scholarly journals Implantation depth and its influence on complications after TAVI with self-expanding valves

2021 ◽  
Author(s):  
Philipp Breitbart ◽  
Jan Minners ◽  
Manuel Hein ◽  
Holger Schröfel ◽  
Franz-Josef Neumann ◽  
...  
Keyword(s):  
Characteristic Curve ◽  
Fusion Imaging ◽  
Paravalvular Leakage ◽  
Conduction Disturbances ◽  
Transcatheter Aortic Valve ◽  
Transcatheter Heart Valve ◽  
Implantation Depth ◽  
The Mean ◽  
Valve Implantation ◽  
To Receive

AbstractPrior studies in patients with transcatheter aortic valve implantation (TAVI) demonstrated an influence of transcatheter heart valve (THV) position on the occurrence of new conductions disturbances (CD) and paravalvular leakage (PVL) post TAVI in balloon-expandable valves (BEV). Purpose of this study was to investigate the THV implantation depth and its influence on the occurrence of CD and PVL in self-expanding valves (SEV). We performed fusion imaging of pre- and post-procedural computed tomography angiography in 104 TAVI-patients (all with Evolut R) to receive a 3-D reconstruction of the THV within the native annulus region. The THV length below the native annulus was measured for assessment of implantation depth. Electrocardiograms pre-discharge were assessed for conduction disturbances (CD), PVL was determined in transthoracic echocardiography. The mean implantation depth of the THV in the whole cohort was 4.3 ± 3.0 mm. Using the best cut-off of ≥ 4 mm in receiver operating characteristic curve analysis (sensitivity 83.3%, specificity 60.0%) patients with lower THV position developed more new CD after TAVI (68.2 vs. 23.7%, P < 0.001). A deep THV position was identified as the only predictor for new CD after TAVI (odds ratio [CI] 1.312[1.119–1.539], P = 0.001). The implantation depth showed no influence on the grade of PVL (r = 0.052, P = 0.598). In patients with TAVI using the Evolut R SEV, a lower THV positioning (≥ 4 mm length below annulus) was a predictor for new conduction disturbances. In contrast, implantation depth was not associated with the extent of PVL. Graphic abstract Prostheses positions of self-expanding valves and their influence on the occurrence of new conduction disturbances and the grade of paravalvular leakage after TAVI.

scholarly journals Prosthesis position and its influence on complications after transcatheter aortic valve implantation with self-expanding valves

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
P Breitbart ◽  
J Minners ◽  
M Hein ◽  
H Schroefel ◽  
F J Neumann ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Characteristic Curve ◽  
Fusion Imaging ◽  
Conduction Disturbances ◽  
Transcatheter Aortic Valve ◽  
Transcatheter Heart Valve ◽  
Implantation Depth ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background/Introduction Prior studies in patients with transcatheter aortic valve implantation (TAVI) demonstrated an influence of transcatheter heart valve (THV) position on the occurrence of new conductions disturbances (CD) and paravalvular leakage (PVL) post TAVI in balloon-expandable valves (BEV). Purpose Purpose of this study was to investigate the THV position and its influence on the occurrence of CD and PVL in self-expanding valves (SEV). Methods We performed fusion imaging of pre- and post-procedural computed tomography angiography in 104 TAVI-patients (all with Evolut R) to receive a 3-D reconstruction of the THV within the native annulus region. The THV length below the native annulus was measured for assessment of implantation depth. Electrocardiograms pre-discharge were assessed for conduction disturbances (CD), PVL was determined in transthoracic echocardiography. Results The mean implantation depth of the THV in the whole cohort was 4.3±3.0 mm. Using the best cut-off of &gt;4 mm in receiver operating characteristic curve analysis (sensitivity 83.3%, specificity 60.0%) patients with lower THV position developed more new CD after TAVI (68.2 vs. 23.7%, P&lt;0.001). A deep THV position was identified as the only predictor for new CD after TAVI (odds ratio [CI]: 1.312 [1.119–1.539], P=0.001). The implantation depth showed no influence on the grade of PVL (r=0.052, P=0.598). Conclusions In patients with TAVI using the Evolut R SEV, a lower THV positioning (&gt;4 mm length below annulus) was a predictor for new conduction disturbances. In contrast, prosthesis position was not associated with the extent of PVL. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Predictors of Conduction Disturbances after Transcatheter Aortic Valve Implantation with Balloon-expandable Valve for Bicuspid Aortic Valve Stenosis

2021 ◽  
Author(s):  
Hirokazu Miyashita ◽  
Noriaki Moriyama ◽  
Futoshi Yamanaka ◽  
Shigeru Saito ◽  
Heidi Lehtola ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Pacemaker Implantation ◽  
Implantation Technique ◽  
Control Group ◽  
Conduction Disturbances ◽  
Transcatheter Aortic Valve ◽  
Implantation Depth ◽  
Valve Implantation ◽  
New Onset

Objective: The implantation depth and membranous septum (MS) length are established as the predictors of new-onset conduction disturbance (CD) after transcatheter aortic valve replacement (TAVR) for tricuspid aortic valve (TAV) stenosis. However, little is known about the predictors with bicuspid aortic valve (BAV). This study investigated the role of MS length and implantation depth in predicting CD following TAVR with a balloon-expandable valve in patients with BAV. Methods and results: This retrospective study analyzed 169 patients who underwent TAVR for BAV with balloon-expandable valve, and TAV cohort was established as a control group using propensity score (PS) matching. The primary endpoint was in-hospital new-onset CD (new-onset left bundle branch block or new permanent pacemaker implantation). New-onset CD developed in 37 patients (21.9%). Multivariate analysis revealed severe LVOT calcification (Odds ratio [OR]: 5.83, 95% confidence interval [CI]: 1.08 – 31.5, p = 0.0407) and implantation depth – MS length (OR: 1.30, 95% CI: 1.12 – 1.51, p = 0.0005) as the predictors of new-onset CD within BAV cohort. The matched comparison between BAV and TAV groups showed similar MS length (3.0 vs 3.2mm, p = 0.5307), but valves were implanted deeper in BAV than TAV group (3.9 vs 3.0mm, p < .0001). New-onset CD was more frequent in patients having BAV (22.3% vs 13.9%, p = 0.0458). Conclusion: The implantation depth - MS length, and severe LVOT calcification predicted new-onset CD following TAVR in BAV with balloon-expandable valve. High implantation technique could be considered to avoid new-onset CD in BAV anatomy.

scholarly journals Real-time observation of a high-echoic mass in the left ventricle during transcatheter aortic valve implantation: a case report

2020 ◽  
Author(s):  
Akiko Masumoto ◽  
Takeshi Kitai ◽  
Mitsuhiko Ota ◽  
Kitae Kim ◽  
Natsuhiko Ehara ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Transcatheter Aortic Valve Implantation ◽  
Severe Aortic Stenosis ◽  
Cerebral Arteries ◽  
Transoesophageal Echocardiography ◽  
Transcatheter Aortic Valve ◽  
Transcatheter Heart Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background Increasing number of symptomatic patients with severe aortic stenosis is treated with transcatheter aortic valve implantation (TAVI). Stroke is one of the most serious complications of TAVI, and the majority of cerebral events in patients undergoing TAVI have an embolic origin. Case summary A 90-year-old female underwent trans-femoral TAVI for symptomatic severe aortic stenosis. Just before the implantation of the transcatheter heart valve (THV), transoesophageal echocardiography (TOE) showed a mobile, high-echoic mass attached to the THV, which gradually enlarged to 26 mm, then spontaneously detached from the THV and flowed up the ascending aorta, disappearing from the TOE field of. After the procedure, the patient presented with ischaemic stroke. The patient’s stroke was thought to have resulted from the embolism migrating to the distal cerebral arteries. Discussion The detailed images acquired with TOE during TAVI enabled the prompt identification of the unusual intracardiac mass.

The Wattson temporary pacing guidewire for transcatheter heart valve implantation

2021 ◽  
Author(s):  
James Carey ◽  
Anthony Buckley ◽  
Stephen O'Connor ◽  
Mark Hensey
Keyword(s):  
Aortic Valve ◽  
Heart Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Pacemaker Implantation ◽  
Left Ventricular ◽  
Temporary Pacing ◽  
Transcatheter Aortic Valve ◽  
Transcatheter Heart Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Transcatheter aortic valve implantation and implantation of other transcatheter heart valves, generally requires insertion of a temporary venous pacemaker. Implantation of a temporary venous pacemaker adds complexity, time and risk to the procedure. Guidewire modification to allow pacing is increasingly popular, however it requires technical expertise and provides unipolar pacing resulting in high thresholds and potential capture loss. The Wattson temporary pacing guidewire is a novel device which offers guidewire support for valve delivery and concomitant bipolar pacing. It may offer a safe and effective solution to guidewire pacing for transcatheter aortic valve implantation and other transcatheter heart valve implantations. Herein, we review the literature surrounding left ventricular guidewire pacing along with the features and clinical data of the Wattson wire.

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