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 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 Use of Electrophysiological Studies in Transcatheter Aortic Valve Implantation

2020 ◽  
Vol 9 (1) ◽  
pp. 20-27
Author(s):  
Oholi Tovia-Brodie ◽  
Yoav Michowitz ◽  
Bernard Belhassen
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Conduction Disturbances ◽  
Permanent Pacemaker Implantation ◽  
Transcatheter Aortic Valve ◽  
Electrophysiological Studies ◽  
Aortic Valve Implantation ◽  
Valve Implantation

New conduction disturbances requiring permanent pacemaker implantation remain common complications following transcatheter aortic valve implantation (TAVI). It has been suggested that electrophysiological studies could help identify patients who will require permanent pacemaker implantation after TAVI. This article summarises contemporary data on the use of electrophysiological studies in patients undergoing TAVI.

Transcatheter Aortic Valve Implantation in the Hybrid Catheterisation Laboratory – Navigating into the Future

2012 ◽  
Vol 7 (1) ◽  
pp. 53 ◽  
Author(s):  
Michael Lauterbach ◽  
Bruno Sontag ◽  
Karl Eugen Hauptmann ◽  
◽  
◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Pacemaker Implantation ◽  
Standard Of Care ◽  
Conduction Disturbances ◽  
Transcatheter Aortic Valve ◽  
Device Implantation ◽  
Risk Patients ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Transcatheter aortic valve implantation (TAVI) has emerged as a viable treatment option for high-risk patients with symptomatic, senile degenerative aortic stenosis. Since the first TAVI in 2002, the technology has evolved tremendously. With the downsizing of the device delivery catheter profile, vascular access site complications have decreased significantly. Current access routes are transfemoral, subclavian, transapical and transaortic, with most centres preferring a ‘transfemoral-first’ strategy. Other significant complications of TAVI are cerebrovascular events and conduction disturbances with the need for pacemaker implantation. The current TAVI devices with the largest number of implantations and the best evidence are the Medtronic CoreValve™ and the Edwards SAPIEN XT™. Both devices are already in their third generation. Navigation technology, such as the HeartNavigator, has been developed to facilitate the preparation of the procedure and the actual device implantation. The use of hybrid catheterisation labs for performing TAVI is becoming the standard of care due to the significant advantages with regard to safety and hygiene.

scholarly journals Intraventricular Conduction Disturbances After Transcatheter Aortic Valve Implantation

2020 ◽  
Vol 15 ◽  
Author(s):  
Shu-I Lin ◽  
Mizuki Miura ◽  
Ana Paula Tagliari ◽  
Ying-Hsiang Lee ◽  
Shinichi Shirai ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Current Trend ◽  
Pacemaker Implantation ◽  
Current Evidence ◽  
Intraventricular Conduction ◽  
Conduction Disturbances ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Despite significant improvements in transcatheter aortic valve implantation (TAVI) outcomes, periprocedural conduction disturbances, such as new-onset left bundle branch block (LBBB) and new pacemaker implantation (PMI), remain relatively frequent concerns. The development of periprocedural conduction disturbances can be explained by the proximity between the aortic valve and the conduction system. Although prior studies reported heterogeneity in PMI rates after TAVI, current evidence supports the potentially deleterious consequence of LBBB and PMI, and several predisposing factors have been reported. Therefore, new strategies to avoid conduction disturbances and to improve their management are required, particularly with the current trend to expand TAVI to a low-risk population.

Sign in / Sign up

Export Citation Format

Share Document