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Kikuchi S, Minamimoto Y, Matsushita K, Cho T, Terasaka K, Hanajima Y, Nakahashi H, Gohbara M, Kimura Y, Yasuda S, Okada K, Matsuzawa Y, Iwahashi N, Kosuge M, Ebina T, Morel O, Ohlmann P, Uchida K, Hibi K. Impact of New-Onset Right Bundle-Branch Block After Transcatheter Aortic Valve Replacement on Permanent Pacemaker Implantation. J Am Heart Assoc 2024; 13:e032777. [PMID: 38639357 PMCID: PMC11179913 DOI: 10.1161/jaha.123.032777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/15/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND A delayed and recurrent complete atrioventricular block (CAVB) is a life-threatening complication of transcatheter aortic valve replacement (TAVR). Post-TAVR evaluation may be important in predicting delayed and recurrent CAVB requiring permanent pacemaker implantation (PPI). The impact of new-onset right bundle-branch block (RBBB) after TAVR on PPI remains unknown. METHODS AND RESULTS In total, 407 patients with aortic stenosis who underwent TAVR were included in this analysis. Intraprocedural CAVB was defined as CAVB that occurred during TAVR. A 12-lead ECG was evaluated at baseline, immediately after TAVR, on postoperative days 1 and 5, and according to the need to identify new-onset bundle-branch block (BBB) and CAVB after TAVR. Forty patients (9.8%) required PPI, 17 patients (4.2%) had persistent intraprocedural CAVB, and 23 (5.7%) had delayed or recurrent CAVB after TAVR. The rates of no new-onset BBB, new-onset left BBB, and new-onset RBBB were 65.1%, 26.8%, and 4.7%, respectively. Compared with patients without new-onset BBB and those with new-onset left BBB, the rate of PPI was higher in patients with new-onset RBBB (3.4% versus 5.6% versus 44.4%, P<0.0001). On post-TAVR evaluation in patients without persistent intraprocedural CAVB, the multivariate logistic regression analysis showed that new-onset RBBB was a statistically significant predictor of PPI compared with no new-onset BBB (odds ratio [OR], 18.0 [95% CI, 5.94-54.4]) in addition to the use of a self-expanding valve (OR, 2.97 [95% CI, 1.09-8.10]). CONCLUSIONS Patients with new-onset RBBB after TAVR are at high risk for PPI.
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Affiliation(s)
- Shinnosuke Kikuchi
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Yugo Minamimoto
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Kensuke Matsushita
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Tomoki Cho
- Cardiovascular CenterYokohama City University Medical CenterYokohamaJapan
| | - Kengo Terasaka
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Yohei Hanajima
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Hidefumi Nakahashi
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Masaomi Gohbara
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Yuichiro Kimura
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Shota Yasuda
- Cardiovascular CenterYokohama City University Medical CenterYokohamaJapan
| | - Kozo Okada
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Yasushi Matsuzawa
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Noriaki Iwahashi
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Masami Kosuge
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Toshiaki Ebina
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Olivier Morel
- Université de Strasbourg, Pôle d’Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier UniversitaireStrasbourgFrance
| | - Patrick Ohlmann
- Université de Strasbourg, Pôle d’Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier UniversitaireStrasbourgFrance
| | - Keiji Uchida
- Cardiovascular CenterYokohama City University Medical CenterYokohamaJapan
| | - Kiyoshi Hibi
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
- Department of CardiologyYokohama City University Graduate School of MedicineYokohamaJapan
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Kowalówka AR, Kowalewski M, Wańha W, Kołodziejczak M, Mariani S, Li T, Pasierski M, Łoś A, Stefaniak S, Malinowski M, Gocoł R, Hudziak D, Bachowski R, Wojakowski W, Jemielity M, Rogowski J, Lorusso R, Suwalski P, Deja M. Surgical and transcatheter aortic valve replacement for severe aortic stenosis in low-risk elective patients: Analysis of the Aortic Valve Replacement in Elective Patients From the Aortic Valve Multicenter Registry. J Thorac Cardiovasc Surg 2024; 167:1714-1723.e4. [PMID: 36424214 DOI: 10.1016/j.jtcvs.2022.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 10/18/2022] [Accepted: 10/22/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Transcatheter aortic valve implantation (TAVI) remains the preferred strategy for high-risk or elderly individuals with aortic valve (AV) stenosis who are not considered to be optimal surgical candidates. Recent evidence suggests that low-risk patients may benefit from TAVI as well. The current study evaluates midterm survival in low-risk patients undergoing elective surgical AV replacement (SAVR) versus TAVI. METHODS The Aortic Valve Replacement in Elective Patients From the Aortic Valve Multicenter Registry (AVALON) compared isolated elective transfemoral TAVI or SAVR with sternotomy or minimally invasive approach in low-risk individuals performed between 2015 and 2019. Propensity score matching was conducted to determine SAVR controls for TAVI group in a 1-to-3 ratio with 0.2 caliper. RESULTS A total of 2393 patients undergoing elective surgery (1765 SAVR and 629 TAVI) with median European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) score 1.81 (interquartile range [IQR], 1.36 to 2.53]) were initially included. Median follow-up was 2.72 years (IQR, 1.32-4.08; max 6.0). Propensity score matching returned 329 TAVI cases and 593 SAVR controls. Thirty-day mortality was 11 out of 329 (3.32%) in TAVI and 18 out of 593 (3.03%) in SAVR (risk ratio, 1.10; 95% CI, 0.52-2.37; P = .801) groups, respectively. At 2 years, survival curves began to diverge in favor of SAVR, which was associated with 30% lower mortality (hazard ratio, 0.70; 95% CI, 0.496-0.997; P = .048). CONCLUSIONS Our data did not demonstrate a survival difference between TAVI and SAVR during the first 2 postprocedure years. After that time, SAVR is associated with improved survival. Extended observations from randomized trials in low-risk patients undergoing elective surgery are warranted to confirm these findings and draw definitive conclusions.
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Affiliation(s)
- Adam R Kowalówka
- Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland; Department of Cardiac Surgery, Medical University of Silesia, Faculty of Medical Sciences, Katowice, Poland
| | - Mariusz Kowalewski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland; Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands; Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland.
| | - Wojciech Wańha
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland; Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Michalina Kołodziejczak
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland; Department of Anaesthesiology and Intensive Care, Collegium Medicum Nicolaus Copernicus University, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
| | - Silvia Mariani
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands; Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
| | - Tong Li
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland; Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Michał Pasierski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland; Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
| | - Andrzej Łoś
- Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Sebastian Stefaniak
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznań, Poland
| | - Marcin Malinowski
- Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland; Department of Cardiac Surgery, Medical University of Silesia, Faculty of Medical Sciences, Katowice, Poland
| | - Radoslaw Gocoł
- Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland
| | - Damian Hudziak
- Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland
| | - Ryszard Bachowski
- Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland; Department of Cardiac Surgery, Medical University of Silesia, Faculty of Medical Sciences, Katowice, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Marek Jemielity
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznań, Poland
| | - Jan Rogowski
- Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Piotr Suwalski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland; Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
| | - Marek Deja
- Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland; Department of Cardiac Surgery, Medical University of Silesia, Faculty of Medical Sciences, Katowice, Poland
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Chamoun N, Jdaidani J, Iskandarani DZ, Ghalayini S, Zgheib A, Khoury A, Alam S, Rebeiz AG, Ghazzal Z, Sawaya F. Short-Term Clinical Outcomes of Transcatheter Aortic Valve Replacement in a Developing Country. Cureus 2024; 16:e58334. [PMID: 38752027 PMCID: PMC11095913 DOI: 10.7759/cureus.58334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION Transcatheter aortic valve replacement (TAVR) is an effective alternative to surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis in all surgical risk groups. Reports of clinical outcomes post-TAVR in developing countries are scarce. We aimed to address the clinical outcomes and safety profile of TAVR in a developing country. METHODS We conducted a single-center, retrospective study on patients undergoing TAVR at the American University of Beirut Medical Center (AUBMC) from January 2016 to April 2023. We included a total of 399 patients. Our primary endpoint was to assess the rate of TAVR in-hospital and 30-day mortality, neurologic events, and new permanent pacemaker implantation (PPI) in patients, stratified by the Society of Thoracic Surgeons (STS) risk of mortality score. RESULTS Survival rates were 98.7% (394) at discharge vs. 97.5% (389) at 30 days post-procedure. The technical success rate was 95% (379) at the end of the procedure. Device success and early safety rates were 93.5% (373) and 83% (331), respectively at 30 days post-procedure. The all-cause mortality rate increased from 1.3% (5) at discharge to 2.5% (10) at 30-day intervals. The rate of ischemic stroke was 1.3% (five) at discharge and increased to 2% (eight) at 30 days post-procedure. PPI was needed in 5.8% (23) of patients at discharge with an increase to 7% (28) at one-month interval. Overall, the rates of TAVR outcomes among the three risk groups were comparable including neurologic events, valve-related complications, bleeding problems, vascular and access-related complications, and myocardial infarction. CONCLUSION This study at AUBMC highlights the successful implementation of the TAVR program in a developing country, showcasing its efficacy and safety within 30 days post-operation, despite challenges such as financial constraints and limited access to specialized training. Larger cohorts and longer follow-up periods are needed to accurately represent clinical outcomes in developing countries.
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Affiliation(s)
- Nadia Chamoun
- Cardiology, American University of Beirut Medical Center, Beirut, LBN
| | - Jennifer Jdaidani
- Cardiology, American University of Beirut Medical Center, Beirut, LBN
| | | | - Sarah Ghalayini
- Cardiology, American University of Beirut Medical Center, Beirut, LBN
| | - Ali Zgheib
- Cardiology, American University of Beirut Medical Center, Beirut, LBN
| | - Alessandro Khoury
- Cardiology, American University of Beirut Medical Center, Beirut, LBN
| | - Samir Alam
- Cardiology, American University of Beirut Medical Center, Beirut, LBN
| | - Abdallah G Rebeiz
- Cardiology, American University of Beirut Medical Center, Beirut, LBN
| | - Ziyad Ghazzal
- Cardiology, American University of Beirut Medical Center, Beirut, LBN
| | - Fadi Sawaya
- Cardiology, American University of Beirut Medical Center, Beirut, LBN
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Cosma J, Russo A, Schino S, Muscoli S, Marchei M, DI Luozzo M, Sangiorgi G, Mariano EG. Pacemaker dependency and conduction system recovery following transcatheter aortic valve implantation. Minerva Cardiol Angiol 2024; 72:182-189. [PMID: 37971708 DOI: 10.23736/s2724-5683.23.06273-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI)-related conduction system disorders are dynamic and may resolve over time. The purpose of this study was to investigate predictive factors of PM dependency among patients receiving permanent PM implantation after TAVI. METHODS We included 37 consecutive patients who underwent PPM implantation within six days after TAVI and who completed a 12-month follow-up. Patients were divided into two groups according to PPM dependency at follow-up: PPM-dependent group and non-PPM-dependent group. Device follow-ups were performed at one, six and 12 months. RESULTS There were no significant differences in either baseline clinical characteristics or procedural data and results. Analysis of baseline ECGs showed a statistical difference in PR interval (200.1±17.2 ms in the PPM-dependent group vs. 175±23.3 ms in the non PPM-dependent group [P=0,003]) and in the presence of RBBB (four patients in the PPM-dependent group vs. no patients in the non PPM-dependent group [P=0.02]) as well as QRS duration (117.3±27.4 ms in the PPM-dependent group and 99±18.3 msec in the non PPM-dependent group [P=0.04]). CONCLUSIONS The rate of PPM dependency was significantly reduced at 12-month follow-up: from 62,2% at the time of implantation to 35,1%. PR interval and RBBB were the most important predictive factors for PPM dependency. Persistent AVB and alternating BBB were prevalent in the PPM-dependent group. In the absence of persistent AVB or alternating BBB, we suggest that patients without long PR interval and RBBB at baseline ECG be carefully evaluated before permanent PM implantation, as conduction system recovery is possible.
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Affiliation(s)
- Joseph Cosma
- Department of Cardiology, Tor Vergata University, Rome, Italy -
- Cardiovascular Institute of Caen, Saint Martin Private Hospital, Caen, France -
| | | | - Sofia Schino
- Department of Cardiology, Tor Vergata University, Rome, Italy
| | - Saverio Muscoli
- Department of Cardiology, Tor Vergata University, Rome, Italy
| | - Massimo Marchei
- Department of Cardiology, Tor Vergata University, Rome, Italy
| | - Marco DI Luozzo
- Department of Cardiology, Tor Vergata University, Rome, Italy
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Kikuchi S, Minamimoto Y, Matsushita K, Cho T, Terasaka K, Hanajima Y, Nakahashi H, Gohbara M, Kimura Y, Yasuda S, Okada K, Matsuzawa Y, Iwahashi N, Kosuge M, Ebina T, Morel O, Ohlmann P, Uchida K, Hibi K. Ratio of left ventricular outflow tract area to aortic annulus area and complete atrioventricular block after transcatheter aortic valve replacement for aortic stenosis. Int J Cardiol 2024; 397:131608. [PMID: 38030042 DOI: 10.1016/j.ijcard.2023.131608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/29/2023] [Accepted: 11/23/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Mechanical compression of cardiac conduction system by transcatheter heart valves leads to complete atrioventricular block (CAVB) after transcatheter aortic valve replacement (TAVR). Bulging of ventricular septum in the left ventricular outflow tract (LVOT) may be associated with greater compression of conduction system, leading to irreversible CAVB. OBJECTIVE This study aimed to investigate the association of ventricular septal bulging with TAVR-related CAVB and permanent pacemaker implantation (PPI). METHODS Among 294 consecutive patients with severe aortic stenosis who underwent TAVR between July 2017 and February 2023, 271 were included in the analysis. As a quantitative evaluation of bulging of the ventricular septum, the ratio of LVOT area to aortic annulus area (L/A ratio) was measured at the systolic phase of computed tomography images. RESULTS TAVR-related CAVB occurred in 64 patients (23.6%). Twenty-eight patients (10.3%) required PPI. The optimal thresholds of L/A ratio for predicting TAVR-related CAVB and PPI were 1.0181 and 0.985, respectively. Patients with less than the cut-off values had higher rate of TAVR-related CAVB and PPI than those above (28.3% vs 13.1%, p = 0.0063; 14.7% vs 4.4%, p = 0.0077, respectively). A multivariate analysis showed that L/A ratio < 1.0181 was an independent predictor of TAVR-related CAVB (odds ratio [OR] 2.65, p = 0.011), in addition to prior right bundle branch block (OR 3.76, p = 0.0005), use of a self-expanding valve (OR 1.99, p = 0.030), and short membranous septum length (OR 0.96, p = 0.037). Only L/A ratio < 0.985 was independently associated with PPI (OR 3.70, p = 0.011). CONCLUSION Low L/A ratio is a predictor of TAVR-related CAVB and PPI.
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Affiliation(s)
- Shinnosuke Kikuchi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yugo Minamimoto
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kensuke Matsushita
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Tomoki Cho
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Kengo Terasaka
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yohei Hanajima
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Hidefumi Nakahashi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Masaomi Gohbara
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yuichiro Kimura
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Shota Yasuda
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Kozo Okada
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yasushi Matsuzawa
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Noriaki Iwahashi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Toshiaki Ebina
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Olivier Morel
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 1 Place de L'Hôpital, 67091 Strasbourg, France
| | - Patrick Ohlmann
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 1 Place de L'Hôpital, 67091 Strasbourg, France
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan; Department of Cardiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
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Shah T, Maarek R, See C, Huang H, Wang Y, Parise H, Forrest JK, Lansky AJ. Effect of antecedent statin usage on conduction disturbances and arrhythmias after transcatheter aortic valve replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 59:3-8. [PMID: 37573173 DOI: 10.1016/j.carrev.2023.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Post-transcatheter aortic valve replacement (TAVR) conduction disturbances and atrial fibrillation (AF) are associated with markedly worse short- and long-term prognosis. Statins have multiple pleotropic effects that may be beneficial in mitigating the risk of these procedural complications as has been found for various other cardiac procedures and surgeries. METHODS Data were retrospectively collected on consecutive patients in the Yale New Haven Health TAVR Registry who did not have a prior pacemaker, had at least 1 pre- and post-TAVR electrocardiogram, and did not have a change to their statin regimen during the index hospitalization. The primary endpoint was the composite of new pacemaker placement, new AF, and other new conduction disturbances evaluated at 7 days post-TAVR. RESULTS Between, July 2012 and August 2019, 612 patients met inclusion criteria. Of these, 162 patients were not on antecedent statins, and 450 were (28 low-intensity, 225 moderate-intensity, and 197 high-intensity). After 1:1 propensity matching, 99 patients on moderate-/high-intensity statins were matched to 99 patients not on antecedent statins. At 7 days, there was no significant difference in the occurrence of the primary endpoint (57 % statin users vs 46 % non-statin users; p = 0.16). There was a trend toward increased conduction disturbances 7 days after TAVR in statin users (56 % vs 42 %; p = 0.07), but rates of AF (5 % vs 8 %; p = 0.39) and pacemaker placement (9 % vs 15 %; p = 0.20) were numerically lower in statin users. There was no significant difference in persistent conduction disturbances (21 % vs 18 %; p = 0.59). CONCLUSIONS Statins do not appear to reduce the risk of post-TAVR AF or conduction abnormalities in this small retrospective study.
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Affiliation(s)
- Tayyab Shah
- Yale School of Medicine, New Haven, CT, United States of America
| | - Rafael Maarek
- Yale School of Medicine, New Haven, CT, United States of America
| | - Claudia See
- Yale School of Medicine, New Haven, CT, United States of America
| | - Haocheng Huang
- Yale School of Medicine, New Haven, CT, United States of America
| | - Yanting Wang
- Yale School of Medicine, New Haven, CT, United States of America
| | - Helen Parise
- Yale School of Medicine, New Haven, CT, United States of America
| | - John K Forrest
- Yale School of Medicine, New Haven, CT, United States of America
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Damas F, Nguyen Trung ML, Postolache A, Petitjean H, Lempereur M, Viva T, Oury C, Dulgheru R, Lancellotti P. Cardiac Damage and Conduction Disorders after Transcatheter Aortic Valve Implantation. J Clin Med 2024; 13:409. [PMID: 38256543 PMCID: PMC10816504 DOI: 10.3390/jcm13020409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/06/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Recently, a staging system using 4 grades has been proposed to quantify the extent of cardiac damage associated with aortic stenosis (AS), namely AS-related cardiac damage staging (ASCDS). ASCDS is independently associated with all-cause mortality and important clinical outcomes. To evaluate whether it might be associated with the occurrence of conduction system disorders after TAVI, a total of 119 symptomatic patients with severe AS who underwent a TAVI were categorized according to ASCDS: group 1 (13.5%): no or LV damage; group 2 (58.8%): left atrial/mitral valve damage, atrial fibrillation (AF); group 3 (27.7%): low-flow state, pulmonary vasculature/tricuspid valve/RV damage. After TAVI, 34% of patients exhibited LBBB and 10% high-degree atrioventricular block (HD-AVB). No patient in group 1 developed HD-AVB whereas new LBBB was frequent in groups 2 and 3. Twenty-one patients presented with paroxysmal AF with a higher rate for each group increment (group 1: n = 0, 0%; group 2: n = 11, 15.7%; group 3: n = 10, 30.3%) (p = 0.012). Patients in group 3 had the higher rate of permanent pacemaker implantation (PPMI) (group 1: n = 1, 6.3%; group 2: n = 7, 10%; group 3: n = 9, 27.3%) (p = 0.012). In conclusion, ASCDS might help identify patients at higher risk of conduction disorders and PPMI requirement after TAVI.
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Affiliation(s)
- François Damas
- Department of Cardiology, CHU Sart Tilman, GIGA Cardiovascular Sciences Liège, University of Liège Hospital, 4000 Liège, Belgium; (F.D.); (M.-L.N.T.); (A.P.); (H.P.); (M.L.); (T.V.); (C.O.); (R.D.)
| | - Mai-Linh Nguyen Trung
- Department of Cardiology, CHU Sart Tilman, GIGA Cardiovascular Sciences Liège, University of Liège Hospital, 4000 Liège, Belgium; (F.D.); (M.-L.N.T.); (A.P.); (H.P.); (M.L.); (T.V.); (C.O.); (R.D.)
| | - Adriana Postolache
- Department of Cardiology, CHU Sart Tilman, GIGA Cardiovascular Sciences Liège, University of Liège Hospital, 4000 Liège, Belgium; (F.D.); (M.-L.N.T.); (A.P.); (H.P.); (M.L.); (T.V.); (C.O.); (R.D.)
| | - Hélène Petitjean
- Department of Cardiology, CHU Sart Tilman, GIGA Cardiovascular Sciences Liège, University of Liège Hospital, 4000 Liège, Belgium; (F.D.); (M.-L.N.T.); (A.P.); (H.P.); (M.L.); (T.V.); (C.O.); (R.D.)
| | - Mathieu Lempereur
- Department of Cardiology, CHU Sart Tilman, GIGA Cardiovascular Sciences Liège, University of Liège Hospital, 4000 Liège, Belgium; (F.D.); (M.-L.N.T.); (A.P.); (H.P.); (M.L.); (T.V.); (C.O.); (R.D.)
| | - Tommaso Viva
- Department of Cardiology, CHU Sart Tilman, GIGA Cardiovascular Sciences Liège, University of Liège Hospital, 4000 Liège, Belgium; (F.D.); (M.-L.N.T.); (A.P.); (H.P.); (M.L.); (T.V.); (C.O.); (R.D.)
- Department of Minimally Invasive Cardiac Surgery, University of Milan, 20122 Milan, Italy
- IRCCS Galeazzi, Sant’Ambrogio Hospital, 20157 Milan, Italy
| | - Cécile Oury
- Department of Cardiology, CHU Sart Tilman, GIGA Cardiovascular Sciences Liège, University of Liège Hospital, 4000 Liège, Belgium; (F.D.); (M.-L.N.T.); (A.P.); (H.P.); (M.L.); (T.V.); (C.O.); (R.D.)
| | - Raluca Dulgheru
- Department of Cardiology, CHU Sart Tilman, GIGA Cardiovascular Sciences Liège, University of Liège Hospital, 4000 Liège, Belgium; (F.D.); (M.-L.N.T.); (A.P.); (H.P.); (M.L.); (T.V.); (C.O.); (R.D.)
| | - Patrizio Lancellotti
- Department of Cardiology, CHU Sart Tilman, GIGA Cardiovascular Sciences Liège, University of Liège Hospital, 4000 Liège, Belgium; (F.D.); (M.-L.N.T.); (A.P.); (H.P.); (M.L.); (T.V.); (C.O.); (R.D.)
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8
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Faggi A, Buzzatti N, Marzi A, Fioravanti F, Denti P, Gatto P, Belluschi I, Agricola E, Godino C, Maisano F. Hisian Lead Electrical Decay After TAVR Intervention. JACC Case Rep 2023; 28:102090. [PMID: 38204541 PMCID: PMC10774790 DOI: 10.1016/j.jaccas.2023.102090] [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: 03/20/2023] [Revised: 08/24/2023] [Accepted: 09/11/2023] [Indexed: 01/12/2024]
Abstract
We report a case of patient with a single-chamber Hisian pacemaker who developed complete atrioventricular block and significant deterioration of the ventricular threshold and sensing after transcatheter aortic valve replacement. Revision of the implantation was required, with ventricular lead extraction and replacement.
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Affiliation(s)
| | | | | | | | - Paolo Denti
- Vita Salute San Raffaele University, Milan, Italy
| | - Pamela Gatto
- Vita Salute San Raffaele University, Milan, Italy
| | | | | | - Cosmo Godino
- Vita Salute San Raffaele University, Milan, Italy
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9
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Halapas A, Koliastasis L, Doundoulakis I, Antoniou CK, Stefanadis C, Tsiachris D. Transcatheter Aortic Valve Implantation and Conduction Disturbances: Focus on Clinical Implications. J Cardiovasc Dev Dis 2023; 10:469. [PMID: 37998527 PMCID: PMC10672026 DOI: 10.3390/jcdd10110469] [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: 10/04/2023] [Revised: 11/06/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is an established alternative to surgery in patients with symptomatic severe aortic stenosis and has expanded its indications to even low-surgical-risk patients. Conduction abnormalities (CA) and permanent pacemaker (PPM) implantations remain a relatively common finding post TAVI due to the close proximity of the conduction system to the aortic root. New onset left bundle branch block (LBBB) and high-grade atrioventricular block are the most commonly reported CA post TAVI. The overall rate of PPM implantation post TAVI varies and is related to pre- and intra-procedural factors. Therefore, when screening patients for TAVI, Heart Teams should take under consideration the various anatomical, pathophysiological and procedural conditions that predispose to CA and PPM requirement after the procedure. This is particularly important as TAVI is being offered to younger patients with longer life-expectancy. Herein, we highlight the incidence, predictors, impact and management of CA in patients undergoing TAVI.
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Affiliation(s)
- Antonios Halapas
- Department of Interventional Cardiologist and THV Program, Athens Medical Center, 11526 Athens, Greece;
| | - Leonidas Koliastasis
- Department of Cardiology, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium;
| | - Ioannis Doundoulakis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (C.-K.A.); (D.T.)
- Athens Heart Centre, Athens Medical Centre, 11526 Athens, Greece;
| | - Christos-Konstantinos Antoniou
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (C.-K.A.); (D.T.)
- Athens Heart Centre, Athens Medical Centre, 11526 Athens, Greece;
| | | | - Dimitrios Tsiachris
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (C.-K.A.); (D.T.)
- Athens Heart Centre, Athens Medical Centre, 11526 Athens, Greece;
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10
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Pagnesi M, Kim WK, Baggio S, Scotti A, Barbanti M, De Marco F, Adamo M, Eitan A, Estévez-Loureiro R, Conradi L, Toggweiler S, Mylotte D, Veulemans V, Søndergaard L, Wolf A, Giannini F, Maffeo D, Pilgrim T, Montorfano M, Zweiker D, Ferlini M, Kornowski R, Hildick-Smith D, Taramasso M, Abizaid A, Schofer J, Sinning JM, Van Mieghem NM, Wöhrle J, Khogali S, Van der Heyden JAS, Wood DA, Ielasi A, MacCarthy P, Brugaletta S, Hamm CW, Costa G, Testa L, Massussi M, Alarcón R, Schäfer U, Brunner S, Reimers B, Lunardi M, Zeus T, Vanhaverbeke M, Naber CK, Di Ienno L, Buono A, Windecker S, Schmidt A, Lanzillo G, Vaknin-Assa H, Arunothayaraj S, Saccocci M, Siqueira D, Brinkmann C, Sedaghat A, Ziviello F, Seeger J, Rottbauer W, Brouwer J, Buysschaert I, Jelisejevas J, Bharucha A, Regueiro A, Metra M, Colombo A, Latib A, Mangieri A. Incidence, Predictors, and Prognostic Impact of New Permanent Pacemaker Implantation After TAVR With Self-Expanding Valves. JACC Cardiovasc Interv 2023; 16:2004-2017. [PMID: 37480891 DOI: 10.1016/j.jcin.2023.05.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/23/2023] [Accepted: 05/08/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVES The authors sought to evaluate the incidence, predictors, and outcomes of new permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR) with contemporary self-expanding valves (SEV). BACKGROUND Need for PPI is frequent post-TAVR, but conflicting data exist on new-generation SEV and on the prognostic impact of PPI. METHODS This study included 3,211 patients enrolled in the multicenter NEOPRO (A Multicenter Comparison of Acurate NEO Versus Evolut PRO Transcatheter Heart Valves) and NEOPRO-2 (A Multicenter Comparison of ACURATE NEO2 Versus Evolut PRO/PRO+ Transcatheter Heart Valves 2) registries (January 2012 to December 2021) who underwent transfemoral TAVR with SEV. Implanted transcatheter heart valves (THV) were Acurate neo (n = 1,090), Acurate neo2 (n = 665), Evolut PRO (n = 1,312), and Evolut PRO+ (n = 144). Incidence and predictors of new PPI and 1-year outcomes were evaluated. RESULTS New PPI was needed in 362 patients (11.3%) within 30 days after TAVR (8.8%, 7.7%, 15.2%, and 10.4%, respectively, after Acurate neo, Acurate neo2, Evolut PRO, and Evolut PRO+). Independent predictors of new PPI were Society of Thoracic Surgeons Predicted Risk of Mortality score, baseline right bundle branch block and depth of THV implantation, both in patients treated with Acurate neo/neo2 and in those treated with Evolut PRO/PRO+. Predischarge reduction in ejection fraction (EF) was more frequent in patients requiring PPI (P = 0.014). New PPI was associated with higher 1-year mortality (16.9% vs 10.8%; adjusted HR: 1.66; 95% CI: 1.13-2.43; P = 0.010), particularly in patients with baseline EF <40% (P for interaction = 0.049). CONCLUSIONS New PPI was frequently needed after TAVR with SEV (11.3%) and was associated with higher 1-year mortality, particularly in patients with EF <40%. Baseline right bundle branch block and depth of THV implantation independently predicted the need of PPI.
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Affiliation(s)
- Matteo Pagnesi
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Won-Keun Kim
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Sara Baggio
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | | | - Marianna Adamo
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Amnon Eitan
- Department of Cardiology, Carmel Medical Center, Haifa, Israel
| | - Rodrigo Estévez-Loureiro
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute, Vigo, Spain
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center, Hamburg, Germany
| | - Stefan Toggweiler
- Heart Center Lucerne, Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Darren Mylotte
- Department of Cardiology, Galway University Hospitals, Galway, Ireland
| | - Verena Veulemans
- Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Lars Søndergaard
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Alexander Wolf
- Contilia Heart and Vascular Centre, Elisabeth-Krankenhaus Essen, Essen, Germany
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Diego Maffeo
- Interventional Cardiology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - David Zweiker
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
| | - David Hildick-Smith
- Department of Cardiology, Royal Sussex County Hospital, Brighton, United Kingdom
| | | | | | - Joachim Schofer
- Department for Percutaneous Treatment of Structural Heart Disease, Albertinen Heart Center, Hamburg, Germany; MVZ Department Structural Heart Disease, Asklepios St. Georg Clinic, Hamburg, Germany
| | - Jan-Malte Sinning
- Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jochen Wöhrle
- Department of Cardiology and Intensive Care, Medical Campus Lake Constance, Friedrichshafen, Germany
| | - Saib Khogali
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
| | - Jan A S Van der Heyden
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands; Interventional Cardiology Unit, AZ Sint-Jan Hospital, Bruges, Belgium
| | - David A Wood
- Centre for Heart Valve and Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Philip MacCarthy
- Department of Cardiology, King's College Hospital, London, United Kingdom
| | - Salvatore Brugaletta
- Clinic Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Christian W Hamm
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Giuliano Costa
- Department of Cardiology, C.A.S.T. Policlinico G. Rodolico, Catania, Italy
| | - Luca Testa
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Mauro Massussi
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Robert Alarcón
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute, Vigo, Spain
| | - Ulrich Schäfer
- Department of Internal Medicine, Marienkrankenhaus, Hamburg, Germany
| | - Stephanie Brunner
- Heart Center Lucerne, Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Bernhard Reimers
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Mattia Lunardi
- Department of Cardiology, Galway University Hospitals, Galway, Ireland
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Maarten Vanhaverbeke
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christoph K Naber
- Contilia Heart and Vascular Centre, Elisabeth-Krankenhaus Essen, Essen, Germany
| | - Luca Di Ienno
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Andrea Buono
- Interventional Cardiology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Albrecht Schmidt
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Giuseppe Lanzillo
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Hana Vaknin-Assa
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
| | | | - Matteo Saccocci
- Cardiac Surgery Unit, Fondazione Poliambulanza, Brescia, Italy
| | | | - Christina Brinkmann
- MVZ Department Structural Heart Disease, Asklepios St. Georg Clinic, Hamburg, Germany
| | - Alexander Sedaghat
- Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Francesca Ziviello
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Julia Seeger
- Department of Cardiology and Intensive Care, Medical Campus Lake Constance, Friedrichshafen, Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II, University Hospital Ulm, Ulm, Germany
| | - Jorn Brouwer
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Ian Buysschaert
- Interventional Cardiology Unit, AZ Sint-Jan Hospital, Bruges, Belgium
| | - Julius Jelisejevas
- Centre for Heart Valve and Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Apurva Bharucha
- Department of Cardiology, King's College Hospital, London, United Kingdom
| | - Ander Regueiro
- Clinic Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy.
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11
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Qi Y, Lin X, Pan W, Zhang X, Ding Y, Chen S, Zhang L, Zhou D, Ge J. A prediction model for permanent pacemaker implantation after transcatheter aortic valve replacement. Eur J Med Res 2023; 28:262. [PMID: 37516891 PMCID: PMC10387194 DOI: 10.1186/s40001-023-01237-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 07/18/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND This study aims to develop a post-procedural risk prediction model for permanent pacemaker implantation (PPMI) in patients treated with transcatheter aortic valve replacement (TAVR). METHODS 336 patients undergoing TAVR at a single institution were included for model derivation. For primary analysis, multivariate logistic regression model was used to evaluate predictors and a risk score system was devised based on the prediction model. For secondary analysis, a Cox proportion hazard model was performed to assess characteristics associated with the time from TAVR to PPMI. The model was validated internally via bootstrap and externally using an independent cohort. RESULTS 48 (14.3%) patients in the derivation set had PPMI after TAVR. Prior right bundle branch block (RBBB, OR: 10.46; p < 0.001), pre-procedural aortic valve area (AVA, OR: 1.41; p = 0.004) and post- to pre-procedural AVA ratio (OR: 1.72; p = 0.043) were identified as independent predictors for PPMI. AUC was 0.7 and 0.71 in the derivation and external validation set. Prior RBBB (HR: 5.07; p < 0.001), pre-procedural AVA (HR: 1.33; p = 0.001), post-procedural AVA to prosthetic nominal area ratio (HR: 0.02; p = 0.039) and post- to pre-procedural troponin-T difference (HR: 1.72; p = 0.017) are independently associated with time to PPMI. CONCLUSIONS The post-procedural prediction model achieved high discriminative power and accuracy for PPMI. The risk score system was constructed and validated, providing an accessible tool in clinical setting regarding the Chinese population.
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Affiliation(s)
- Yiming Qi
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Xiaolei Lin
- School of Data Science, Fudan University, Shanghai, China
| | - Wenzhi Pan
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Xiaochun Zhang
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yuefan Ding
- School of Data Science, Fudan University, Shanghai, China
| | - Shasha Chen
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Lei Zhang
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Daxin Zhou
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
- National Clinical Research Center for Interventional Medicine, Shanghai, China.
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
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12
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Lauten P, Costello-Boerrigter LC, Goebel B, Gonzalez-Lopez D, Schreiber M, Kuntze T, Al Jassem M, Lapp H. Transcatheter Aortic Valve Implantation: Addressing the Subsequent Risk of Permanent Pacemaker Implantation. J Cardiovasc Dev Dis 2023; 10:230. [PMID: 37367395 PMCID: PMC10299451 DOI: 10.3390/jcdd10060230] [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: 04/26/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is now a commonly used therapy in patients with severe aortic stenosis, even in those patients at low surgical risk. The indications for TAVI have broadened as the therapy has proven to be safe and effective. Most challenges associated with TAVI after its initial introduction have been impressively reduced; however, the possible need for post-TAVI permanent pacemaker implantation (PPI) secondary to conduction disturbances continues to be on the radar. Conduction abnormalities post-TAVI are always of concern given that the aortic valve lies in close proximity to critical components of the cardiac conduction system. This review will present a summary of noteworthy pre-and post-procedural conduction blocks, the best use of telemetry and ambulatory device monitoring to avoid unnecessary PPI or to recognize the need for late PPI due to delayed high-grade conduction blocks, predictors to identify those patients at greatest risk of requiring PPI, important CT measurements and considerations to optimize TAVI planning, and the utility of the MInimizing Depth According to the membranous Septum (MIDAS) technique and the cusp-overlap technique. It is stressed that careful membranous septal (MS) length measurement by MDCT during pre-TAVI planning is necessary to establish the optimal implantation depth before the procedure to reduce the risk of compression of the MS and consequent damage to the cardiac conduction system.
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Affiliation(s)
- Philipp Lauten
- Department of Cardiology, Heart Center, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99437 Bad Berka, Germany (B.G.); (H.L.)
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13
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Sammour YM, Lak H, Gajulapalli RD, Chawla S, Abushouk A, Parikh P, Alkhalaileh F, Kumar S, Svensson L, Yun J, Popovic Z, Harb S, Tarakji K, Wazni O, Reed GW, Puri R, Krishnaswamy A, Kapadia SR. Pacing-Related Differences After SAPIEN-3 TAVI: Clinical and Echocardiographic Correlates. Am J Cardiol 2023; 197:24-33. [PMID: 37137251 DOI: 10.1016/j.amjcard.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/15/2023] [Accepted: 04/02/2023] [Indexed: 05/05/2023]
Abstract
Data regarding the impact of pacing on outcomes after transcatheter aortic valve implantation (TAVI) is evolving especially with regards to pre-existing permanent pacemaker (PPM). We examined the impact of new and previous PPM on the clinical and hemodynamic outcomes after SAPIEN-3 TAVI. We included all consecutive patients who underwent transfemoral TAVI using SAPIEN-3 valve from 2015 to 2018 at our institution. Among 1,028 patients, 10.2% required a new PPM within 30 days, whereas 14% had a pre-existing PPM. The presence of either previous or new PPM had no impact on the 3-year mortality (log-rank p = 0.6) or 1-year major adverse cardiac and cerebrovascular events (log-rank p = 0.65). New PPM was associated with lower left ventricular (LV) ejection fraction (LVEF) at both 30 days (54.4 ± 11.3% vs 58.4 ± 10.1%, p = 0.001) and 1 year (54.2 ± 12% vs 59.1 ± 9.9%, p = 0.009) than no PPM. Similarly, previous PPM was associated with worse LVEF at 30 days (53.6 ± 12.3%, p <0.001) and 1 year (55.5 ± 12.1%, p = 0.006) than no PPM. Interestingly, new PPM was associated with lower 1-year mean gradient (11.4 ± 3.8 vs 12.6 ± 5.6 mm Hg, p = 0.04) and peak gradient (21.3 ± 6.5 vs 24.1 ± 10.4 mm Hg, p = 0.01), despite no baseline differences. Previous PPM was also associated with lower 1-year mean gradient (10.3 ± 4.4 mm Hg, p = 0.001) and peak gradient (19.4 ± 8 mm Hg, p <0.001) and higher Doppler velocity index (0.51 ± 0.12 vs 0.47 ± 0.13, p = 0.039). Moreover, 1-year LV end-systolic volume index was higher with new (23.2 ± 16.1 vs 20 ± 10.8 ml/m2, p = 0.038) and previous PPM (24.5 ± 19.7, p = 0.038) than no PPM. Previous PPM was associated with higher moderate-to-severe tricuspid regurgitation (35.3% vs 17.7%, p <0.001). There were no differences regarding the rest of the studied echocardiographic outcomes at 1 year. In conclusion, new and previous PPM did not affect 3-year mortality or 1-year major adverse cardiac and cerebrovascular events; however, they were associated with worse LVEF, higher 1-year LV end-systolic volume index, and lower mean and peak gradients on follow-up than no PPM.
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Affiliation(s)
- Yasser M Sammour
- Aortic Valve Center, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hassan Lak
- Section of Clinical Cardiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Sanchit Chawla
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Abdelrahman Abushouk
- Aortic Valve Center, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Parth Parikh
- Aortic Valve Center, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Sachin Kumar
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Lars Svensson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - James Yun
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Zoran Popovic
- Aortic Valve Center, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Serge Harb
- Aortic Valve Center, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Khaldoun Tarakji
- Aortic Valve Center, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Oussama Wazni
- Aortic Valve Center, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Grant W Reed
- Aortic Valve Center, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rishi Puri
- Aortic Valve Center, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amar Krishnaswamy
- Aortic Valve Center, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samir R Kapadia
- Aortic Valve Center, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
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14
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Sammour YM, Lak H, Chahine J, Abushouk A, Chawla S, Kadri A, Alkhalaileh F, Kumar S, Ghimire B, Svensson L, Popovic Z, Tarakji K, Wazni O, Reed GW, Yun J, Puri R, Krishnaswamy A, Kapadia SR. Clinical and echocardiographic outcomes with new-onset left bundle branch block after SAPIEN-3 transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2023; 101:187-196. [PMID: 36378620 DOI: 10.1002/ccd.30488] [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: 03/24/2022] [Revised: 10/13/2022] [Accepted: 10/30/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND New-onset left bundle branch block (LBBB) can develop after transcatheter aortic valve replacement (TAVR) resulting in worse outcomes. AIMS Describe clinical and echocardiographic outcomes with new-onset LBBB after TAVR. METHODS We included consecutive patients who underwent transfemoral-TAVR with SAPIEN-3 (S3) valve between April 2015 and December 2018. Exclusion criteria included pre-existing LBBB, right BBB, left anterior hemiblock, left posterior hemiblock, wide QRS ≥ 120ms, prior permanent pacemaker (PPM), and nontransfemoral access. RESULTS Among 612 patients, 11.4% developed new-onset LBBB upon discharge. The length of stay was longer with new-onset LBBB compared with no LBBB [3 (2-5) days versus 2 (1-3) days; p < 0.001]. New-onset LBBB was associated with higher rates of 30-day PPM requirement (18.6% vs. 5.4%; p < 0.001) and 1-year heart failure hospitalizations (10.7% vs. 4.4%; p = 0.033). There was no difference in 3-year mortality between both groups (30.9% vs. 30.6%; p = 0.829). Further, new-onset LBBB was associated with lower left ventricular ejection fraction (LVEF) at both 30 days (55.9 ± 11.4% vs. 59.3 ± 9%; p = 0.026) and 1 year (55 ± 12% vs. 60.1 ± 8.9%; p = 0.002). These changes were still present when we stratified patients according to baseline LVEF (≥50% or <50%). New-onset LBBBs were associated with a higher 1-year LV end-diastolic volume index (51.4 ± 18.6 vs. 46.4 ± 15.1 ml/m2 ; p = 0.036), and LV end-systolic volume index (23.2 ± 14.1 vs. 18.9 ± 9.7 ml/m2 ; p = 0.009). Compared with resolved new-onset LBBB, persistent new-onset LBBB was associated with worse LVEF and higher PPM at 1 year. CONCLUSIONS New-onset LBBB after S3 TAVR was associated with higher PPM requirement, worse LVEF, higher LV volumes, and increased heart failure hospitalizations, with no difference in mortality.
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Affiliation(s)
- Yasser M Sammour
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Hassan Lak
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Johnny Chahine
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Abdelrahman Abushouk
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Sanchit Chawla
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Amer Kadri
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Feras Alkhalaileh
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Sachin Kumar
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Bindesh Ghimire
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Lars Svensson
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Zoran Popovic
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Khaldoun Tarakji
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Oussama Wazni
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Grant W Reed
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - James Yun
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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15
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Prosthesis Tailoring for Patients Undergoing Transcatheter Aortic Valve Implantation. J Clin Med 2023; 12:jcm12010338. [PMID: 36615141 PMCID: PMC9821207 DOI: 10.3390/jcm12010338] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has risen over the past 20 years as a safe and effective alternative to surgical aortic valve replacement for treatment of severe aortic stenosis, and is now a well-established and recommended treatment option in suitable patients irrespective of predicted risk of mortality after surgery. Studies of numerous devices, either newly developed or reiterations of previous prostheses, have been accruing. We hereby review TAVI devices, with a focus on commercially available options, and aim to present a guide for prosthesis tailoring according to patient-related anatomical and clinical factors that may favor particular designs.
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16
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Dumitrof LC, Roca M, Mihăescu T, Tinică G. Prognostic value of biological parameters in patients with severe aortic stenosis undergoing TAVI - results at six months. BALNEO AND PRM RESEARCH JOURNAL 2022. [DOI: 10.12680/balneo.2022.519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
(1) Background: Aortic stenosis is the most common valvulopathy in elderly patients over 60 years of age. The absence of immediate surgical intervention through classic valve replacement or through a minimally invasive procedure, namely transcatheter implantation of the aortic valve (TAVI) leads to an increase in the risk of morbidity and mortality through the deterioration of the clinical condition. Since the first interventional transcatheter aortic valve implantation procedure was performed in 2012 and until now, the progression of medical technology and state-of-the-art valves have led to the refinement of the treatment strategy and the improvement of the prognosis of patients with aortic stenosis undergoing TAVI in the first 6 months after the procedure; (2) Methods: We conducted a prospective study in which 86 patients diagnosed with severe aortic stenosis underwent minimally invasive valve replacement by TAVI; (3) Results: The presence of preoperative anemia is associated with a negative prognosis both in the medium term and in evolution, and in addition to hematological parameters, we also evaluated a series of biochemical data, with special attention to renal function and lipid profile; (4) Conclusions: Biological parameters followed after TAVI may be predictors associated with a negative long-term prognosis.
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Affiliation(s)
- Luiza Cristina Dumitrof
- 1 University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iaşi, Romania; 2 Institute of Cardiovascular Diseases ”Prof. Dr. George I.M. Georgescu”, 700503 Iași, Romania
| | - Mihai Roca
- University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iaşi, Romania
| | - Traian Mihăescu
- University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iaşi, Romania
| | - Grigore Tinică
- University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iaşi, Romania
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17
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Monizzi G, Olivares P, Makmur G, Fabbiocchi F, Grancini L, Mastrangelo A, Ferrari C, Galli S, Montorsi P, Bartorelli AL. Conduction disorders after transcatheter aortic valve implantation: A comparison between SAPIEN 3 and SAPIEN 3 Ultra balloon-expandable valves. Front Cardiovasc Med 2022; 9:922696. [DOI: 10.3389/fcvm.2022.922696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
BackgroundConduction disorders (CD) are the most common complications after Transcatheter Aortic Valve Implantation (TAVI). The last generation of Edwards balloon expandable valves, the SAPIEN 3 Ultra (S3U), is provided with an external sealing skirt that aims to further reduce paravalvular leakage (PVL) compared to SAPIEN 3 (S3) and could potentially lead to higher CD rate. We sought to investigate the rate of new-onset CD in patients undergoing TAVI with the S3 or S3U valve.MethodsWe included 582 consecutive patients undergoing TAVI in a single high-volume Center. Patients with previously implanted pacemaker and Valve in valve procedures were excluded. CD rate was evaluated early after implantation and at discharge.ResultsNo significant difference in the overall CD rate was found between S3 and S3U patients both immediately after the procedure (S3 45.5% vs. S3U 41.8%, p = 0.575) and at discharge (S3 30.4% vs. S3U 35.6%, p = 0.348) with low rate of permanent pacemaker implantation (S3 6.3% vs. S3U 5.5%, p = 0.749). No significant differences were found also in patients with pre-existing atrial fibrillation (S3 8.2% vs. S3U 5%, p = 0.648). A significantly lower rate of PVL was found with S3U compared to S3 (S3 42% vs. S3U 26%, p = 0.007). According to the manufacturer’s guidelines we confirmed that S3U were implanted in a significantly higher position compared to S3 (S3 4.89 ± 1.57 mm vs. S3U 4.47 ± 1.36 mm, p = 0.001).ConclusionNo significant difference in the rate of CD, including the need for PPM implantation, was found in patients undergoing TAVI with the S3 compared to S3U. Moreover, S3U significantly reduced the PVL rate.
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18
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Laricchia A, Cereda A, Lucreziotti S, Sticchi A, Regazzoli D, Reimers B, Colombo A, Latib A, Mangieri A. Expanding our horizons for the use of transcatheter self-expanding valves: what does the future hold? Expert Rev Cardiovasc Ther 2022; 20:497-501. [PMID: 35673979 DOI: 10.1080/14779072.2022.2085688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Transcatheter aortic valve implantation (TAVI) is an established alternative to aortic valve surgery in patient with severe aortic valve stenosis. As interventionalists are pushing towards treatment of patients with lower risk profile with a wide range of anatomies, contemporary transcatheter heart valves (THV) should offer an excellent performance in terms of residual gradient, rate of pacemaker and perivalvular leak. AREAS COVERED Self-expandable (SE) valve offer a valid alternative to balloon-expandable (BE) valves, nevertheless comparative trials suggest a better outcome of patients treated with BE over SE platforms. New generation SE valves offer an excellent outcome in terms of procedural safety, however implementations in valve design and performance are required to reach the BE valves performance. EXPERT COMMENTARY in the near future, new devices should be able to obtain optimal results with a negligible rate of complications. Developments in the design of the delivery system together with refinements in valve technology are desirable to achieve results which are comparable to surgical aortic valve replacement.
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Affiliation(s)
| | - Alberto Cereda
- Cardiovascular department, ASST Santi Paolo Carlo, Milano, Italy
| | | | - Alessandro Sticchi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy.,Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Damiano Regazzoli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy.,Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Bernhard Reimers
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy.,Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy.,Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, 1825 Eastchester Road, Bronx, NY 10461, USA
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy.,Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
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19
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Weferling M, Rolf A, Fischer-Rasokat U, Liebetrau C, Renker M, Choi YH, Hamm CW, Dey D, Kim WK. Epicardial fat volume is associated with preexisting atrioventricular conduction abnormalities and increased pacemaker implantation rate in patients undergoing transcatheter aortic valve implantation. Int J Cardiovasc Imaging 2022; 38:1399-1406. [PMID: 34954805 PMCID: PMC11143016 DOI: 10.1007/s10554-021-02502-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/19/2021] [Indexed: 11/30/2022]
Abstract
Epicardial fat tissue (EFT) is a highly metabolically active fat depot surrounding the heart and coronary arteries that is related to early atherosclerosis and adverse cardiac events. We aimed to investigate the relationship between the amount of EFT and preexisting cardiac conduction abnormalities (CCAs) and the need for new postinterventional pacemaker in patients with severe aortic stenosis planned for transcatheter aortic valve implantation (TAVI). A total of 560 consecutive patients (54% female) scheduled for TAVI were included in this retrospective study. EFT volume was measured via a fully automated artificial intelligence software (QFAT) using computed tomography (CT) performed before TAVI. Baseline CCAs [first-degree atrioventricular (AV) block, right bundle branch block (RBBB), and left bundle branch block (LBBB)] were diagnosed according to 12-lead ECG before TAVI. Aortic valve calcification was determined by the Agatston score assessed in the pre-TAVI CT. The median EFT volume was 129.5 ml [IQR 94-170]. Baseline first-degree AV block was present in 17%, RBBB in 10.4%, and LBBB in 10.2% of the overall cohort. In adjusted logistic regression analysis, higher EFT volume was associated with first-degree AV block (OR 1.006 [95% CI 1.002-1.010]; p = 0.006) and the need for new pacemaker implantation after TAVI (OR 1.005 [95% CI 1.0-1.01]; p = 0.035) but not with the presence of RBBB or LBBB. EFT volume did not correlate with the Agatston score of the aortic valve. Greater EFT volume is associated independently with preexisting first-degree AV block and new pacemaker implantation in patients undergoing TAVI. It may play a causative role in degenerative processes and the susceptibility of the AV conduction system.
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Affiliation(s)
- Maren Weferling
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, 61231, Bad Nauheim, Germany.
- German Centre for Cardiovascular Research (DZHK), Partner Site RheinMain, Frankfurt, Germany.
| | - Andreas Rolf
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, 61231, Bad Nauheim, Germany
| | - Ulrich Fischer-Rasokat
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, 61231, Bad Nauheim, Germany
| | - Christoph Liebetrau
- Cardioangiological Center Bethanien (CCB), Department of Cardiology, Agaplesion Bethanien Hospital, Frankfurt, Germany
| | - Matthias Renker
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, 61231, Bad Nauheim, Germany
- Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Yeoung-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, 61231, Bad Nauheim, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site RheinMain, Frankfurt, Germany
- Department of Cardiology, University Hospital of Giessen, Giessen, Germany
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Taper A238, Los Angeles, CA, 90048, USA
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, 61231, Bad Nauheim, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site RheinMain, Frankfurt, Germany
- Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
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20
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Isogai T, Dykun I, Agrawal A, Shekhar S, Tarakji KG, Wazni OM, Kalra A, Krishnaswamy A, Reed GW, Kapadia SR, Puri R. Early Resolution of New-Onset Left Bundle Branch Block After Transcatheter Aortic Valve Implantation With the SAPIEN 3 Valve. Am J Cardiol 2022; 168:117-127. [PMID: 35045936 DOI: 10.1016/j.amjcard.2021.12.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/05/2021] [Accepted: 12/07/2021] [Indexed: 11/29/2022]
Abstract
New-onset left bundle branch block (LBBB) is common after transcatheter aortic valve implantation (TAVI) but can resolve in the post-TAVI period. We sought to examine the incidence, predictors, and outcomes of early resolution of new-onset LBBB among TAVI recipients with a SAPIEN 3 (S3) valve. Among 1,203 S3-TAVI recipients without a pre-existing pacemaker or wide QRS complex at our institution between 2016 and 2019, we identified 143 patients who developed new-onset LBBB during TAVI and divided them according to the resolution or persistence of LBBB by the next day post-TAVI to compare high-degree atrioventricular block (HAVB) and permanent pacemaker (PPM) rates. Patients with resolved LBBB (n = 74, 52%), compared with those with persistent LBBB, were more often women and had a shorter QRS duration at baseline and post-TAVI, with a smaller S3 size and a shallower implantation depth. A multivariable logistic regression model demonstrated significant associations of post-TAVI QRS duration (per 10 ms increase, odds ratio = 0.60 [95% confidence interval = 0.44 to 0.82]) and implantation depth (per 1-mm-depth-increase, 0.77 [0.61 to 0.97]) with a lower likelihood of LBBB resolution. No patient with resolved LBBB developed HAVB within 30 days post-TAVI. Meanwhile, 8 patients (11.6%) with persistent LBBB developed HAVB. The 2-year PPM rate was significantly higher after persistent LBBB than after resolved LBBB (30.3% vs 4.5%, log-rank p <0.001), mainly driven by higher 30-day PPM rate (18.8% vs 0.0%). In conclusion, about half of new-onset LBBBs that occurred during S3-TAVI resolved by the next day post-TAVI without HAVB. In contrast, new-onset persistent LBBB may need follow-up with ambulatory monitoring within 30 days because of the HAVB risk.
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Affiliation(s)
- Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Iryna Dykun
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Ankit Agrawal
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Shashank Shekhar
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Khaldoun G Tarakji
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Oussama M Wazni
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Grant W Reed
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
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21
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Mitsis A, Eftychiou C, Christophides T, Sakellaropoulos S, Avraamides P. The conjunction conundrum in Transcatheter Aortic Valve Implantation. Curr Probl Cardiol 2022; 48:101130. [PMID: 35114293 DOI: 10.1016/j.cpcardiol.2022.101130] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022]
Abstract
A continuous discussion regarding the predictors for permanent pacemaker implantation (PPI) following transcatheter aortic valve implantation (TAVI) is ongoing, especially in the era of low and medium risk patients. The aim of this article is to review the data so far regarding the pathophysiology, risk factors, and the indications for permanent pacemaker implantation after TAVI. The factors that contribute to rhythm abnormalities post TAVI can be divided into pre-existing conduction abnormalities, patient-related anatomical factors, and peri-procedural technical factors. The latter components are potentially modifiable, and this is where attention should be directed, particularly now that in an era of TAVI expansion towards lower-risk patients.
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Key Words
- AF, Atrial fibrillation
- AS, Aortic stenosis
- AV, Atrioventricular
- BAV, Balloon aortic valvuloplasty
- BBB, Bundle branch block
- BEV, Balloon expandable valve
- CAVB, Complete Atrioventricular block
- CRT,
- CT, Computer tomography
- Cardiac resynchronization therapy
- ECG, Electrocardiogram
- EPS, Electrophysiology study
- ID, Implantation depth
- LAH, Left anterior hemiblock
- LBBB, Left bundle branch block
- LCC, Left coronary cusp
- LVEF, Left ventricular ejection function
- LVOT, Left ventricular outflow track
- LVOT- EI, Left ventricular outflow track eccentricity index
- LVOT-CA, Left ventricular outflow track calcification
- MS, Membranous septum
- NCC, Non coronary cusp
- PPI, Permanent pacemaker implantation
- PVL, Paravalvular leak
- RAO, Right anterior oblique
- RBBB, Right bundle branch block
- RCC, Right coronary cusp
- SAS, Severe aortic stenosis
- SEV, Self-expandable valve
- TAVI, Transcatheter aortic valve implantation
- Transcatheter aortic valve implantation, pacemaker implantation, LBBB, balloon expandable valves, self-expandable valves, LVOT. List of abbreviations, AMCC, Aortomitral continuity calcification
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Affiliation(s)
- Andreas Mitsis
- Cardiology Department, Nicosia General Hospital, 2029, Nicosia, Cyprus.
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22
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Aymond JD, Benn F, Williams CM, Bernard ML, Hiltbold AE, Khatib S, Polin GM, Rogers PA, Tafur Soto JD, Ramee SR, Parrino PE, Falterman JB, Al-Khatib SM, Morin DP. Epidemiology, evaluation, and management of conduction disturbances after transcatheter aortic valve replacement. Prog Cardiovasc Dis 2021; 66:37-45. [PMID: 34332660 DOI: 10.1016/j.pcad.2021.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aortic stenosis is the most common valvulopathy requiring replacement by means of the surgical or transcatheter approach. Transcatheter aortic valve replacement (TAVR) has quickly become a viable and often preferred treatment strategy compared to surgical aortic valve replacement. However, transcatheter heart valve system deployment not infrequently injures the specialized electrical system of the heart, leading to new conduction disorders including high-grade atrioventricular block and complete heart block (CHB) necessitating permanent pacemaker implantation (PPI), which may lead to deleterious effects on cardiac function and patient outcomes. Additional conduction disturbances (e.g., new-onset persistent left bundle branch block, PR/QRS prolongation, and transient CHB) currently lack clearly defined management algorithms leading to variable strategies among institutions. This article outlines the current understanding of the pathophysiology, patient and procedural risk factors, means for further risk stratification and monitoring of patients without a clear indication for PPI, our institutional approach, and future directions in the management and evaluation of post-TAVR conduction disturbances.
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Affiliation(s)
- Joshua D Aymond
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - Francis Benn
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - Cody M Williams
- Ochsner Medical Center, New Orleans, LA, United States of America
| | | | - A Elise Hiltbold
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - Sammy Khatib
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - Glenn M Polin
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - Paul A Rogers
- Ochsner Medical Center, New Orleans, LA, United States of America
| | | | - Stephen R Ramee
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - P Eugene Parrino
- Ochsner Medical Center, New Orleans, LA, United States of America
| | | | - Sana M Al-Khatib
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - Daniel P Morin
- Ochsner Medical Center, New Orleans, LA, United States of America.
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23
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Galli V, Loncaric F, Rocatello G, Astudillo P, Sanchis L, Regueiro A, De Backer O, Swaans M, Bosmans J, Ribeiro JM, Lamata P, Sitges M, de Jaegere P, Mortier P. Towards patient-specific prediction of conduction abnormalities induced by transcatheter aortic valve implantation: a combined mechanistic modelling and machine learning approach. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:606-615. [PMID: 36713106 PMCID: PMC9708019 DOI: 10.1093/ehjdh/ztab063] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/12/2021] [Indexed: 02/01/2023]
Abstract
Aims Post-procedure conduction abnormalities (CA) remain a common complication of transcatheter aortic valve implantation (TAVI), highlighting the need for personalized prediction models. We used machine learning (ML), integrating statistical and mechanistic modelling to provide a patient-specific estimation of the probability of developing CA after TAVI. Methods and results The cohort consisted of 151 patients with normal conduction and no pacemaker at baseline who underwent TAVI in nine European centres. Devices included CoreValve, Evolut R, Evolut PRO, and Lotus. Preoperative multi-slice computed tomography was performed. Virtual valve implantation with patient-specific computer modelling and simulation (CM&S) allowed calculation of valve-induced contact pressure on the anatomy. The primary composite outcome was new onset left or right bundle branch block or permanent pacemaker implantation (PPI) before discharge. A supervised ML approach was applied with eight models predicting CA based on anatomical, procedural and mechanistic data. CA occurred in 59% of patients (n = 89), more often after mechanical than first or second generation self-expanding valves (68% vs. 60% vs. 41%). CM&S revealed significantly higher contact pressure and contact pressure index in patients with CA. The best model achieved 83% accuracy (area under the curve 0.84) and sensitivity, specificity, positive predictive value, negative predictive value, and F1-score of 100%, 62%, 76%, 100%, and 82%. Conclusion ML, integrating statistical and mechanistic modelling, achieved an accurate prediction of CA after TAVI. This study demonstrates the potential of a synergetic approach for personalizing procedure planning, allowing selection of the optimal device and implantation strategy, avoiding new CA and/or PPI.
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Affiliation(s)
- Valeria Galli
- FEops NV, Technologiepark 122, 9052 Ghent, Belgium,Corresponding authors. Tel: +32 3480113684, (V.G.); Tel: +32 474274543, (P.M.)
| | - Filip Loncaric
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Carrer del Rosselló, 149, 08036, Barcelona, Spain
| | | | | | - Laura Sanchis
- Cardiovascular Institute, Hospital Clínic and Universitat de Barcelona, C. de Villarroel, 170, 08036 Barcelona, Spain
| | - Ander Regueiro
- Cardiovascular Institute, Hospital Clínic and Universitat de Barcelona, C. de Villarroel, 170, 08036 Barcelona, Spain
| | - Ole De Backer
- Department of Cardiology, Rigshospitalet University Hospital, Blegdamsvej 9, 2100 København, Denmark
| | - Martin Swaans
- Department of Cardiology, St. Antonius Ziekenhuis, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
| | - Johan Bosmans
- Department of Cardiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Antwerp, Belgium
| | - Joana Maria Ribeiro
- Department of Cardiology, Erasmus MC, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Pablo Lamata
- Department of Biomedical Engineering, King’s College London, Strand, London WC2R 2LS, UK
| | - Marta Sitges
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Carrer del Rosselló, 149, 08036, Barcelona, Spain,Cardiovascular Institute, Hospital Clínic and Universitat de Barcelona, C. de Villarroel, 170, 08036 Barcelona, Spain,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0 28029 Madrid, Spain
| | - Peter de Jaegere
- Department of Cardiology, Erasmus MC, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Peter Mortier
- FEops NV, Technologiepark 122, 9052 Ghent, Belgium,Corresponding authors. Tel: +32 3480113684, (V.G.); Tel: +32 474274543, (P.M.)
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24
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Sammour Y, Krishnaswamy A, Kumar A, Puri R, Tarakji KG, Bazarbashi N, Harb S, Griffin B, Svensson L, Wazni O, Kapadia SR. Incidence, Predictors, and Implications of Permanent Pacemaker Requirement After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2021; 14:115-134. [PMID: 33478630 DOI: 10.1016/j.jcin.2020.09.063] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/04/2020] [Accepted: 09/29/2020] [Indexed: 12/29/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is a safe and feasible alternative to surgery in patients with symptomatic severe aortic stenosis regardless of the surgical risk. Conduction abnormalities requiring permanent pacemaker (PPM) implantation remain a common finding after TAVR due to the close proximity of the atrioventricular conduction system to the aortic root. High-grade atrioventricular block and new onset left bundle branch block (LBBB) are the most commonly reported conduction abnormalities after TAVR. The overall rate of PPM implantation after TAVR varies and is related to pre-procedural and intraprocedural factors. The available literature regarding the impact of conduction abnormalities and PPM requirement on morbidity and mortality is still conflicting. Pre-procedural conduction abnormalities such as right bundle branch block and LBBB have been linked with increased PPM implantation and mortality after TAVR. When screening patients for TAVR, heart teams should be aware of various anatomical and pathophysiological conditions that make patients more susceptible to increased risk of conduction abnormalities and PPM requirement after the procedure. This is particularly important as TAVR has been recently approved for patients with low surgical risk. The purpose of this review is to discuss the incidence, predictors, impact, and management of the various conduction abnormalities requiring PPM implantation in patients undergoing TAVR.
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Affiliation(s)
- Yasser Sammour
- Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA; Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Amar Krishnaswamy
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Arnav Kumar
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rishi Puri
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Khaldoun G Tarakji
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Najdat Bazarbashi
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Serge Harb
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Brian Griffin
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Lars Svensson
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Oussama Wazni
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Samir R Kapadia
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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25
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Sammour Y, Sato K, Kumar A, Gajulapalli RD, Lak H, Chawla S, Banerjee K, Kaur M, Patel J, Incognito C, Svensson L, Popovic Z, Tarakji K, Wazni O, Reed GW, Yun J, Puri R, Krishnaswamy A, Kapadia SR. Impact of baseline conduction abnormalities on outcomes after transcatheter aortic valve replacement with SAPIEN-3. Catheter Cardiovasc Interv 2021; 98:E127-E138. [PMID: 33010100 DOI: 10.1002/ccd.29309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 09/21/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Baseline conduction abnormalities are known risk factors for permanent pacemaker (PPM) implantation after transcatheter aortic valve replacement (TAVR). We sought to determine the impact of baseline right bundle branch block (RBBB), left bundle branch block (LBBB), left anterior hemiblock (LAHB), first-degree atrioventricular block (AVB) and atrial fibrillation/flutter (AF) on TAVR outcomes. METHODS Consecutive patients who underwent transfemoral TAVR with SAPIEN-3 (S3) were included. We excluded patients with prior PPM, nontransfemoral access or valve-in-valve. RESULTS Among 886 patients, baseline RBBB was seen in 15.9%, LBBB in 6.3%, LAHB in 6.2%, first-degree AVB in 26.3% and AF in 37.5%. The rate of 30-day PPM was 10.1%. Baseline RBBB (OR 4.005; 95% CI 2.386-6.723; p < .001) and first-degree AVB (OR 1.847; 95% CI 1.133-3.009; p = .014) were independent predictors of 30 day PPM. LAHB also resulted in higher PPM rates but only in unadjusted analysis (21.8% vs. 9.4%; p = .003). Baseline LBBB and AF were associated with lower left ventricular ejection fraction (LVEF) at both baseline and 1 year after TAVR. However, Δ LVEF over time were noted to be similar with baseline LBBB (1.8% vs. 1.4%; p = .809) and AF (1.1% vs. 1.7%; p = .458). Moreover, baseline AF was also associated with higher stroke/transient ischemic attack (TIA) at 1 year (4.4% vs. 1.8%; p = .019), 1-year major adverse cardiac and cerebrovascular events (MACCE) (19.5% vs. 13.3%; p = .012) and 2 year mortality (23.5% vs. 15.2%; p = .016). None of the other baseline conduction defects affected long-term mortality or MACCE. CONCLUSION In our S3 TAVR population, baseline RBBB and first-degree AVB predicted higher PPM risk. Prior LBBB and AF were associated with lower LVEF at both baseline and 1 year. Lastly, preexisting AF was associated with higher rates of mortality, stroke/TIA, and MACCE.
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Affiliation(s)
- Yasser Sammour
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Kimi Sato
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Arnav Kumar
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Rama Dilip Gajulapalli
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Hassan Lak
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Sanchit Chawla
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Kinjal Banerjee
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Manpreet Kaur
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Jay Patel
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Cameron Incognito
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Lars Svensson
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Zoran Popovic
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Khaldoun Tarakji
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Oussama Wazni
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Grant W Reed
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - James Yun
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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26
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Weferling M, Liebetrau C, Renker M, Fischer-Rasokat U, Choi YH, Hamm CW, Kim WK. Right bundle branch block is not associated with worse short- and mid-term outcome after transcatheter aortic valve implantation. PLoS One 2021; 16:e0253332. [PMID: 34133470 PMCID: PMC8208572 DOI: 10.1371/journal.pone.0253332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/03/2021] [Indexed: 11/18/2022] Open
Abstract
Background Transcatheter aortic valve implantation (TAVI) is the standard treatment option for patients with severe aortic stenosis (AS) at intermediate or high surgical risk. Preexisting right bundle branch block (RBBB) is a strong predictor of new pacemaker implantation (PPM) after TAVI, and previous data indicate a worse short- and long-term outcome of patients. The aim of this study was to investigate whether preexisting RBBB has an effect on the short- and mid-term outcome of patients undergoing TAVI in a German high-volume TAVI center. Methods For the present retrospective analysis, a total of 1,891 patients with native severe AS with successful TAVI without preexisting PPM were included. The primary endpoint was all-cause mortality after 30 days and 12 months. Baseline RBBB was present in 190 (10.1%) of cases. Results Patients with preexisting RBBB had a considerably higher rate of new PPM after TAVI compared with patients without RBBB (87/190 [45.8%] vs. 219/1,701 [12.9%]; p<0.001). RBBB had no impact on all-cause mortality at 30 days (2.1% vs. 2.7%; p = 0.625) and at 12 months (14.4% vs. 13.6%; p = 0.765). Further stratification according to the presence of new PPM showed a difference in mid-term survival rates between the four groups, with the worst outcome for patients without RBBB and new PPM (log rank p = 0.024). However, no difference in mid-term cardiovascular survival was found. Conclusion Preexisting RBBB is a common finding in patients with severe AS undergoing TAVI and is associated with considerably higher PPM rates but not with worse short- and mid-term outcome.
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Affiliation(s)
- Maren Weferling
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site RheinMain, Berlin, Germany
- * E-mail:
| | - Christoph Liebetrau
- Cardioangiological Center Bethanien (CCB), Department of Cardiology, Agaplesion Bethanien Hospital, Frankfurt, Germany
| | - Matthias Renker
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
- Kerckhoff Heart and Thorax Center, Department of Cardiac Surgery, Bad Nauheim, Germany
| | | | - Yeoung-Hoon Choi
- Kerckhoff Heart and Thorax Center, Department of Cardiac Surgery, Bad Nauheim, Germany
| | - Christian W. Hamm
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site RheinMain, Berlin, Germany
- Department of Cardiology, University Hospital of Giessen, Giessen, Germany
| | - Won-Keun Kim
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
- Kerckhoff Heart and Thorax Center, Department of Cardiac Surgery, Bad Nauheim, Germany
- Department of Cardiology, University Hospital of Giessen, Giessen, Germany
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27
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Keiler J, Meinel FG, Ortak J, Weber MA, Wree A, Streckenbach F. Morphometric Characterization of Human Coronary Veins and Subvenous Epicardial Adipose Tissue-Implications for Cardiac Resynchronization Therapy Leads. Front Cardiovasc Med 2021; 7:611160. [PMID: 33426007 PMCID: PMC7793918 DOI: 10.3389/fcvm.2020.611160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022] Open
Abstract
Subvenous epicardial fat tissue (SEAT), which acts as an electrical insulation, and the venous diameter (VD) both constitute histomorphological challenges for optimal application and lead design in cardiac synchronization therapy (CRT). In this study, we characterized the morphology of human coronary veins to improve the technical design of future CRT systems and to optimize the application of CRT leads. We retrospectively analyzed data from cardiac computed tomography (CT) of 53 patients and did studies of 14 human hearts using the postmortem freeze section technique and micro CT. Morphometric parameters (tributary distances, offspring angles, luminal VD, and SEAT thickness) were assessed. The left posterior ventricular vein (VVSP) had a mean proximal VD of 4.0 ± 1.4 mm, the left marginal vein (VMS) of 3.2 ± 1.5 mm and the anterior interventricular vein (VIA) of 3.9 ± 1.3 mm. More distally (5 cm), VDs decreased to 2.4 ± 0.6 mm, 2.3 ± 0.7 mm, and 2.4 ± 0.6 mm, respectively. In their proximal portions (15 mm), veins possessed mean SEAT thicknesses of 3.2 ± 2.4 (VVSP), 3.4 ± 2.4 mm (VMS), and 4.2 ± 2.8 mm (VIA), respectively. More distally (20-70 mm), mean SEAT thicknesses decreased to alternating low levels of 1.3 ± 1.1 mm (VVSP), 1.7 ± 1.1 mm (VMS), and 4.3 ± 2.6 mm (VIA), respectively. In contrast to the VD, SEAT thicknesses alternated along the further distal vein course and did not display a continuous decrease. Besides the CRT responsiveness of different areas of the LV myocardium, SEAT is a relevant electrophysiological factor in CRT, potentially interfering with sensing and pacing. A sufficient VD is crucial for successful CRT lead placement. Measurements revealed a trend toward greater SEAT thickness for the VIA compared to VVSP and VMS, suggesting a superior signal-to-noise-ratio in VVSP and VMS.
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Affiliation(s)
- Jonas Keiler
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
| | - Felix G Meinel
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Jasmin Ortak
- Rhythmology and Clinical Electrophysiology, Divisions of Cardiology, Rostock University Medical Center, Rostock, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Andreas Wree
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
| | - Felix Streckenbach
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany.,Center for Transdisciplinary Neurosciences Rostock (CTNR), Rostock University Medical Center, Rostock, Germany
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28
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Bruno F, D'Ascenzo F, Vaira MP, Elia E, Omedè P, Kodali S, Barbanti M, Rodès-Cabau J, Husser O, Sossalla S, Van Mieghem NM, Bax J, Hildick-Smith D, Munoz-Garcia A, Pollari F, Fischlein T, Budano C, Montefusco A, Gallone G, De Filippo O, Rinaldi M, la Torre M, Salizzoni S, Atzeni F, Pocar M, Conrotto F, De Ferrari GM. Predictors of pacemaker implantation after transcatheter aortic valve implantation according to kind of prosthesis and risk profile: a systematic review and contemporary meta-analysis. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 7:143-153. [PMID: 33289527 DOI: 10.1093/ehjqcco/qcaa089] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/14/2020] [Accepted: 11/19/2020] [Indexed: 12/12/2022]
Abstract
AIMS Permanent pacemaker implantation (PPI) may be required after transcatheter aortic valve implantation (TAVI). Evidence on PPI prediction has largely been gathered from high-risk patients receiving first-generation valve implants. We undertook a meta-analysis of the existing literature to examine the incidence and predictors of PPI after TAVI according to generation of valve, valve type, and surgical risk. METHODS AND RESULTS We made a systematic literature search for studies with ≥100 patients reporting the incidence and adjusted predictors of PPI after TAVI. Subgroup analyses examined these features according to generation of valve, specific valve type, and surgical risk. We obtained data from 43 studies, encompassing 29 113 patients. Permanent pacemaker implantation rates ranged from 6.7% to 39.2% in individual studies with a pooled incidence of 19% (95% CI 16-21). Independent predictors for PPI were age [odds ratio (OR) 1.05, 95% confidence interval (CI) 1.01-1.09], left bundle branch block (LBBB) (OR 1.45, 95% CI 1.12-1.77), right bundle branch block (RBBB) (OR 4.15, 95% CI 3.23-4.88), implantation depth (OR 1.18, 95% CI 1.11-1.26), and self-expanding valve prosthesis (OR 2.99, 95% CI 1.39-4.59). Among subgroups analysed according to valve type, valve generation and surgical risk, independent predictors were RBBB, self-expanding valve type, first-degree atrioventricular block, and implantation depth. CONCLUSIONS The principle independent predictors for PPI following TAVI are age, RBBB, LBBB, self-expanding valve type, and valve implantation depth. These characteristics should be taken into account in pre-procedural assessment to reduce PPI rates. PROSPERO ID CRD42020164043.
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Affiliation(s)
- Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Matteo Pio Vaira
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Edoardo Elia
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Pierluigi Omedè
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Susheel Kodali
- Department of Cardiology, Division of Cardiology, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Marco Barbanti
- Department of Cardiology, C.A.S.T. Policlinic G. Rodolico Hospital, University of Catania, Catania, Italy
| | - Josep Rodès-Cabau
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Oliver Husser
- Klinik für Innere Medizin I St.-Johannes-Hospital, Dortmund, Germany
| | - Samuel Sossalla
- Department for Internal Medicine II, Cardiology, Pneumology, Intensive Care, University Hospital Regensburg, Regensburg, Germany
| | - Nicolas M Van Mieghem
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jeroen Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
| | - David Hildick-Smith
- Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | | | - Francesco Pollari
- Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg - Paracelsus Medical University, Breslauer Str. 201, Nuremberg, Germany
| | - Theodor Fischlein
- Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg - Paracelsus Medical University, Breslauer Str. 201, Nuremberg, Germany
| | - Carlo Budano
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Antonio Montefusco
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Guglielmo Gallone
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Mauro Rinaldi
- Division of Cardiosurgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Michele la Torre
- Division of Cardiosurgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Stefano Salizzoni
- Division of Cardiosurgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Francesco Atzeni
- Division of Cardiosurgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Marco Pocar
- Division of Cardiosurgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Federico Conrotto
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
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Predictors and Biomarkers of Subclinical Leaflet Thrombosis after Transcatheter Aortic Valve Implantation. J Clin Med 2020; 9:jcm9113742. [PMID: 33233321 PMCID: PMC7700436 DOI: 10.3390/jcm9113742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/12/2020] [Accepted: 11/18/2020] [Indexed: 01/03/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is a recent revolutionary treatment for high-risk patients with severe aortic stenosis who are not suitable for surgery, expanding to intermediate and low-risk patients. Valve leaflet thrombosis (LT) is a potentially fatal complication after TAVI. The incidence of subclinical LT is as high as 25% among patients in the first year after TAVI. Subclinical LT may evolve into symptomatic thrombosis or lead to premature bioprosthesis degeneration, increasing the risk of neurological complications. Because imaging-based methods have limited sensitivity to detect subclinical LT, there is an urgent need for predictors and biomarkers that would make it possible to predict LT after TAVI. Here, we summarize recent data regarding (i) patient-related, (ii) procedure-related, (iii) blood-based and (iv) imaging predictors and biomarkers which might be useful for the early diagnosis of subclinical LT after TAVI. Prevention of LT might offer an opportunity to improve risk stratification and tailor therapy after TAVI.
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30
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Lilly SM, Deshmukh AJ, Epstein AE, Ricciardi MJ, Shreenivas S, Velagapudi P, Wyman JF. 2020 ACC Expert Consensus Decision Pathway on Management of Conduction Disturbances in Patients Undergoing Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2020; 76:2391-2411. [DOI: 10.1016/j.jacc.2020.08.050] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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31
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Adam R, Munteanu A, Mititelu R, Onciul S, Deleanu D, Iliescu VA, Popescu BA, Jurcut R. Severe Aortic Stenosis and ATTRwt Amyloidosis - Beware in the Aging: A Case Report and Review of the Literature. Clin Interv Aging 2020; 15:1863-1872. [PMID: 33061335 PMCID: PMC7537991 DOI: 10.2147/cia.s265103] [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: 06/12/2020] [Accepted: 08/05/2020] [Indexed: 11/24/2022] Open
Abstract
Degenerative aortic valve (AV) disease is the most frequent valvular heart disease slowly progressing to severe aortic stenosis (AS) which usually requires aortic valve replacement. Another frequent condition, especially among elderly people, is cardiac amyloidosis (CA), particularly the wild-type transthyretin cardiac amyloidosis (ATTRwt). Since both of these diseases are considered a marker of ageing, there is a significant proportion of elderly patients who associate both severe AS and CA. Recent studies reported a high prevalence of both severe AS and CA (AS-CA) in elderly patients referred for TAVR of 13–16%, carrying a worse prognosis. The present case illustrates the diagnostic algorithm and the management of ATTRwt CA in an elderly patient with severe paradoxical low-flow low-gradient AS, accompanied by a review of the current literature about the red flags which help identifying CA in patients with severe AS, as well as the prognosis and management of these disease association.
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Affiliation(s)
- Robert Adam
- Department of Cardiology, "Prof. Dr. C.C. Iliescu" Emergency Institute for Cardiovascular Diseases, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Alice Munteanu
- Department of Cardiology, Emergency University Central Military Hospital, Bucharest, Romania
| | - Raluca Mititelu
- Department of Nuclear Medicine, Emergency University Central Military Hospital, Bucharest, Romania
| | - Sebastian Onciul
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Cardiology, Clinical Emergency Hospital, Bucharest, Romania
| | - Dan Deleanu
- Department of Cardiology, "Prof. Dr. C.C. Iliescu" Emergency Institute for Cardiovascular Diseases, Bucharest, Romania
| | - Vlad Anton Iliescu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Cardiovascular Surgery, "Prof. Dr. C.C. Iliescu" Emergency Institute for Cardiovascular Diseases, Bucharest, Romania
| | - Bogdan A Popescu
- Department of Cardiology, "Prof. Dr. C.C. Iliescu" Emergency Institute for Cardiovascular Diseases, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Ruxandra Jurcut
- Department of Cardiology, "Prof. Dr. C.C. Iliescu" Emergency Institute for Cardiovascular Diseases, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Shoar S, Batra S, Gulraiz A, Ikram W, Javed M, Hosseini F, Naderan M, Shoar N, John J, Modukuru VR, Sharma SK. Effect of pre-existing left bundle branch block on post-procedural outcomes of transcatheter aortic valve replacement: a meta-analysis of comparative studies. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2020; 10:294-300. [PMID: 33224576 PMCID: PMC7675150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 09/03/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND As an established procedure for patients with aortic valve stenosis and a high surgical risk profile, transcatheter aortic valve replacement (TAVR) can be associated with conductance abnormalities. However, data regarding the impact of pre-existing left bundle branch block (LBBB) on post-TAVR outcome is scarce. OBJECTIVES We conducted this meta-analysis to pool available data in the literature on the impact of pre-existing LBBB on the clinical outcomes of patients undergoing TAVR. METHODS We queried Medline/PubMed, Scopus, and Cochrane Library to identify comparative studies of patients with and without a pre-existing LBBB undergoing TAVR for aortic stenosis. Risk ratio (RR) and the corresponding 95% confidence interval (95% CI) were estimated to measure the effect of pre-existing LBBB on developing post-procedure stroke, permanent pacemaker implantation (PPM), or moderate/severe aortic regurgitation (AR). RESULTS Data of three clinical trials encompassing 4,668 patients undergoing TAVR were included in this meta-analysis. Patients with pre-existing LBBB prior to TAVR had an increased risk of developing moderate/severe AR (RR = 1.04 [0.79-1.37]; P = 0.77), stroke (RR = 1.72 [0.61-4.85]; P = 0.31), and a need for PPM implantation (RR = 4.43 [0.43-45.64]; P = 0.21) following TAVR. CONCLUSION Preexisting LBBB seems to increase the risk of developing stroke, aortic regurgitation, and the need for a permanent pacemaker implantation. However, due to scarcity of data and high heterogeneity among the current studies, further clinical trials are warranted.
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Affiliation(s)
- Saeed Shoar
- Department of Clinical Research, ScientificWriting CorporationHouston, TX, USA
| | - Simran Batra
- Department of Internal Medicine, Dow University of Health SciencesKarachi, Pakistan
| | - Azouba Gulraiz
- Department of Medicine, Nishtar Medical UniversityMultan, Pakistan
| | - Waleed Ikram
- Department of Medicine, Lahore Medical and Dental CollegeLahore, Pakistan
| | - Moiz Javed
- Department of Medicine, Lahore Medical and Dental CollegeLahore, Pakistan
| | - Fatemeh Hosseini
- Faculty of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Mohammad Naderan
- Faculty of Medicine, Tehran University of Medical SciencesTehran, Iran
| | - Nasrin Shoar
- Faculty of Medicine, Kashan University of Medical SciencesKashan, Iran
| | - Jobby John
- Department of Medicine, Dr. Somervell C.S.I. Medical College and HospitalKarakonam, Trivandrum, Kerala, India
| | - Venkat R Modukuru
- Department of Surgery, Metropolitan Hospital, New York College of MedicineManhattan, New York, USA
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount SinaiNY, USA
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Laricchia A, Khokhar AA, Gallo F, Giannini F, Colombo A, Latib A, Mangieri A. Transcatheter aortic valve replacement: potential use in lower-risk aortic stenosis. Expert Rev Cardiovasc Ther 2020; 18:723-731. [PMID: 33021849 DOI: 10.1080/14779072.2020.1833717] [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] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The widespread use of transcatheter aortic valve implantation (TAVI) is expanding to low-risk patients. Nevertheless, a low clinical risk does not always correspond to a low procedural risk for the percutaneous approach. AREAS COVERED The initial trials on TAVI in low-risk populations had encouraging results, showing non-inferiority in comparison to surgical aortic valve replacement (SAVR). However, the low-risk definition is based on risk score calculators developed for the surgical setting and not including other specific features that are more relevant to TAVI and can affect procedural outcomes. For example, the presence of bicuspid aortic valves, high calcific burden, low coronary height or conduction disturbances is all potentially associated with suboptimal results or even procedural complications. In addition, the lack of longer follow-up prevents us to draw conclusions about long-term outcomes, including data about valve durability and coronary re-access. EXPERT OPINION Although current evidence suggest similar results for TAVI and SAVR in low-risk populations, there are some technical and procedural limitations that still need to be addressed in order to close the gap between TAVI and surgery. Optimal, lasting results with a low rate of procedural complications are highly expected in low-risk, otherwise healthy subjects, with potential for longevity.
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Affiliation(s)
- Alessandra Laricchia
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Arif A Khokhar
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Francesco Gallo
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Francesco Giannini
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Antonio Colombo
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center , Bronx, NY, USA
| | - Antonio Mangieri
- Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital , Cotignola, Italy
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Next-generation transcatheter aortic valve implantation. JTCVS OPEN 2020; 3:14-24. [PMID: 36003870 PMCID: PMC9390526 DOI: 10.1016/j.xjon.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 06/14/2020] [Accepted: 06/17/2020] [Indexed: 11/22/2022]
Abstract
Objective Transcatheter aortic valve implantation (TAVI) procedures are increasing rapidly, but the durability of tissue valve and periprocedural complications are not satisfactory. Immune reaction to the galactose-α-1,3 galactose β-1,4-N-acetylglucosamine (α-Gal) and conventional processing protocols of cardiac xenografts lead to calcification. Next-generation TAVI needs to be made with α-Gal–free xenografts by multiple anticalcification therapies to avoid immune rejection and enhance durability, and three-dimensional (3D) printing technology to improve the procedural safety. Methods Porcine pericardia were decellularized and immunologically modified with α-galactosidase. The pericardia were treated by space filler, crosslinked with glutaraldehyde in organic solvent, and detoxified. The sheep-specific nitinol (nickel–titanium memory alloy) wire backbone was made from a 3D-printed model for ovine aortic root. After it passed the fitting test, we manufactured a self-expandable stented valve with the porcine pericardia mounted on the customized nitinol wire–based stent. After in vitro circulation using customized silicone aortic root, we performed TAVI in 9 sheep and obtained hemodynamic, radiological, immunohistopathological, and biochemical results. Results The valve functioned well, with excellent stent fitting and good coronary flow under in vitro circulation. Sheep were sequentially scheduled to be humanely killed until 238 days after TAVI. Echocardiography and cardiac catheterization demonstrated good hemodynamic status and function of the aortic valve. The xenografts were well preserved without α-Gal immune reaction or calcification based on the immunological, radiographic, microscopic, and biochemical examinations. Conclusions We proved preclinical safety and efficacy for next-generation α-Gal–free TAVI with multiple anticalcification therapies and 3D-printing technology. A future clinical study is warranted based on these promising preclinical results.
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Manuel AM, Almeida J, Guerreiro C, Dias T, Barbosa A, Teixeira P, Ribeiro J, Dias A, Caeiro D, Fonseca M, Teixeira M, Oliveira M, Gonçalves H, Primo J, Rodrigues A, Gama V, Braga P, Fontes-Carvalho R. The effects of transcatheter aortic valve implantation on cardiac electrical properties. Rev Port Cardiol 2020; 39:431-440. [DOI: 10.1016/j.repc.2020.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 12/31/2019] [Accepted: 02/22/2020] [Indexed: 11/26/2022] Open
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Manuel AM, Almeida J, Guerreiro C, Dias T, Barbosa A, Teixeira P, Ribeiro J, Dias A, Caeiro D, Fonseca M, Teixeira M, Oliveira M, Gonçalves H, Primo J, Rodrigues A, Gama V, Braga P, Fontes-Carvalho R. The effects of transcatheter aortic valve implantation on cardiac electrical properties. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2020.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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37
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Risk factors for permanent pacemaker implantation in patients receiving a balloon-expandable transcatheter aortic valve prosthesis. Heart Vessels 2020; 35:1735-1745. [DOI: 10.1007/s00380-020-01653-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/17/2020] [Indexed: 11/27/2022]
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Subramani S, Arora L, Krishnan S, Hanada S, Sharma A, Ramakrishna H. Analysis of Conduction Abnormalities and Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement. J Cardiothorac Vasc Anesth 2020; 34:1082-1093. [DOI: 10.1053/j.jvca.2019.07.132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 07/17/2019] [Indexed: 12/31/2022]
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Kooistra NHM, van Mourik MS, Rodríguez-Olivares R, Maass AH, Nijenhuis VJ, van der Werf R, ten Berg JM, Kraaijeveld AO, Baan Jr J, Voskuil M, Vis MM, Stella PR. Late onset of new conduction disturbances requiring permanent pacemaker implantation following TAVI. Heart 2020; 106:1244-1251. [DOI: 10.1136/heartjnl-2019-315967] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/27/2019] [Accepted: 01/08/2020] [Indexed: 12/31/2022] Open
Abstract
BackgroundThe timing of onset and associated predictors of late new conduction disturbances (CDs) leading to permanent pacemaker implantation (PPI) following transcatheter aortic valve implantation (TAVI) are still unknown, however, essential for an early and safe discharge. This study aimed to investigate the timing of onset and associated predictors of late onset CDs in patients requiring PPI (LCP) following TAVI.Methods and resultsWe performed retrospective analysis of prospectively collected data from five large volume centres in Europe. Post-TAVI electrocardiograms and telemetry data were evaluated in patients with a PPI post-TAVI to identify the onset of new advanced CDs. Early onset CDs were defined as within 48 hours after procedure, and late onset CDs as after 48 hours. A total of 2804 patients were included for analysis. The PPI rate was 12%, of which 18% was due to late onset CDs (>48 hours). Independent predictors for LCP were pre-existing non-specific intraventricular conduction delay, pre-existing right bundle branch block, self-expandable valves and predilation. At least one of these risk factors was present in 98% of patients with LCP. Patients with a balloon-expandable valve without predilation did not develop CDs requiring PPI after 48 hours.ConclusionsSafe early discharge might be feasible in patients without CDs in the first 48 hours after TAVI if no risk factors for LCP are present.
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Sattar Y, Rauf H, Bareeqa SB, Ullah W, Myla M. Transcatheter Aortic Valve Replacement versus Surgical Aortic Valve Replacement: A Review of Aortic Stenosis Management. Cureus 2019; 11:e6431. [PMID: 31993269 PMCID: PMC6970438 DOI: 10.7759/cureus.6431] [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] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Severe aortic stenosis (AS) affects 3.4% of the elderly over 60 years of age. It presents with exertional dyspnea, syncope, angina, and progression to irreversible congestive heart failure. Early intervention produces a better outcome in preventing the clinical deterioration of AS. The choice of intervention is transcatheter aortic valve implantation or surgical aortic valve replacement (SAVR). The decision should be made after evaluating an individual case based on its clinical features and the user’s experience with transcatheter aortic valve replacement (TAVR). We reviewed available data to illustrate the types of ASs, the background of interventions, current guidelines for TAVR, and its comparison with SAVR in terms of adverse effects.
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Affiliation(s)
- Yasar Sattar
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Hiba Rauf
- Internal Medicine, Dow Medical College, Karachi, PAK
| | | | - Waqas Ullah
- Internal Medicine, Abington Hospital - Jefferson Health, Abington, USA
| | - Madhura Myla
- Cardiovascular Disease, University of New Mexico Health Sciences Center, Albuquerque, USA
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Schoechlin S, Jalil F, Blum T, Ruile P, Hein M, Nührenberg TG, Arentz T, Neumann FJ. Need for pacemaker implantation in patients with normal QRS duration immediately after transcatheter aortic valve implantation. Europace 2019; 21:1851-1856. [DOI: 10.1093/europace/euz261] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 08/29/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
We sought to assess the need for permanent pacemaker implantation (PPI) in patients with QRS <120 ms in electrocardiogram (ECG) after transcatheter aortic valve implantation (TAVI).
Methods and results
We retrospectively analysed 1139 consecutive patients who underwent transfemoral TAVI between 2008 and 2016, receiving different valve types. All patients were surveyed by continuous ECG monitoring for 48 h, 12-lead ECGs starting immediately after procedure, as well as 24-h Holter recording the day before discharge. Indication for PPI was at the discretion of the attending physician. Among 760 patients with QRS <120 ms prior to the TAVI procedure, 400 patients showed QRS <120 ms immediately after procedure, whereas 360 patients had QRS ≥120 ms. In the group with QRS <120 ms, PPI was performed in 34 patients [8.5%; 95% confidence interval (CI) 5.6–11.2%] during the first week. Eight of the PPIs in the group with QRS <120 ms (2%; CI 0.8–3.5%) fulfilled Class I indications for PPI after TAVI, whereas 26 PPIs had different indications [left bundle branch block, sick sinus, low-grade atrioventricular (AV) block]. Complete AV block developed in three patients of the group of QRS <120 ms (0.75%; CI 0.0–1.7%), which in all cases occurred after the 48 h-surveillance period. During 1-year follow-up, 11 PPIs were performed (2.8%; CI 1.2–4.5%), thereof three PPI for Class I indications including one complete AV block.
Conclusion
In patients with QRS duration <120 ms immediately after TAVI, the risk for complete AV block was low during the first week after TAVI and 1-year follow-up.
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Affiliation(s)
- Simon Schoechlin
- Division of Cardiology and Angiology II, University Heart Centre Freiburg-Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany
| | - Fares Jalil
- Division of Cardiology and Angiology II, University Heart Centre Freiburg-Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany
| | - Thomas Blum
- Division of Cardiology and Angiology II, University Heart Centre Freiburg-Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany
| | - Philipp Ruile
- Division of Cardiology and Angiology II, University Heart Centre Freiburg-Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany
| | - Manuel Hein
- Division of Cardiology and Angiology II, University Heart Centre Freiburg-Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany
| | - Thomas G Nührenberg
- Division of Cardiology and Angiology II, University Heart Centre Freiburg-Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany
| | - Thomas Arentz
- Division of Cardiology and Angiology II, University Heart Centre Freiburg-Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Division of Cardiology and Angiology II, University Heart Centre Freiburg-Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany
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Judson GL, Agrawal H, Mahadevan VS. Conduction System Abnormalities After Transcatheter Aortic Valve Replacement: Mechanism, Prediction, and Management. Interv Cardiol Clin 2019; 8:403-409. [PMID: 31445724 DOI: 10.1016/j.iccl.2019.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Conduction disturbances following TAVR are a common occurrence given the proximity of the various conduction system tissues, including the AV node, His-bundle, and bundle branches to the left ventricular outflow tract and aortic root. Impairment of these conduction system abnormalities may necessitate permanent pacemaker implantation, which increases morbidity and mortality, as well as length of stay, for the patient. The incidence, mechanisms, and predictors of conduction abnormalities and treatment options are discussed in this up-to-date review of the topic.
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Affiliation(s)
- Gregory L Judson
- Division of Cardiology, University of California, San Francisco, 505 Parnassus Avenue, L524, San Francisco, CA 94143, USA
| | - Harsh Agrawal
- Division of Cardiology, University of California, San Francisco, 505 Parnassus Avenue, L524, San Francisco, CA 94143, USA
| | - Vaikom S Mahadevan
- Division of Cardiology, University of California, San Francisco, 505 Parnassus Avenue, L524, San Francisco, CA 94143, USA.
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