Incidence rate and predictors of permanent pacemaker implantation after transcatheter aortic valve implantation with self-expanding CoreValve prosthesis.
ABSTRACT Conduction disorders and permanent pacemaker (PPM) implantation are common complications in patients undergoing transcatheter aortic valve implantation (TAVI). Previous studies, evaluating small populations, have identified several different predictors of PPM implantation after TAVI. The aim of this study was to assess the incidence rate of conduction disorders and the predictors of postoperative PPM requirement in a large series of patients undergoing TAVI.
Data were analyzed from 181 consecutive patients at high-risk surgery who underwent TAVI at our institute between July 2007 and April 2011. All patients underwent implantation of the third-generation percutaneous self-expanding CoreValve® prosthesis (CoreValve, Inc., Irvine, CA, USA). In all patients, a 12-lead electrocardiogram and a 24-h holter monitoring was recorded before and after the procedure in order to assess the presence of conduction disorders. Clinical data, preoperative conduction disorders, echocardiographic patterns, and procedural data were tested as predictors of PPM implantation after TAVI.
Left bundle branch block (LBBB) was the most common conduction disorder, with an incidence of 50.3% at discharge. Fifty-two (32.1%) patients developed a persistent complete AVB requiring PPM implantation. PPM implantation was strongly correlated with the presence of preoperative right bundle branch block (RBBB) which was found to be the only independent predictor of PPM implantation (HR 16.5, CI 3.3-82.3, p < 0.001).
LBBB and PPM implantation requirement after TAVI are common occurrences using the self-expanding CoreValve prosthesis. In this large series of consecutive patients, only RBBB was found to be a strong predictor of PPM requirement.
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ABSTRACT: Transcatheter aortic valve implantation (TAVI) has recently emerged as a treatment option for patients with severe aortic valve stenosis (AS). For patients who are deemed inoperable for surgical aortic valve replacement (SAVR), TAVI has a significant mortality benefit compared to medical therapy. This review discusses established and emerging roles for multimodality imaging and focuses on the application of these technologies for patient selection, intraprocedural guidance, and the detection and quantification of acute and chronic complications of this novel procedure.Methodist DeBakey cardiovascular journal 04/2012; 8(2):29-37.
Article: Transcatheter aortic valve replacement: design, clinical application, and future challenges.[show abstract] [hide abstract]
ABSTRACT: Transcatheter aortic valve replacement (TAVR) is a new technology that recently has been shown to improve survival and quality of life in patients with severe symptomatic aortic stenosis who are not surgical candidates. The development and design of transcatheter valves has been ongoing for the past 20 years, and TAVR has now been approved by the FDA as a treatment for aortic stenosis in patients who are not surgical candidates. In the United States, there are currently two transcatheter valves available: the Edwards Sapien Valve and the Medtronic CoreValve. While similar in some design elements, they also have characteristic differences that affect both the mechanism of delivery as well as performance in patients. This review aims to take a closer look at the development of this new technology, review the published clinical results, and look toward the future of transcatheter valve therapeutics and the challenges therein.The Yale journal of biology and medicine 06/2012; 85(2):239-47.