TY - JOUR
T1 - Calcium distribution patterns of the aortic valve as a risk factor for the need of permanent pacemaker implantation after transcatheter aortic valve implantation
AU - Fujita, Buntaro
AU - Kütting, Maximilian
AU - Seiffert, Moritz
AU - Scholtz, Smita
AU - Egron, Sandrine
AU - Prashovikj, Emir
AU - Börgermann, Jochen
AU - Schäfer, Timm
AU - Scholtz, Werner
AU - Preuss, Rainer
AU - Gummert, Jan
AU - Steinseifer, Ulrich
AU - Ensminger, Stephan M.
N1 - Funding Information:
This work was supported by ADUMED-Stiftung.
Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2016
Y1 - 2016
N2 - Aims New-onset conduction disturbances still represent a considerable problem after transcatheter aortic valve implantation (TAVI). The aim of this study was to identify calcification patterns with an elevated risk for permanent pacemaker implantation (PPI) after TAVI and investigate underlying mechanisms in an ex vivo setting Methods One hundred and sixty-two patients who underwent TAVI with the Edwards SAPIEN XTw or Medtronic CoreValvew and results at our institution were analysed. The calcium load of the device landing zone was quantified with 3mensiow, and calcium patterns with an elevated risk for PPI were identified. Ex vivo simulations of balloon valvuloplasty were performed in 3D-printed silicone annuli of patients matching the identified risk profile. Patients with a calcium load of the left coronary cusp (LCC) above 209 mm3 had a higher rate of PPI than patients below this threshold (16.7 vs. 2.6%, P ¼ 0.003). Multivariate regression revealed pre-existing right bundle branch block (RBBB) and increased LCC calcification as independent predictors for PPI. Simulation of the TAVI procedure in a silicone annulus revealed an off-centreline shift of the valvuloplasty balloon and transcatheter heart valve away from the LCC towards the commissure between right- and non-coronary cusp Conclusion Pre-existing RBBB and elevated LCC calcification were identified as independent predictors for PPI. These two risk factors enabled us to distinguish between patients according to their risk for PPI after TAVI. Ex vivo simulations suggested an off-centreline shift of the balloon as a possible explanation.
AB - Aims New-onset conduction disturbances still represent a considerable problem after transcatheter aortic valve implantation (TAVI). The aim of this study was to identify calcification patterns with an elevated risk for permanent pacemaker implantation (PPI) after TAVI and investigate underlying mechanisms in an ex vivo setting Methods One hundred and sixty-two patients who underwent TAVI with the Edwards SAPIEN XTw or Medtronic CoreValvew and results at our institution were analysed. The calcium load of the device landing zone was quantified with 3mensiow, and calcium patterns with an elevated risk for PPI were identified. Ex vivo simulations of balloon valvuloplasty were performed in 3D-printed silicone annuli of patients matching the identified risk profile. Patients with a calcium load of the left coronary cusp (LCC) above 209 mm3 had a higher rate of PPI than patients below this threshold (16.7 vs. 2.6%, P ¼ 0.003). Multivariate regression revealed pre-existing right bundle branch block (RBBB) and increased LCC calcification as independent predictors for PPI. Simulation of the TAVI procedure in a silicone annulus revealed an off-centreline shift of the valvuloplasty balloon and transcatheter heart valve away from the LCC towards the commissure between right- and non-coronary cusp Conclusion Pre-existing RBBB and elevated LCC calcification were identified as independent predictors for PPI. These two risk factors enabled us to distinguish between patients according to their risk for PPI after TAVI. Ex vivo simulations suggested an off-centreline shift of the balloon as a possible explanation.
UR - http://www.scopus.com/inward/record.url?scp=84995344345&partnerID=8YFLogxK
U2 - 10.1093/ehjci/jev343
DO - 10.1093/ehjci/jev343
M3 - Journal articles
C2 - 26758411
AN - SCOPUS:84995344345
SN - 2047-2404
VL - 17
SP - 1385
EP - 1393
JO - European Heart Journal Cardiovascular Imaging
JF - European Heart Journal Cardiovascular Imaging
IS - 12
ER -