scholarly journals Effect of Eccentric Calcification of an Aortic Valve on the Implant Depth of a Venus-A Prosthesis During Transcatheter Aortic Valve Replacement: A Retrospective Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Lanlan Li ◽  
Yang Liu ◽  
Ping Jin ◽  
Jiayou Tang ◽  
Linhe Lu ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Root ◽  
Transcatheter Aortic Valve Replacement ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Release Process ◽  
Standard Position ◽  
Transcatheter Aortic Valve

ObjectOur goal was to assess the implant depth of a Venus-A prosthesis during transcatheter aortic valve replacement (TAVR) when the areas of eccentric calcification were distributed in different sections of the aortic valve.MethodsA total of 53 patients with eccentric calcification of the aortic valve who underwent TAVR with a Venus-A prosthesis from January 2018 to November 2019 were retrospectively analyzed. The patients were divided into three groups (A, B, and C) according to the location of the eccentric calcification, which was determined by preprocedural computerized tomography angiography (CTA) images. The prosthesis release process and position were evaluated by contrast aortography during TAVR, and the differences in valve implant depths were compared among the three groups. The effects of different aortic root structures and procedural strategies on prosthesis implant depth were analyzed.ResultsEleven patients had eccentric calcification in region A; 19 patients, in region B; and 23 patients, in region C. The patients with eccentric calcification in region B had a higher risk of prosthesis migration (10.5% upward and 21.1% downward), and the position of the prosthesis after TAVR in group B was the deepest among the three groups. When eccentric calcification was located in region A or C, the prosthesis was released at the standard position with more stability, and the location of the prosthesis was less deep after TAVR (region A: 4.12 ± 3.4 mm; region B: 10.2 ± 5.3 mm; region C: 8.4 ± 4.0 mm; region A vs. region B, P = 0.0004; region C vs. region B; and P = 0.0360). In addition, the left ventricular outflow tract (LVOT) (P = 0.0213) and aortic root angulation (P = 0.0263) also had a significant effect on implant depth in the aortic root structure of the patients. The prosthesis size was 28.3 ± 2.4 in the deep implant group and 26.4 ± 2.0 in the appropriate implant group (P = 0.0068).ConclusionThe implant depth of the Venus-A prosthesis is closely related to the distribution of eccentric calcification in the aortic valve during TAVR. Surgeons should adjust the surgical strategy according to aortic root morphology to prevent prosthesis migration.

scholarly journals Anatomical Predictors of Pacemaker Dependency after Transcatheter Aortic Valve Replacement

2020 ◽  
Author(s):  
Luca Nai Fovino ◽  
Alberto Cipriani ◽  
Tommaso Fabris ◽  
Mauro Massussi ◽  
Andrea Scotti ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Conduction Disturbances ◽  
Transcatheter Aortic Valve ◽  
Left Ventricular Outflow

Background - Conduction disturbances after transcatheter aortic valve replacement (TAVR) are often transient. Limited data exist on anatomic factors predisposing to PM dependency after TAVR. We sought to assess the rate and the possible predictors of pacemaker (PM) dependency after transcatheter aortic valve replacement (TAVR). Methods - Consecutive patients undergoing PM implantation up to 30-day after TAVR between May 2014 and September 2019 were included. Baseline electrocardiographic, computed tomography and procedural characteristics were collected, including valve implantation depth (ID) and membranous septum (MS) length, an anatomic surrogate of the distance between the aortic annulus and the His bundle. PM dependency at 30-day and 1-year and all-cause mortality during follow up were evaluated. Results - Of 728 TAVR patients, 112 (53.5% males, median age 81) underwent PM implantation after TAVR. Of these, 44.6% (50/112) were PM-dependent at 30-day, 46.7% (36/77) at 1-year. By multivariate analysis, independent predictors of 30-day PM dependency included left ventricular outflow tract (LVOT) calcifications under the left coronary cusp (LCC) (OR: 5.69, 95%CI: 1.45-22.31, p=0.013) and a difference between MS length and ID (ΔMSID) ≥3 mm (OR: 7.58, 95%CI: 2.07-27.78, p=0.002). Conversely, MS length and ID alone were not associated with PM dependency (OR: 0.79, 95%CI: 0.60-1.05, p=0.11 and OR: 1.11, 95%CI: 0.99-1.24, p=0.08). At a median follow-up of 28.1 [11.7-48.6] months, PM-dependent patients did not show a worse survival (p=0.26). Conclusions - Less than half of the patients undergoing PM implantation after TAVR are PM-dependent at mid-term follow-up. ΔMSID ≥3mm and presence of LVOT calcifications under the LCC, but not MS length nor ID alone, are predictive of long-term PM dependency after TAVR, thus influencing device selection and programming.

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