Biomechanical Identification of High-Risk Patients Requiring Permanent Pacemaker After Transcatheter Aortic Valve Replacement

BackgroundCardiac conduction disturbance requiring new permanent pacemaker implantation (PPI) is an important complication of TAVR that has been associated with increased mortality. It is extremely challenging to optimize the valve size alone to prevent a complete atrioventricular block (AVB).MethodsIn this study, we randomly took 48 patients who underwent TAVR and had been followed for at least 2 years to assess the risk of AVB. CT images of 48 patients with TAVR were analyzed using three-dimensional (3D) anatomical models of the aortic valve apparatus. The stresses were formulated according to loading force and tissue properties. Support vector regression (SVR) was used to model the relationship between AVB risk and biomechanical stresses. To avoid AVB, overlapping regions on the prosthetic valve where AV bundle passes will be removed as cylindrical sector with the angle θ. Thus, the optimization of the valve shape will be predicted with the joint optimization of the θ and valve size R.ResultsThe average AVB risk prediction accuracy was 83.33% in the range from 0.8–0.85 with 95% CI for all cases; specifically, 85.71% for Group A (no AVB), and 80.0% for Group B (undergoing AVB after the TAVR).ConclusionsThis model can estimate the optimal valve size and shape to avoid the risk of AVB after TAVR. This optimization may eliminate the excessive stresses to keep the normal function of both AV bundle and valve leaflets, leading to a favorable clinical outcome. The combination of biomechanical properties and machine learning method substantially improved prediction of surgical results.

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FACTORS ASSOCIATED WITH CARDIAC CONDUCTION DISORDERS AND PERMANENT PACEMAKER IMPLANTATION AFTER PERCUTANEOUS AORTIC VALVE IMPLANTATION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(10)61388-5 ◽

2010 ◽

Vol 55 (10) ◽

pp. A148.E1387

Author(s):

Ze Yie Yong ◽

Jan Baan ◽

Karel T. Koch ◽

José P.S. Henriques ◽

Berto J. Bouma ◽

...

Keyword(s):

Aortic Valve ◽

Pacemaker Implantation ◽

Permanent Pacemaker ◽

Cardiac Conduction ◽

Factors Associated ◽

Permanent Pacemaker Implantation ◽

Conduction Disorders ◽

Aortic Valve Implantation ◽

Valve Implantation

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Oversizing Increases Pacemaker Implantation Rate After Sutureless Minimally Invasive Aortic Valve Replacement

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/1556984520938897 ◽

2020 ◽

Vol 15 (5) ◽

pp. 449-455

Author(s):

Borut Geršak ◽

Mattia Glauber ◽

Denis Bouchard ◽

Jure Jug ◽

Marco Solinas

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Pacemaker Implantation ◽

Implantation Rate ◽

Permanent Pacemaker ◽

Multivariable Logistic Regression Model ◽

Permanent Pacemaker Implantation ◽

Valve Size

Objective Cardiac conduction system disturbances potentially leading to permanent pacemaker implantation are significant postoperative complications after aortic valve replacement. The aim of this study was to assess the impact of sutureless prosthetic valve oversizing on permanent pacemaker implantation rate. Methods This multicenter retrospective study included 306 patients who underwent minimally invasive aortic valve replacement with the Perceval sutureless valve. Oversizing was determined by the implanted valve size indexed to body surface area. Data were analyzed with a multivariable logistic regression model. Results This study confirmed excellent postoperative results for minimally invasive aortic valve replacement with right anterior minithoracotomy approach and rapid deployment sutureless valves. Mortality rate was 1%. Eighteen (5.9%) patients received a new permanent pacemaker. Multivariable logistic regression model ( P = 0.05) found oversizing as significant risk factor ( P = 0.017) for permanent postoperative pacemaker implantation independent of patient age. There was a significant negative correlation between the indexed implanted valve size and the mean and peak postoperative transvalvular gradients ( P < 0.001). Conclusions Oversizing of sutureless prosthetic aortic valves is a risk factor for postoperative permanent pacemaker implantation. Proper sizing of Perceval is important to avoid complications and ensure optimal valve performance.

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Permanent pacemaker implantation after On-X surgical aortic valve replacement: SWEDEHEART observational study

BMJ Open ◽

10.1136/bmjopen-2020-047962 ◽

2021 ◽

Vol 11 (11) ◽

pp. e047962

Author(s):

Magnus Dalén ◽

Michael Persson ◽

Natalie Glaser ◽

Ulrik Sartipy

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Pacemaker Implantation ◽

Permanent Pacemaker ◽

Cardiac Conduction ◽

Permanent Pacemaker Implantation ◽

Mechanical Valves ◽

Valve Housing ◽

Bileaflet Mechanical Valves

ObjectiveBioprosthetic aortic valves with an extended subannular component, such as transcatheter valves, exert increased compression on the cardiac conduction system and increase the risk for permanent pacemaker implantation. It is unknown if the On-X mechanical prosthetic valve, which has an elongated subannular valve housing, increases the risk of permanent pacemaker implantation following aortic valve replacement.DesignObservational nationwide cohort study.SettingSwedish population-based study.ParticipantsAll patients aged 18–65 years who underwent primary mechanical aortic valve replacement in Sweden between 2005 and 2018. We used the Swedish Web system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies register and other Swedish national health-data registers.ExposurePatients implanted with an On-X valve versus patients implanted with other bileaflet mechanical valves.Primary and secondary outcome measuresPrimary outcome measure was permanent pacemaker implantation within 30 days of surgery.ResultsA total of 2602 patients were included, and 581 patients received an On-X valve and 2021 patients received a St Jude Masters/Regent (n=945) or Carbomedics Reduced valve (n=1076). In the total study population, 115 (4.4%) permanent pacemaker implantations were performed within 30 days after aortic valve replacement. In the propensity score matched population, there was no significant difference in the rate of permanent pacemaker implantation in the On-X group compared with the control group: 3.6% (95% CI: 2.4% to 5.5%) vs 4.0% (95% CI: 2.7% to 5.9%), p=0.877.ConclusionsThe On-X prosthetic heart valve was associated with a similarly low risk for permanent pacemaker implantation after aortic valve replacement compared with other conventional bileaflet mechanical valves. The On-X elongated subannular valve housing does not interfere with the cardiac conduction system.

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