Impact of implantation depth and calcium burden on infranodal conduction delay after transcatheter aortic valve replacement

Figures

• 

  Figure 1. Assessment methods for implantation depth evaluation after valve deployment. A: Implantation depth was assessed using 4 different methods: noncoronary cusp (NCC) distance (ND), left coronary cusp (LCC) distance (LD), arithmetic mean (AM), and the deepest edge (DE) (eg, ND = 2.7 mm, LD = 4.7 mm, AM = 3.7 mm, DE = 4.,7 mm). B: Angle of implantation (α) was measured as arctan (LD-NDValve size)∗180π.

• 

  Figure 2. Calcium quantification of the device landing zone according to leaflet sector. A: Calcium load at the aortic valve complex (AVC) level: noncoronary cusp (NC) 938 mm3, right coronary cusp (RC) 1270 mm3, left coronary cusp (LC) 1312 mm3. B: Calcium at the left ventricular outflow tract (LVOT) level (LVOTNCC 25 mm3, LVOTRCC 0 mm3, LVOTLCC 640 mm3). C: AVC was defined as the volume 15 mm above the annular plane to the lower coronary ostium. D: LVOT was defined as the volume 10 mm below the annular plane. LVOTNCC calcification was associated with prolonged HV interval.

• 

  Figure 3. Prolonged HV interval intraprocedure post-transcatheter aortic valve replacement was not associated with the depth of valve prosthesis regardless of the method applied to determine the implantation depth. AM = arithmetic mean; DE = deepest edge; LD = left coronary cusp distance; ND = noncoronary cusp distance.

• 

  Figure 4. A: Scatterplot and Pearson correlation coefficient between left ventricular outflow tract (LVOT) calcification and baseline HV interval. B: Scatterplot and Pearson correlation coefficient between LVOT calcification and HV interval intraprocedural post-TAVR. C: Quantile regression model showing the prediction of baseline HV interval using LVOT calcification when given a series of baseline parameters (subscript). D: Quantile regression model showing prediction of HV interval intraprocedural post-TAVR using LVOT calcification given a series of baseline and procedural parameters (see Results). Orange dotted line marks the limit of 55 ms for an abnormal HV interval. Red dotted line marks the 70-ms cutoffs for the HV interval to trigger the pacemaker implant. “After TAVR” indicates intraprocedure immediately after valve deployment. LBBB = left bundle branch block; LVEF = left ventricular ejection fraction; NCC = noncoronary cusp; TAVR = transcatheter aortic valve replacement.