation on clinical outcomes after transcatheter aortic valve replacement: a systematic review and meta-analysis. J Thorac Dis 2019; 11:5130-5139. [PMID: 32030230 DOI: 10.21037/jtd.2019.12.02] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background The incidence of conduction disturbances requiring permanent pacemaker (PPM) implantation following transcatheter aortic valve replacement (TAVR) have remained a common concern. The purpose of this study was to evaluate the impact of postprocedural PPM implantation following TAVR on clinical outcomes. Methods We performed a systematic search in PubMed and EMBASE databases for studies that reported raw data on clinical outcomes of patients with and without PPM implantation after TAVR and followed up patients for 10 months or longer. The primary endpoint was all-cause death. The secondary endpoints were cardiovascular death, heart failure and a composite of stroke and myocardial infarction (MI). Results Data from 20 studies with a total of 21,666 patients undergoing TAVR, of whom 12.5% required PPM implantation after intervention, were analysed and the mean duration follow-up was 16.9 months. The rate of PPM ranged from 6.2% to 32.8% among different studies. A total of 6,753 (31.2%) patients underwent TAVR with self-expandable prosthesis and 14,913 (68.8%) with balloon-expandable prosthesis. The incidence of postprocedural PPM implantation was higher with the self-expandable prosthesis (n=1,717, 25.4%) compared with the balloon-expandable prosthesis (n=996, 6.7%). PPM after TAVR was associated with a higher risk of all-cause death (RR: 1.13; 95% CI: 1.01-1.25; P=0.03) but not incidence of stroke and MI (RR: 0.85; 95% CI: 0.64-1.13; P=0.27). Conclusions In patients undergoing TAVR, the PPM implantation after intervention was associated higher all-cause mortality but not cardiovascular mortality, heart failure and stroke or MI, which remain an unsolved issue of TAVR.
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Affiliation(s)
- Ziwei Xi
- Department of Cardiology, Beijing Anzhen hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Tong Liu
- Department of Cardiology, Beijing Anzhen hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Jing Liang
- Department of Cardiology, Beijing Anzhen hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Yu-Jie Zhou
- Department of Cardiology, Beijing Anzhen hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Wei Liu
- Department of Cardiology, Beijing Anzhen hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
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20
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Meduri CU, Kereiakes DJ, Rajagopal V, Makkar RR, O'Hair D, Linke A, Waksman R, Babliaros V, Stoler RC, Mishkel GJ, Rizik DG, Iyer VS, Schindler J, Allocco DJ, Meredith IT, Feldman TE, Reardon MJ. Pacemaker Implantation and Dependency After Transcatheter Aortic Valve Replacement in the REPRISE III Trial. J Am Heart Assoc 2019; 8:e012594. [PMID: 31640455 PMCID: PMC6898843 DOI: 10.1161/jaha.119.012594] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background As transcatheter aortic valve replacement expands to younger and/or lower risk patients, the long‐term consequences of permanent pacemaker implantation are a concern. Pacemaker dependency and impact have not been methodically assessed in transcatheter aortic valve replacement trials. We report the incidence and predictors of pacemaker implantation and pacemaker dependency after transcatheter aortic valve replacement with the Lotus valve. Methods and Results A total of 912 patients with high/extreme surgical risk and symptomatic aortic stenosis were randomized 2:1 (Lotus:CoreValve) in REPRISE III (The Repositionable Percutaneous Replacement of Stenotic Aortic Valve through Implantation of Lotus Valve System—Randomized Clinical Evaluation) trial. Systematic assessment of pacemaker dependency was pre‐specified in the trial design. Pacemaker implantation within 30 days was more frequent with Lotus than CoreValve. By multivariable analysis, predictors of pacemaker implantation included baseline right bundle branch block and depth of implantation; diabetes mellitus was also a predictor with Lotus. No association between new pacemaker implantation and clinical outcomes was found. Pacemaker dependency was dynamic (30 days: 43%; 1 year: 50%) and not consistent for individual patients over time. Predictors of pacemaker dependency at 30 days included baseline right bundle branch block, female sex, and depth of implantation. No differences in mortality or stroke were found between patients who were pacemaker dependent or not at 30 days. Rehospitalization was higher in patients who were not pacemaker dependent versus patients without a pacemaker or those who were dependent. Conclusions Pacemaker implantation was not associated with adverse clinical outcomes. Most patients with a new pacemaker at 30 days were not dependent at 1 year. Mortality and stroke were similar between patients with or without pacemaker dependency and patients without a pacemaker. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier NCT02202434.
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Affiliation(s)
| | - Dean J Kereiakes
- The Christ Hospital Heart and Vascular Center The Lindner Research Center Cincinnati OH
| | | | | | | | - Axel Linke
- Dresden University Hospital, Heart Center Dresden Germany
| | | | | | | | | | - David G Rizik
- HonorHealth and the Scottsdale-Lincoln Health Network Scottsdale AZ
| | - Vijay S Iyer
- University at Buffalo/Gates Vascular Institute Buffalo NY
| | | | | | | | - Ted E Feldman
- Edwards Lifesciences Irvine California.,Northshore University Health System Evanston Hospital Evanston Illinois
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21
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Witberg G, Patterson T, Redwood S, Prendergast B. Perspectivas futuras. Implante percutáneo de válvula aórtica para pacientes en bajo riesgo: ¿una realidad a corto plazo o se debe esperar? Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2019.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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22
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Russo E, Potenza DR, Casella M, Massaro R, Russo G, Braccio M, Dello Russo A, Cassese M. Rate and Predictors of Permanent Pacemaker Implantation After Transcatheter Aortic Valve Implantation: Current Status. Curr Cardiol Rev 2019; 15:205-218. [PMID: 30516109 PMCID: PMC6719385 DOI: 10.2174/1573403x15666181205105821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 11/15/2018] [Accepted: 11/27/2018] [Indexed: 11/22/2022] Open
Abstract
Transcather aortic valve implantation (TAVI) has become a safe and indispensable treatment option for patients with severe symptomatic aortic stenosis who are at high surgical risk. Recently, outcomes after TAVI have improved significantly and TAVI has emerged as a qualified alternative to surgical aortic valve replacement in the treatment of intermediate risk patients and greater adoption of this procedure is to be expected in a wider patients population, including younger patients and low surgical risk patients. However since the aortic valve has close spatial proximity to the conduction system, conduction anomalies are frequently observed in TAVI. In this article, we aim to review the key aspects of pathophysiology, current incidence, predictors and clinical association of conduction anomalies following TAVI.
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Affiliation(s)
- Eleonora Russo
- Department of Cardiovascular Disease, Division of Cardiac Surgery, Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy.,Department of Cardiovascular Disease, Division of Cardiology, Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - Domenico R Potenza
- Department of Cardiovascular Disease, Division of Cardiology, Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - Michela Casella
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Raimondo Massaro
- Department of Cardiovascular Disease, Division of Cardiology, Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - Giulio Russo
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Maurizio Braccio
- Department of Cardiovascular Disease, Division of Cardiac Surgery, Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - Antonio Dello Russo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Mauro Cassese
- Department of Cardiovascular Disease, Division of Cardiac Surgery, Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
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23
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Witberg G, Patterson T, Redwood S, Prendergast B. Future Directions. Transcatheter Aortic Valve Implantation for Low-risk Patients: Inevitable Evolution or a Step Too Far? ACTA ACUST UNITED AC 2019; 72:664-671. [PMID: 30930254 DOI: 10.1016/j.rec.2019.02.009] [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: 01/18/2019] [Accepted: 02/15/2019] [Indexed: 11/29/2022]
Abstract
Transcatheter aortic valve replacement has become the treatment of choice for inoperable and high-risk patients with symptomatic aortic stenosis, and is becoming more and more common as the first choice for intermediate-risk patients as well. The next step in this evolution would be the expansion of treatment indications to low-risk patients. Successful treatment of this patient population will require setting new standards in terms of clinical outcomes and cost effectiveness. In this review, we present the main challenges that need to be addressed before transcatheter aortic valve replacement can be applied as a standard treatment for low-risk patients.
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Affiliation(s)
- Guy Witberg
- Department of Cardiology, St Thomas' Hospital, London, United Kingdom.
| | - Tiffany Patterson
- Department of Cardiology, St Thomas' Hospital, London, United Kingdom
| | - Simon Redwood
- Department of Cardiology, St Thomas' Hospital, London, United Kingdom
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24
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Ueshima D, Nai Fovino L, Mojoli M, Napodano M, Fraccaro C, Tarantini G. The interplay between permanent pacemaker implantation and mortality in patients treated by transcatheter aortic valve implantation: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2018; 92:E159-E167. [DOI: 10.1002/ccd.27681] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 04/23/2018] [Accepted: 05/15/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Daisuke Ueshima
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences; University of Padua Medical School; Padua Italy
| | - Luca Nai Fovino
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences; University of Padua Medical School; Padua Italy
| | - Marco Mojoli
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences; University of Padua Medical School; Padua Italy
| | - Massimo Napodano
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences; University of Padua Medical School; Padua Italy
| | - Chiara Fraccaro
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences; University of Padua Medical School; Padua Italy
| | - Giuseppe Tarantini
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences; University of Padua Medical School; Padua Italy
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25
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Mohananey D, Jobanputra Y, Kumar A, Krishnaswamy A, Mick S, White JM, Kapadia SR. Clinical and Echocardiographic Outcomes Following Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: Meta-Analysis and Meta-Regression. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.117.005046. [PMID: 28698290 DOI: 10.1161/circinterventions.117.005046] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 05/15/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Transcatheter aortic valve replacement has become the procedure of choice for inoperable, high-risk, and many intermediate-risk patients with aortic stenosis. Conduction abnormalities are a common finding after transcatheter aortic valve replacement and often result in permanent pacemaker (PPM) implantation. Data pertaining to the clinical impact of PPM implantation are controversial. We used meta-analysis techniques to summarize the effect of PPM implantation on clinical and echocardiographic outcomes after transcatheter aortic valve replacement. METHODS AND RESULTS Data were summarized as Mantel-Haenszel relative risk (RR) and 95% confidence intervals (CIs) for dichotomous variables and as standardized mean difference and 95% CI for continuous variables We used the Higgins I2 statistic to evaluate heterogeneity. We found that patients with and without PPM have similar all-cause mortality (RR, 0.85; 95% CI, 0.70-1.03), cardiovascular mortality (RR, 0.84; 95% CI, 0.59-1.18), myocardial infarction (RR, 0.47; 95% CI, 0.20-1.11), and stroke (RR, 1.26; 95% CI, 0.70-2.26) at 30 days. The groups were also comparable in all-cause mortality (RR, 1.03; 95% CI, 0.92-1.16), cardiovascular mortality (RR, 0.69; 95% CI, 0.39-1.24), myocardial infarction (RR, 0.58; 95% CI, 0.30-1.13), and stroke (RR, 0.70; 95% CI, 0.47-1.04) at 1 year. We observed that the improvement in left ventricular ejection fraction was significantly greater in the patients without PPM (standardized mean difference, 0.22; 95% CI, 0.12-0.32). CONCLUSIONS PPM implantation is not associated with increased risk of all-cause mortality, cardiovascular mortality, stroke, or myocardial infarction both at short- and long-term follow-up. However, PPM is associated with impaired left ventricular ejection fraction recovery post-transcatheter aortic valve replacement.
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Affiliation(s)
- Divyanshu Mohananey
- From the Department of Hospital Medicine (D.M., A.K.), Department of Cardiovascular Medicine (Y.J., A.K., J.M.W., S.R.K.), and Department of Cadiothoracic Surgery (S.M.), Cleveland Clinic, OH.
| | - Yash Jobanputra
- From the Department of Hospital Medicine (D.M., A.K.), Department of Cardiovascular Medicine (Y.J., A.K., J.M.W., S.R.K.), and Department of Cadiothoracic Surgery (S.M.), Cleveland Clinic, OH
| | - Arnav Kumar
- From the Department of Hospital Medicine (D.M., A.K.), Department of Cardiovascular Medicine (Y.J., A.K., J.M.W., S.R.K.), and Department of Cadiothoracic Surgery (S.M.), Cleveland Clinic, OH
| | - Amar Krishnaswamy
- From the Department of Hospital Medicine (D.M., A.K.), Department of Cardiovascular Medicine (Y.J., A.K., J.M.W., S.R.K.), and Department of Cadiothoracic Surgery (S.M.), Cleveland Clinic, OH
| | - Stephanie Mick
- From the Department of Hospital Medicine (D.M., A.K.), Department of Cardiovascular Medicine (Y.J., A.K., J.M.W., S.R.K.), and Department of Cadiothoracic Surgery (S.M.), Cleveland Clinic, OH
| | - Jonathon M White
- From the Department of Hospital Medicine (D.M., A.K.), Department of Cardiovascular Medicine (Y.J., A.K., J.M.W., S.R.K.), and Department of Cadiothoracic Surgery (S.M.), Cleveland Clinic, OH
| | - Samir R Kapadia
- From the Department of Hospital Medicine (D.M., A.K.), Department of Cardiovascular Medicine (Y.J., A.K., J.M.W., S.R.K.), and Department of Cadiothoracic Surgery (S.M.), Cleveland Clinic, OH
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26
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Conduction abnormalities after transcatheter aortic valve implantation. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2018; 15:105-112. [PMID: 29434632 PMCID: PMC5803544 DOI: 10.11909/j.issn.1671-5411.2018.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In the last few years, transcatheter aortic valve implantation (TAVI) has become an alternative procedure in patients with severe aortic stenosis and high risk for surgical aortic replacement. Due to the anatomic correlation between aortic valve structure and conduction system of the heart, one of the most common complications after TAVI is conduction system disturbances which including bundle branch block, complete heart block and need for permanent pacemaker implantation. Although these disturbances are usually not lethal, they may have a great influence on patients' state and long term-survival. Several risk factors for conduction disturbances have been identified which including age, anatomy of the heart, periprocedural factors, type of implanted valve, preexisting abnormalities and comorbidities. As this technique becomes more familiar to physicians, patients should be carefully screened for risk factors for the development of conduction abnormalities after TAVI in order to provide effective prevention and proper treatment.
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27
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Dimitriadis Z, Scholtz S, Scholtz W, Wiemer M, Piper C, Ensminger S, Fox H, Horstkotte D, Faber L. Impact of procedure-related conduction disturbances after transcatheter aortic valve implantation on myocardial performance and survival evaluated by conventional and speckle tracking echocardiography. Echocardiography 2018; 35:621-631. [PMID: 29437242 DOI: 10.1111/echo.13823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Although procedure-related new cardiac conduction disturbances (CCDs) remain an important issue in transcatheter aortic valve implantation (TAVI), their effect on myocardial function and overall patient outcome remains unclear. The goal of this study was to analyze the influence of procedure-related CCDs on systolic and diastolic LV performance and on patient survival after TAVI. METHODS AND RESULTS Ninety-five patients who underwent TAVI for severe symptomatic aortic stenosis (AS) and had a complete follow-up were evaluated with respect to procedure-related CCDs. Left ventricular (LV) performance was measured using standard echocardiographic parameters and speckle tracking analysis. Survival was assessed during longer-term follow-up (mean: 29.1 ± 16.9 months). After TAVI, the improvement of global LV function expressed as ejection fraction (LVEF; from 45.5 ± 10.0 to 47.8 ± 13.9%, P = .13) was not significant. New CCDs were found in 35.7% of TAVI recipients. A comparison between patients with and without new CCDs showed that LV systolic function improved in those without CCDs, while it tended to deteriorate in patients with CCDs (change in LVEF: 5.5 ± 12.3% vs -4.9% ± 11.5%, P = .001; change in global longitudinal strain (GLS): -1.1 ± 4.6% vs 1.2 ± 4.5%, P = .01). Changes in diastolic function did not differ significantly between the groups (changes in transmitral E/A-ratio: -0.3 ± 0.6 vs -0.5 ± 0.5, P = .1). Kaplan-Meier survival analysis revealed no significant differences between the two cohorts (P = .795). CONCLUSION Procedure-related conduction abnormalities after TAVI lead to an LBBB-related dyssynchrony with impairment of LV performance but not of overall survival.
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Affiliation(s)
- Zisis Dimitriadis
- Clinic for Cardiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Smita Scholtz
- Clinic for Cardiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Werner Scholtz
- Clinic for Cardiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Marcus Wiemer
- Clinic for Cardiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Cornelia Piper
- Clinic for Cardiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Stephan Ensminger
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Henrik Fox
- Clinic for Cardiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Dieter Horstkotte
- Clinic for Cardiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Lothar Faber
- Clinic for Cardiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
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Rocatello G, El Faquir N, De Santis G, Iannaccone F, Bosmans J, De Backer O, Sondergaard L, Segers P, De Beule M, de Jaegere P, Mortier P. Patient-Specific Computer Simulation to Elucidate the Role of Contact Pressure in the Development of New Conduction Abnormalities After Catheter-Based Implantation of a Self-Expanding Aortic Valve. Circ Cardiovasc Interv 2018; 11:e005344. [DOI: 10.1161/circinterventions.117.005344] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 12/18/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Giorgia Rocatello
- From the IBiTech-bioMMeda, Ghent University, Belgium (G.R., P.S., M.D.B.); Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands (N.E.F., P.d.J.); FEops NV, Ghent, Belgium (G.D.S., F.I., M.D.B., P.M.); University Hospital Antwerp, Belgium (J.B.); and Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (O.D.B., L.S.)
| | - Nahid El Faquir
- From the IBiTech-bioMMeda, Ghent University, Belgium (G.R., P.S., M.D.B.); Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands (N.E.F., P.d.J.); FEops NV, Ghent, Belgium (G.D.S., F.I., M.D.B., P.M.); University Hospital Antwerp, Belgium (J.B.); and Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (O.D.B., L.S.)
| | - Gianluca De Santis
- From the IBiTech-bioMMeda, Ghent University, Belgium (G.R., P.S., M.D.B.); Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands (N.E.F., P.d.J.); FEops NV, Ghent, Belgium (G.D.S., F.I., M.D.B., P.M.); University Hospital Antwerp, Belgium (J.B.); and Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (O.D.B., L.S.)
| | - Francesco Iannaccone
- From the IBiTech-bioMMeda, Ghent University, Belgium (G.R., P.S., M.D.B.); Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands (N.E.F., P.d.J.); FEops NV, Ghent, Belgium (G.D.S., F.I., M.D.B., P.M.); University Hospital Antwerp, Belgium (J.B.); and Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (O.D.B., L.S.)
| | - Johan Bosmans
- From the IBiTech-bioMMeda, Ghent University, Belgium (G.R., P.S., M.D.B.); Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands (N.E.F., P.d.J.); FEops NV, Ghent, Belgium (G.D.S., F.I., M.D.B., P.M.); University Hospital Antwerp, Belgium (J.B.); and Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (O.D.B., L.S.)
| | - Ole De Backer
- From the IBiTech-bioMMeda, Ghent University, Belgium (G.R., P.S., M.D.B.); Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands (N.E.F., P.d.J.); FEops NV, Ghent, Belgium (G.D.S., F.I., M.D.B., P.M.); University Hospital Antwerp, Belgium (J.B.); and Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (O.D.B., L.S.)
| | - Lars Sondergaard
- From the IBiTech-bioMMeda, Ghent University, Belgium (G.R., P.S., M.D.B.); Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands (N.E.F., P.d.J.); FEops NV, Ghent, Belgium (G.D.S., F.I., M.D.B., P.M.); University Hospital Antwerp, Belgium (J.B.); and Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (O.D.B., L.S.)
| | - Patrick Segers
- From the IBiTech-bioMMeda, Ghent University, Belgium (G.R., P.S., M.D.B.); Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands (N.E.F., P.d.J.); FEops NV, Ghent, Belgium (G.D.S., F.I., M.D.B., P.M.); University Hospital Antwerp, Belgium (J.B.); and Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (O.D.B., L.S.)
| | - Matthieu De Beule
- From the IBiTech-bioMMeda, Ghent University, Belgium (G.R., P.S., M.D.B.); Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands (N.E.F., P.d.J.); FEops NV, Ghent, Belgium (G.D.S., F.I., M.D.B., P.M.); University Hospital Antwerp, Belgium (J.B.); and Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (O.D.B., L.S.)
| | - Peter de Jaegere
- From the IBiTech-bioMMeda, Ghent University, Belgium (G.R., P.S., M.D.B.); Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands (N.E.F., P.d.J.); FEops NV, Ghent, Belgium (G.D.S., F.I., M.D.B., P.M.); University Hospital Antwerp, Belgium (J.B.); and Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (O.D.B., L.S.)
| | - Peter Mortier
- From the IBiTech-bioMMeda, Ghent University, Belgium (G.R., P.S., M.D.B.); Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands (N.E.F., P.d.J.); FEops NV, Ghent, Belgium (G.D.S., F.I., M.D.B., P.M.); University Hospital Antwerp, Belgium (J.B.); and Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (O.D.B., L.S.)
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29
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Chamandi C, Barbanti M, Munoz-Garcia A, Latib A, Nombela-Franco L, Gutiérrez-Ibanez E, Veiga-Fernandez G, Cheema AN, Cruz-Gonzalez I, Serra V, Tamburino C, Mangieri A, Colombo A, Jiménez-Quevedo P, Elizaga J, Laughlin G, Lee DH, Garcia del Blanco B, Rodriguez-Gabella T, Marsal JR, Côté M, Philippon F, Rodés-Cabau J. Long-Term Outcomes in Patients With New Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2018; 11:301-310. [DOI: 10.1016/j.jcin.2017.10.032] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/18/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022]
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30
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Alasti M, Rashid H, Rangasamy K, Kotschet E, Adam D, Alison J, Gooley R, Zaman S. Long-term pacemaker dependency and impact of pacing on mortality following transcatheter aortic valve replacement with the LOTUS valve. Catheter Cardiovasc Interv 2018; 92:777-782. [DOI: 10.1002/ccd.27463] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/01/2017] [Accepted: 11/25/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Mohammad Alasti
- Monash Cardiac Rhythm Management Department; MonashHeart, Monash Medical Centre; Melbourne Australia
| | - Hashrul Rashid
- Monash Cardiovascular Research Centre, MonashHeart, Monash Medical Centre and Monash University; Melbourne Australia
| | - Karthikeyan Rangasamy
- Monash Cardiac Rhythm Management Department; MonashHeart, Monash Medical Centre; Melbourne Australia
| | - Emily Kotschet
- Monash Cardiac Rhythm Management Department; MonashHeart, Monash Medical Centre; Melbourne Australia
| | - David Adam
- Monash Cardiac Rhythm Management Department; MonashHeart, Monash Medical Centre; Melbourne Australia
| | - Jeff Alison
- Monash Cardiac Rhythm Management Department; MonashHeart, Monash Medical Centre; Melbourne Australia
| | - Robert Gooley
- Monash Cardiovascular Research Centre, MonashHeart, Monash Medical Centre and Monash University; Melbourne Australia
| | - Sarah Zaman
- Monash Cardiovascular Research Centre, MonashHeart, Monash Medical Centre and Monash University; Melbourne Australia
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31
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Monteiro C, Ferrari ADL, Caramori PRA, Carvalho LAF, Siqueira DADA, Thiago LEKS, Perin M, Lima VCD, Guérios E, Brito Junior FSD. Permanent Pacing After Transcatheter Aortic Valve Implantation: Incidence, Predictors and Evolution of Left Ventricular Function. Arq Bras Cardiol 2017; 109:550-559. [PMID: 29185614 PMCID: PMC5783436 DOI: 10.5935/abc.20170170] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 07/12/2017] [Indexed: 12/21/2022] Open
Abstract
Background Transcatheter aortic valve implantation (TAVI) is a well-established
procedure; however, atrioventricular block requiring permanent pacemaker
implantation (PPI) is a common complication. Objectives To determine the incidence, predictors and clinical outcomes of PPI after
TAVI, focusing on how PPI affects left ventricular ejection fraction (LVEF)
after TAVI. Methods The Brazilian Multicenter TAVI Registry included 819 patients submitted to
TAVI due to severe aortic stenosis from 22 centers from January/2008 to
January/2015. After exclusions, the predictors of PPI were assessed in 670
patients by use of multivariate regression. Analysis of the ROC curve was
used to measure the ability of the predictors; p < 0.05 was the
significance level adopted. Results Within 30 days from TAVI, 135 patients (20.1%) required PPI. Those patients
were older (82.5 vs. 81.1 years; p = 0.047) and mainly of the male sex
(59.3% vs 45%; p = 0.003). Hospital length of stay was longer in patients
submitted to PPI (mean = 15.7 ± 25.7 vs. 11.8 ± 22.9 days; p
< 0.001), but PPI affected neither all-cause death (26.7% vs. 25.6%; p =
0.80) nor cardiovascular death (14.1% vs. 14.8%; p = 0.84). By use of
multivariate analysis, the previous presence of right bundle-branch block
(RBBB) (OR, 6.19; 3.56-10.75; p ≤ 0.001), the use of
CoreValve® prosthesis (OR, 3.16; 1.74-5.72; p ≤
0.001) and baseline transaortic gradient > 50 mm Hg (OR, 1.86; 1.08-3.2;
p = 0.025) were predictors of PPI. The estimated risk of PPI ranged from 4%,
when none of those predictors was present, to 63%, in the presence of all of
them. The model showed good ability to predict the need for PPI: 0.69
(95%CI: 0.64 - 0.74) in the ROC curve. The substudy of 287 echocardiograms
during the 1-year follow-up showed worse LVEF course in patients submitted
to PPI (p = 0.01). Conclusion BRD prévio, gradiente aórtico médio > 50 mmHg e
CoreValve® são preditores independentes de implante de MPD
pós-TAVI. Ocorreu implante de MPD em aproximadamente 20% dos casos de
TAVI, o que prolongou a internação hospitalar, mas não
afetou a mortalidade. O implante de MPD afetou negativamente a FEVE
pós-TAVI.
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Affiliation(s)
- Cláudio Monteiro
- Centro de Pesquisas Cardiovasculares do Hospital São Lucas da PUCRS, Porto Alegre, RS - Brazil
| | - Andres Di Leoni Ferrari
- Centro de Pesquisas Cardiovasculares do Hospital São Lucas da PUCRS, Porto Alegre, RS - Brazil
| | | | | | | | | | - Marco Perin
- Hospital Israelita Albert Einstein, São Paulo, SP - Brazil
| | - Valter C de Lima
- Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS - Brazil
| | - Enio Guérios
- Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, PR - Brazil - Brazil
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32
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Auffret V, Puri R, Urena M, Chamandi C, Rodriguez-Gabella T, Philippon F, Rodés-Cabau J. Conduction Disturbances After Transcatheter Aortic Valve Replacement. Circulation 2017; 136:1049-1069. [DOI: 10.1161/circulationaha.117.028352] [Citation(s) in RCA: 302] [Impact Index Per Article: 43.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has become a well-accepted option for treating patients with aortic stenosis at intermediate to high or prohibitive surgical risk. TAVR-related conduction disturbances, mainly new-onset left bundle-branch block and advanced atrioventricular block requiring permanent pacemaker implantation, remain the most common complication of this procedure. Furthermore, improvements in TAVR technology, akin to the increasing experience of operators/centers, have translated to a major reduction in periprocedural complications, yet the incidence of conduction disturbances has remained relatively high, with perhaps an increasing trend over time. Several factors have been associated with a heightened risk of conduction disturbances and permanent pacemaker implantation after TAVR, with prior right bundle-branch block and transcatheter valve type and implantation depth being the most commonly reported. New-onset left bundle-branch block and the need for permanent pacemaker implantation may have a significant detrimental association with patients’ prognosis. Consequently, strategies intended to reduce the risk and to improve the management of such complications are of paramount importance, particularly in an era when TAVR expansion toward treating lower-risk patients is considered inevitable. In this article, we review the available evidence on the incidence, predictive factors, and clinical association of conduction disturbances after TAVR and propose a strategy for the management of these complications.
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Affiliation(s)
- Vincent Auffret
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - Rishi Puri
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - Marina Urena
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - Chekrallah Chamandi
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - Tania Rodriguez-Gabella
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - François Philippon
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
| | - Josep Rodés-Cabau
- From University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France (V.A.); Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (V.A., R.P., C.C., T.R.-G., F.P., J.R.,-C.); and Bichat-Claude Bernard University Hospital, Paris, France (M.U.)
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33
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Raelson CA, Gabriels J, Ruan J, Ip JE, Thomas G, Liu CF, Cheung JW, Lerman BB, Patel A, Markowitz SM. Recovery of atrioventricular conduction in patients with heart block after transcatheter aortic valve replacement. J Cardiovasc Electrophysiol 2017; 28:1196-1202. [PMID: 28677917 DOI: 10.1111/jce.13291] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 06/13/2017] [Accepted: 06/23/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Recovery of conduction has been demonstrated in >50% of patients who receive pacemakers (PPMs) for high-degree atrioventricular block (HD-AVB) after transcatheter aortic valve replacement (TAVR). Little information is available about the time course of conduction recovery in these patients and if any features predict early recovery of conduction. METHODS A retrospective review was performed of patients who underwent TAVR with balloon and self-expanding valves who required PPMs for HD-AVB. Serial PPM interrogations were analyzed to detect recovery of AV conduction. Analysis was performed to identify predictors and timing of conduction recovery. RESULTS Of a total population of 578 patients, 54 (9%) received PPMs for HD-AVB. In multivariate analysis, predictors of HD-AVB requiring a PPM included age (P = 0.014), right bundle branch block (OR 7.33 [3.64-14.8], P < 0.0001), atrial fibrillation (OR 2.16 [1.16-4.05], P = 0.016), and self-expanding valves (OR 4.19 [2.20-7.97], P < 0.0001). Of the 54 patients who received PPMs, 38 had follow-up sufficient to evaluate AV conduction recovery. Of these, 23 (61%) showed recovery of AV nodal conduction; 20 had already recovered by their first interrogation, a median of 22 days (IQR 14-31) post-PPM placement. There were no statistically significant predictors of AV nodal conduction recovery, including type of valve implanted. CONCLUSIONS A majority of patients who receive PPMs for HD-AVB after TAVR recover AV conduction during follow-up, and in most patients conduction recovery occurs within weeks. These findings imply that programming to minimize ventricular pacing may be beneficial in a majority of these patients.
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Affiliation(s)
- Colin A Raelson
- Division of Cardiology, Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | | | | | - James E Ip
- Division of Cardiology, Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - George Thomas
- Division of Cardiology, Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Christopher F Liu
- Division of Cardiology, Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Jim W Cheung
- Division of Cardiology, Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Bruce B Lerman
- Division of Cardiology, Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | | | - Steven M Markowitz
- Division of Cardiology, Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
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34
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Franzone A, Windecker S. The Conundrum of Permanent Pacemaker Implantation After Transcatheter Aortic Valve Implantation. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005514. [DOI: 10.1161/circinterventions.117.005514] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Anna Franzone
- From the Department of Cardiology, Bern University Hospital, University of Bern, Switzerland
| | - Stephan Windecker
- From the Department of Cardiology, Bern University Hospital, University of Bern, Switzerland
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35
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Rampat R, Khawaja MZ, Hilling-Smith R, Byrne J, MacCarthy P, Blackman DJ, Krishnamurthy A, Gunarathne A, Kovac J, Banning A, Kharbanda R, Firoozi S, Brecker S, Redwood S, Bapat V, Mullen M, Aggarwal S, Manoharan G, Spence MS, Khogali S, Dooley M, Cockburn J, de Belder A, Trivedi U, Hildick-Smith D. Conduction Abnormalities and Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement Using the Repositionable LOTUS Device. JACC Cardiovasc Interv 2017. [DOI: 10.1016/j.jcin.2017.03.044] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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36
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Seeger J, Gonska B, Rottbauer W, Wöhrle J. Outcome With the Repositionable and Retrievable Boston Scientific Lotus Valve Compared With the Balloon-Expandable Edwards Sapien 3 Valve in Patients Undergoing Transfemoral Aortic Valve Replacement. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.116.004670. [DOI: 10.1161/circinterventions.116.004670] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 05/01/2017] [Indexed: 11/16/2022]
Abstract
Background—
New generation devices for transfemoral aortic valve replacement were optimized on valve positioning and reduction of residual aortic regurgitation. We compared 30-day, 12-month, and 24-month outcomes of the Boston Scientific Lotus valve (Lotus) and the balloon-expandable Edwards Sapien 3 (ES3) valve. Primary end point was all-cause mortality or disabling stroke within 12 months.
Methods and Results—
Between 2014 and 2016, 537 patients were enrolled at our center, and 202 patients received Lotus and 335 ES3. There was no residual moderate or severe aortic regurgitation. Rate of mild aortic regurgitation was lower with the repositionable and retrievable Lotus valve compared with the ES3. Rate of pacemaker implantation was significantly higher with the Lotus valve compared with the ES3 valve (36.1% versus 14.9%,
P
<0.01). Valve Academic Research Consortium-2 early safety end point at 30 days was 7.4% with both devices with no difference in all-cause mortality (Lotus, 1.9%; ES3, 1.8%;
P
=0.87), rate of disabling stroke (Lotus, 1.5%; ES3, 2.1%;
P
=0.62), or major vascular complications (Lotus, 2.9%; ES3, 2.4%;
P
=0.69). The primary end point at 12 months was similar between groups. In a propensity score–matched comparison, there was no difference in the primary end point within 12 months (Lotus, 15.5%; ES3, 18.6%;
P
=0.69) and 24 months (Lotus, 21.9%; ES3, 26.4%;
P
=0.49).
Conclusions—
Transfemoral aortic valve replacement with the ES3 and the Lotus were associated with similar 30-day, 12-month, and 24-month clinical outcomes. Need for permanent pacemaker implantation was significantly higher with the repositionable Lotus device.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT02162069.
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Affiliation(s)
- Julia Seeger
- From the Department of Internal Medicine II, Cardiology, University of Ulm, Germany
| | - Birgid Gonska
- From the Department of Internal Medicine II, Cardiology, University of Ulm, Germany
| | - Wolfgang Rottbauer
- From the Department of Internal Medicine II, Cardiology, University of Ulm, Germany
| | - Jochen Wöhrle
- From the Department of Internal Medicine II, Cardiology, University of Ulm, Germany
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Barbanti M, Gulino S, Costa G, Tamburino C. Pathophysiology, incidence and predictors of conduction disturbances during Transcatheter Aortic Valve Implantation. Expert Rev Med Devices 2017; 14:135-147. [PMID: 28092726 DOI: 10.1080/17434440.2017.1282819] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Over the past decade, transcatheter aortic valve implantation (TAVI) has evolved rapidly toward an extremely reproducible, safe and effective procedure, with a marked reduction of its related complications. However, the occurrence of conduction disturbances and the need for permanent pacemaker implantation (PPI) after TAVI remains a concern. Areas covered: In this article review, we will go through the mechanisms involved in conduction disturbances after TAVI, and we will discuss the key aspects of pathophysiology, incidence and predictors of conduction disturbances following Transcatheter Aortic Valve Implantation. The evaluation of patient's valve anatomy and the selection of the most appropriate prosthesis have been proposed as a valuable options to reduce the incidence of conductions disturbances. Moreover, in recent times, a great number of new TAVI devices, so-called 'second-generation devices', have been introduced to address the limitations of the first-generation devices, including conduction disturbance, with scarce results. Expert commentary: Conduction disturbances after TAVI are increasingly recognized as an important issue in TAVI complications. Further characterization of the procedural- and patient-related factors that contribute to the development of conduction abnormalities will help to improve prosthesis designs and patient selection, making TAVI even more safer.
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Affiliation(s)
- Marco Barbanti
- a Division of Cardiology , Ferrarotto Hospital, University of Catania , Catania , Italy
| | - Simona Gulino
- a Division of Cardiology , Ferrarotto Hospital, University of Catania , Catania , Italy
| | - Giuliano Costa
- a Division of Cardiology , Ferrarotto Hospital, University of Catania , Catania , Italy
| | - Corrado Tamburino
- a Division of Cardiology , Ferrarotto Hospital, University of Catania , Catania , Italy
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Sinning JM, Petronio AS, Van Mieghem N, Zucchelli G, Nickenig G, Bekeredjian R, Bosmans J, Bedogni F, Branny M, Stangl K, Kovac J, Nordell A, Schiltgen M, Piazza N, de Jaegere P. Relation Between Clinical Best Practices and 6-Month Outcomes After Transcatheter Aortic Valve Implantation With CoreValve (from the ADVANCE II Study). Am J Cardiol 2017; 119:84-90. [PMID: 27776799 DOI: 10.1016/j.amjcard.2016.09.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/13/2016] [Accepted: 09/13/2016] [Indexed: 10/20/2022]
Abstract
Best practices for transcatheter aortic valve implantation with CoreValve include patient screening and valve size selection using multislice computed tomography, adherence to manufacturer recommendations for oversizing, control of implant depth to 6 mm or less, and management of conduction disturbances according to international guidelines. The ADVANCE II study implemented these strategies and demonstrated their relation to clinical outcomes. From October 2011 to April 2013, 200 patients with severe aortic stenosis were enrolled, and 194 were implanted. All imaging and electrocardiographic data were analyzed by an independent core laboratory, and adverse events were adjudicated to valve academic research consortium-2 definitions. The mean age was 80.2 ± 6.7 years and the mean Society of Thoracic Surgeons Predicted Risk of Mortality was 7.2 ± 6.8% for the enrolled patients. At 6 months, all-cause mortality was 9.2%, stroke was 2.6%, and permanent pacemaker implantation was 19.2% for class I and II indications. In patients with implant depth ≤6 mm, both mortality and permanent pacemaker implantation were lower than in patients with depth >6 mm (2.5% vs 14.5%, p <0.01 and 18.1% vs 31.7%, p = 0.03, respectively). The rate of moderate and severe paravalvular leak was 9.8% at 7 days after transcatheter aortic valve implantation, decreasing to 4.3% at 6 months (p = 0.02). Valves were significantly more oversized in patients with mild or less paravalvular leak at day 7 compared with those with moderate or severe (15.8 ± 8.0% vs 11.8 ± 4.9%, p = 0.01). In conclusion, findings from the ADVANCE II study reinforce that adherence to best clinical practices improves patient outcomes.
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Meredith IT, Walters DL, Dumonteil N, Worthley SG, Tchétché D, Manoharan G, Blackman DJ, Rioufol G, Hildick-Smith D, Whitbourn RJ, Lefèvre T, Lange R, Müller R, Redwood S, Feldman TE, Allocco DJ, Dawkins KD. 1-Year Outcomes With the Fully Repositionable and Retrievable Lotus Transcatheter Aortic Replacement Valve in 120 High-Risk Surgical Patients With Severe Aortic Stenosis: Results of the REPRISE II Study. JACC Cardiovasc Interv 2016; 9:376-384. [PMID: 26892084 DOI: 10.1016/j.jcin.2015.10.024] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 10/01/2015] [Accepted: 10/08/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This analysis presents the first report of 1-year outcomes of the 120 patients enrolled in the REPRISE II (Repositionable Percutaneous Placement of Stenotic Aortic Valve Through Implantation of Lotus Valve System-Evaluation of Safety and Performance) study. BACKGROUND The fully repositionable and retrievable Lotus Valve (Boston Scientific, Marlborough, Massachusetts) was designed to facilitate accurate positioning, early valve function, and hemodynamic stability during deployment and to minimize paravalvular regurgitation in patients undergoing transcatheter aortic valve replacement. METHODS The study enrolled 120 symptomatic patients 70 years of age or older at 14 centers in Australia and Europe. Patients had severe calcific aortic stenosis and were deemed to be at high or extreme risk of surgery based on assessment by the heart team. RESULTS The mean age was 84.4 ± 5.3 years, 57% (68 of 120) of patients were women, and the mean Society of Thoracic Surgeons score was 7.1 ± 4.6. The mean baseline aortic valve area was 0.7 ± 0.2 cm(2), and the mean transvalvular pressure gradient was 46.4 ± 15.0 mm Hg. All patients were successfully implanted with a Lotus Valve, and 1-year clinical follow-up was available for 99.2% (119 of 120 of patients). The mean 1-year transvalvular aortic pressure gradient was 12.6 ± 5.7 mm Hg, and the mean valve area was 1.7 ± 0.5 cm(2). A total of 88.6% patients had no or trivial paravalvular aortic regurgitation at 1 year by independent core lab adjudication, and 97.1% of patients were New York Heart Association functional class I or II. At 1 year, the all-cause mortality rate was 10.9% (13 of 119 patients), disabling stroke rate was 3.4% (4 of 119 patients), disabling bleeding rate was 5.9% (7 of 119 patients), with no repeat procedures for valve-related dysfunction. A total of 31.9% (38 of 119 patients) underwent new permanent pacemaker implantation at 1 year. CONCLUSIONS At 1 year of follow-up, the Lotus Valve demonstrated excellent valve hemodynamics, no moderate or severe paravalvular regurgitation, and significant and sustained improvement in New York Heart Association functional class status, with good clinical outcomes. (Repositionable Percutaneous Placement of Stenotic Aortic Valve Through Implantation of Lotus Valve System-Evaluation of Safety and Performance [REPRISE II]; NCT01627691).
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Affiliation(s)
- Ian T Meredith
- MonashHeart, Monash Medical Centre and Monash University, Clayton, Victoria, Australia.
| | - Darren L Walters
- The Prince Charles Hospital, Brisbane and University of Queensland, Brisbane, Queensland, Australia
| | - Nicolas Dumonteil
- Rangueil University Hospital, Cardiovascular and Metabolic Pole, Toulouse, France
| | | | | | | | | | | | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Robert J Whitbourn
- Cardiovascular Research Centre, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | | | | | | | - Simon Redwood
- Guy's and St. Thomas NHS Foundation Trust, London, United Kingdom
| | - Ted E Feldman
- NorthShore University HealthSystem, Evanston Hospital, Evanston, Illinois
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Zaman S, McCormick L, Gooley R, Rashid H, Ramkumar S, Jackson D, Hui S, Meredith IT. Incidence and predictors of permanent pacemaker implantation following treatment with the repositionable Lotus™ transcatheter aortic valve. Catheter Cardiovasc Interv 2016; 90:147-154. [DOI: 10.1002/ccd.26857] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 10/12/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Sarah Zaman
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), School of Clinical Sciences; Monash University
- Cardiovascular Division; Monash Heart, Monash Medical Centre; Melbourne Victoria Australia
| | - Liam McCormick
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), School of Clinical Sciences; Monash University
- Cardiovascular Division; Monash Heart, Monash Medical Centre; Melbourne Victoria Australia
| | - Robert Gooley
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), School of Clinical Sciences; Monash University
- Cardiovascular Division; Monash Heart, Monash Medical Centre; Melbourne Victoria Australia
| | - Hashrul Rashid
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), School of Clinical Sciences; Monash University
| | - Satish Ramkumar
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), School of Clinical Sciences; Monash University
| | - Damon Jackson
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), School of Clinical Sciences; Monash University
| | - Samuel Hui
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), School of Clinical Sciences; Monash University
| | - Ian T. Meredith
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), School of Clinical Sciences; Monash University
- Cardiovascular Division; Monash Heart, Monash Medical Centre; Melbourne Victoria Australia
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Engborg J, Riechel-Sarup C, Gerke O, Mickley H, Sandgaard NC, Nissen H, Diederichsen ACP. Effect of permanent pacemaker on mortality after transcatheter aortic valve replacement. SCAND CARDIOVASC J 2016; 51:40-46. [DOI: 10.1080/14017431.2016.1236982] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Conduction disturbances after transcatheter aortic valve implantation procedures - predictors and management. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2016; 12:203-11. [PMID: 27625682 PMCID: PMC5011535 DOI: 10.5114/aic.2016.61640] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 06/29/2016] [Indexed: 12/02/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has become a safe and efficient alternative to cardiac surgery in patients with severe aortic stenosis. In many countries the number of performed TAVI procedures equals the number of surgical implantations. Indications for TAVI are becoming more liberal, allowing a wider spectrum of patients to benefit from the advantages of transcatheter therapy. Due to its invasive nature, TAVI is associated with some complications such as conduction disturbances. Although these disturbances are usually not lethal, they have a great influence on patients’ state and long term-survival. The most relevant and common are His’ bundle branch blocks, atrioventricular blocks, and need for permanent pacemaker implantation. With the frequency at 10% to even 50%, conduction abnormalities are among the most important TAVI-related adverse events. Risk factors for conduction disturbances include age, anatomy of the heart, periprocedural factors, type of implanted valve, and comorbidities. Severity of occurring complications varies; therefore selection of a proper treatment approach is required. Considered as the most effective management, permanent pacemaker implantation turned out to negatively influence both recovery and survival. Moreover, there is no expert consensus on use of resynchronization therapy after TAVI. In this paper, the authors present a comprehensive analysis of the most common conduction disturbances accompanying TAVI, factors related to their occurrence, and treatment approach.
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Regueiro A, Abdul-Jawad Altisent O, Del Trigo M, Campelo-Parada F, Puri R, Urena M, Philippon F, Rodés-Cabau J. Impact of New-Onset Left Bundle Branch Block and Periprocedural Permanent Pacemaker Implantation on Clinical Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2016; 9:e003635. [DOI: 10.1161/circinterventions.115.003635] [Citation(s) in RCA: 193] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 03/21/2016] [Indexed: 11/16/2022]
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Bedogni F, Frigiola A, Ranucci M, Brambilla N, Montone RA, Agnifili M, Menicanti L, Testa L. Transcatheter aortic valve replacement-state of the art and a glimpse to the future: 'the Tailored Approach'. Eur Heart J Suppl 2016; 18:E86-E95. [PMID: 28533722 DOI: 10.1093/eurheartj/suw017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Transcatheter aortic valve replacement determined a paradigm shift in the treatment of high-risk patients with severe symptomatic aortic valve stenosis. Notwithstanding the impressive results of the first-generation prostheses, a fast-paced technological evolution is taking place to overcome their limitations, in particular the vascular access damage and the paravalvular leak. Nowadays, with the availability of several different devices, the expert operator can select the right prosthesis for the specific anatomical and clinical situation. As 'One does not fit all', the 'Tailored TAVR Approach' we describe will conceivably become the future of this therapy.
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Affiliation(s)
- Francesco Bedogni
- Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese, piazza E. Malan, Milan, Italy
| | - Alessandro Frigiola
- Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese, piazza E. Malan, Milan, Italy
| | - Marco Ranucci
- Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese, piazza E. Malan, Milan, Italy
| | - Nedy Brambilla
- Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese, piazza E. Malan, Milan, Italy
| | - Rocco Antonio Montone
- Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese, piazza E. Malan, Milan, Italy
| | - Mauro Agnifili
- Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese, piazza E. Malan, Milan, Italy
| | - Lorenzo Menicanti
- Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese, piazza E. Malan, Milan, Italy
| | - Luca Testa
- Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese, piazza E. Malan, Milan, Italy
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Schernthaner C, Kraus J, Danmayr F, Hammerer M, Schneider J, Hoppe UC, Strohmer B. Short-term pacemaker dependency after transcatheter aortic valve implantation. Wien Klin Wochenschr 2016; 128:198-203. [DOI: 10.1007/s00508-015-0906-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 11/18/2015] [Indexed: 12/14/2022]
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A Meta-Analysis Examining Differences in Short-Term Outcomes between Sutureless and Conventional Aortic Valve Prostheses. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015; 10:375-82. [DOI: 10.1097/imi.0000000000000221] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective Sutureless aortic valve prostheses are anchored by radial force in a mechanism similar to that of transcatheter aortic valve implantation. Transcatheter aortic valve implantation is associated with an increased permanent pacemaker (PPM) requirement in a significant proportion of patients. We undertook a meta-analysis to examine the incidence of PPM insertion associated with sutureless compared with conventional surgical aortic valve replacement. Methods A systematic review was conducted in accordance with the Prisma guidelines.1 All searches were performed on August 10, 2014. Studies between 2007 and 2014 were included in the search. Results A total of 832 patients were included in the sutureless group and 3,740 in the conventional group. Aortic cross-clamp (39.8 vs 62.4 minutes; P < 0.001) and cardiopulmonary bypass (64.9 vs 86.7 minutes; P = 0.002) times were shorter in the sutureless group. Permanent pacemaker implantation rate was higher in the sutureless cohort (9.1% vs 2.4%; P = 0.025). Conclusions Sutureless aortic valve prostheses are associated with significantly shorter cardiopulmonary bypass and aortic cross-clamp times and a higher incidence of PPM insertion than conventional. Further investigation of the prognostic significance is required.
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Hurley ET, O'Sullivan KE, Segurado R, Hurley JP. A Meta-Analysis Examining Differences in Short-Term Outcomes between Sutureless and Conventional Aortic Valve Prostheses. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015. [DOI: 10.1177/155698451501000602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Ricardo Segurado
- CSTAR Centre for Statistical Training and Research, University College, Dublin, Ireland
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Nazif TM, Dizon J, Hahn RT, Xu K, Babaliaros V, Douglas PS, El-Chami MF, Herrmann HC, Mack M, Makkar RR, Miller DC, Pichard A, Tuzcu EM, Szeto WY, Webb JG, Moses JW, Smith CR, Williams MR, Leon MB, Kodali SK. Predictors and Clinical Outcomes of Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2015; 8:60-9. [DOI: 10.1016/j.jcin.2014.07.022] [Citation(s) in RCA: 388] [Impact Index Per Article: 43.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 07/24/2014] [Accepted: 07/31/2014] [Indexed: 11/27/2022]
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Egger F, Nürnberg M, Rohla M, Weiss TW, Unger G, Smetana P, Geppert A, Gruber SC, Bambazek A, Falkensammer J, Waldenberger FR, Huber K, Freynhofer MK. High-degree atrioventricular block in patients with preexisting bundle branch block or bundle branch block occurring during transcatheter aortic valve implantation. Heart Rhythm 2014; 11:2176-82. [DOI: 10.1016/j.hrthm.2014.07.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Indexed: 11/26/2022]
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Abdel-Wahab M, El-Mawardy M, Richardt G. Update on transcatheter aortic valve replacement. Trends Cardiovasc Med 2014; 25:154-61. [PMID: 25453986 DOI: 10.1016/j.tcm.2014.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 10/03/2014] [Accepted: 10/04/2014] [Indexed: 11/25/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is currently the treatment modality of choice for patients with symptomatic severe aortic stenosis who are inoperable or at high risk for surgical aortic valve replacement. TAVR has shown a clear mortality benefit compared to conservative treatment in inoperable patients and is at least non-inferior to surgical aortic valve replacement in high-risk operable patients. Through improvements in pre-procedural imaging, refinement in valve technologies, increasing operator and team experience, and continuous valuable research, TAVR has developed rapidly in the past few years and is expected to further boost in the near future. In this review, we highlight the current status of TAVR, summarize recent updates, and discuss briefly the future expectations of this rapidly evolving technology.
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Affiliation(s)
- Mohamed Abdel-Wahab
- Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, Bad Segeberg 23795, Germany.
| | - Mohamed El-Mawardy
- Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, Bad Segeberg 23795, Germany
| | - Gert Richardt
- Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, Bad Segeberg 23795, Germany
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