Universität zu Köln

Mauri, Victor, Deuschl, Florian, Frohn, Thomas, Schofer, Niklas, Linder, Matthias, Kuhn, Elmar, Schaefer, Andreas, Rudolph, Volker, Madershahian, Navid, Conradi, Lenard, Rudolph, Tanja K. and Schaefer, Ulrich (2018). Predictors of paravalvular regurgitation and permanent pacemaker implantation after TAVR with a next-generation self-expanding device. Clin. Res. Cardiol., 107 (8). S. 688 - 698. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1861-0692

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Abstract

To identify predictors of paravalvular regurgitation (PVR) and permanent pacemaker implantation (PPI) following TAVR with a next-generation self-expanding device. Device landing zone (DLZ) calcification, angiographic implantation depth, and baseline and procedural characteristics were analyzed in 212 patients being treated with the ACURATE neo aortic bioprosthesis. PVR was none/trace in 57.1% and mild in 42.9% (37% mild, 6% moderate). DLZ calcification (705 (IQR 240-624) vs. 382 (IQR 240-624) mm(3); P < 0.001) as well as absolute calcium asymmetry (233 +/- 159 vs. 151 +/- 151 mm(3); P < 0.001) was significantly higher in patients with PVR mild. On multivariate analysis, calcification of the aortic valve cusps (AVC) > 410.6 mm(3) was independently associated with PVR mild. PPI rate was 10.3% (n = 20). Patients with and without need for PPI had similar total DLZ calcium volume (740 (IQR 378-920) vs. 536 (IQR 315-822) mm(3); P = 0.263), but exhibited different calcium distribution patterns: LVOT calcium > 41.4 mm(3) in the sector below the left coronary cusp (LVOTLC) was associated with increased PPI risk (26.9 vs. 7.7%; P = 0.008). The quantity of AVC calcium predicts residual PVR. Multivariable analysis identified LVOTLC calcium, pre-existing RBBB, and age > 82.7 years as independent predictors of PPI. Based on these risk factors, a patient's individual PPI risk can be stratified ranging from 3.8 to 100%.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Mauri, Victor UNSPECIFIED UNSPECIFIED UNSPECIFIED Deuschl, Florian UNSPECIFIED UNSPECIFIED UNSPECIFIED Frohn, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Schofer, Niklas UNSPECIFIED UNSPECIFIED UNSPECIFIED Linder, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Kuhn, Elmar UNSPECIFIED UNSPECIFIED UNSPECIFIED Schaefer, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Rudolph, Volker UNSPECIFIED UNSPECIFIED UNSPECIFIED Madershahian, Navid UNSPECIFIED UNSPECIFIED UNSPECIFIED Conradi, Lenard UNSPECIFIED UNSPECIFIED UNSPECIFIED Rudolph, Tanja K. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schaefer, Ulrich UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-178985
DOI:	10.1007/s00392-018-1235-1
Journal or Publication Title:	Clin. Res. Cardiol.
Volume:	107
Number:	8
Page Range:	S. 688 - 698
Date:	2018
Publisher:	SPRINGER HEIDELBERG
Place of Publication:	HEIDELBERG
ISSN:	1861-0692
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language AORTIC-VALVE-REPLACEMENT; LANDING ZONE CALCIFICATION; EDWARDS SAPIEN; RISK PATIENTS; TRANSCATHETER; OUTCOMES; REGISTRY; TRIAL; METAANALYSIS; SEVERITY Multiple languages Cardiac & Cardiovascular Systems Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/17898