Universität zu Köln

Mauri, Victor, Reimann, Andreas, Stern, Daniel, Scherner, Maximilian, Kuhn, Elmar, Rudolph, Volker, Rosenkranz, Stephan, Eghbalzadeh, Kaveh, Friedrichs, Kai, Wahlers, Thorsten, Baldus, Stephan, Madershahian, Navid and Rudolph, Tanja K. (2016). Predictors of Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement With the SAPIEN 3. JACC-Cardiovasc. Interv., 9 (21). S. 2200 - 2210. NEW YORK: ELSEVIER SCIENCE INC. ISSN 1876-7605

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Abstract

OBJECTIVES The aim of this study was to identify predictors of permanent pacemaker implantation (PPMI) following transcatheter aortic valve replacement (TAVR) with a balloon-expandable transcatheter valve (Edwards SAPIEN 3). BACKGROUND New-onset conduction disturbances requiring PPMI remain a major concern following TAVR. Predictors are not yet well defined. METHODS The influence of angiographic implantation depth, device landing zone calcium volume, oversizing, pre- and post-dilation, and baseline conduction disturbances on PPMI rate was analyzed in 229 patients undergoing TAVR with the SAPIEN 3 device. RESULTS PPMI was performed in 14.4% of patients. Patients requiring PPMI had higher left ventricular outflow tract (LVOT) calcium volume in the area below the left coronary cusp (LVOTLC) and the area below right coronary cusp (LVOTRC) (LVOTLC median calcium 23.7 mm(3) vs. 3.0 mm(3); p < 0.001; LVOTRC median calcium 6.6 mm(3) vs. 0.3 mm(3); p = 0.014), a higher prevalence of pre-existing right bundle branch block (15% vs. 2%, p = 0.004), and lower implantation depth (ventricular portion of the stent frame 29 +/- 12% vs. 21 +/- 5%; p < 0.001). On multivariate regression analysis, LVOTLC calcium volume > 13.7 mm(3), LVOTRC calcium volume > 4.8 mm(3), pre-existing right bundle branch block, and implantation depth > 25.5% emerged as independent predictors of PPMI. Upon modification of the implantation technique, aiming at a high final valve position, implantation depth decreased from 24% ventricular portion to 21% (p = 0.012), accompanied by a decrease in PPMI rate (19.2% vs. 9.2%; p = 0.038). CONCLUSIONS LVOTLC and LVOTRC calcium load, baseline right bundle branch block, and implantation depth were identified as independent predictors of the need for PPMI post-TAVR. Patient groups with different PPMI risk could be stratified using these 4 predictors. A slightly higher valve implantation site may prevent excessive PPMI rates. (C) 2016 by the American College of Cardiology Foundation.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Mauri, Victor UNSPECIFIED UNSPECIFIED UNSPECIFIED Reimann, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Stern, Daniel UNSPECIFIED UNSPECIFIED UNSPECIFIED Scherner, Maximilian UNSPECIFIED UNSPECIFIED UNSPECIFIED Kuhn, Elmar UNSPECIFIED UNSPECIFIED UNSPECIFIED Rudolph, Volker UNSPECIFIED UNSPECIFIED UNSPECIFIED Rosenkranz, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Eghbalzadeh, Kaveh UNSPECIFIED UNSPECIFIED UNSPECIFIED Friedrichs, Kai UNSPECIFIED UNSPECIFIED UNSPECIFIED Wahlers, Thorsten UNSPECIFIED UNSPECIFIED UNSPECIFIED Baldus, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Madershahian, Navid UNSPECIFIED UNSPECIFIED UNSPECIFIED Rudolph, Tanja K. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-255740
DOI:	10.1016/j.jcin.2016.08.034
Journal or Publication Title:	JACC-Cardiovasc. Interv.
Volume:	9
Number:	21
Page Range:	S. 2200 - 2210
Date:	2016
Publisher:	ELSEVIER SCIENCE INC
Place of Publication:	NEW YORK
ISSN:	1876-7605
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CLINICAL-OUTCOMES; HEART-VALVE; IMPACT; XT; EXPERIENCE; COREVALVE; STENOSIS; SYSTEM; DEPTH Multiple languages Cardiac & Cardiovascular Systems Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/25574