Left ventricular outflow tract calcification beneath the non-coronary cusp was independently associated with an increased risk of permanent atrioventricular block after TAVI (OR 1.6 per 100 mm3).
Cohort (n=569)
No
What are the clinical, anatomical, and procedural risk factors for conduction disturbances following TAVI?
Anatomical factors such as LVOT calcification and procedural factors like balloon post-dilatation and oversizing are key independent predictors of conduction disturbances after TAVI, regardless of prosthesis model.
Estimación del efecto: OR 1.6 (95% CI 1.2-2.1)
valor p: p=<0.01
OBJECTIVES: To assess the impact of prosthesis choice and aortic valve calcifications on the occurrence of conduction disturbances after transcatheter aortic valve implantation (TAVI). METHODS: We retrospectively analyzed the preoperative clinical characteristics, electrocardiograms, contrast-enhanced multidetector computed tomography scans and procedural strategies of patients who underwent TAVI in our center between January 2012 and June 2017. Quantification of calcium volume was performed for each aortic cusp above (aortic valve) and below (left ventricular outflow tract, LVOT) the basal plane. Multivariate analysis was performed to evaluate risk factors for the onset of new bundle branch block (BBB), transient and permanent atrioventricular block (tAVB, pAVB). RESULTS: = 63). The logistic regression analysis for BBB showed association with baseline left anterior hemiblock. The logistic regression for tAVB, found the prior valvuloplasty and the balloon post-dilatation associated with the outcome. Baseline left and right BBB, degree of oversizing, and LVOT calcification beneath the non-coronary cusp were associated with pAVB. Neither the prosthesis model, nor the use of a self-expandable prosthesis showed statistical significance with the above-mentioned outcomes on univariate analysis. CONCLUSIONS: LVOT calcification beneath the non-coronary cusp, baseline left anterior hemiblock, right BBB, balloon post-dilatation, prior valvuloplasty and oversizing are independently associated with postprocedural conduction disturbances after TAVI. Use of a self-expandable prosthesis may show a lower incidence of AVB, if applied in lower calcified aortic valves.
Pollari et al. (Mon,) conducted a cohort in Severe aortic valve stenosis (n=569). Transcatheter aortic valve implantation (TAVI) vs. Different prosthesis types (Edwards Sapien XT/3, Medtronic CoreValve/Evolut R, Symetis Acurate/Acurate neo) was evaluated on Permanent high-degree atrioventricular block (pAVB) (OR 1.6, 95% CI 1.2-2.1, p=<0.01). Left ventricular outflow tract calcification beneath the non-coronary cusp was independently associated with an increased risk of permanent atrioventricular block after TAVI (OR 1.6 per 100 mm3).