Depth of valve implantation, conduction disturbances and pacemaker implantation with CoreValve and CoreValve Accutrak system for Transcatheter Aortic Valve Implantation, a multi-center study

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:176

Article

Lenders, Guy D.¹  Collas, Valerie¹  Maria Hernandez, Jose²  Legrand, Victor³  Danenberg, Haim D.⁴  den Heijer, Peter⁵  Rodrigus, Inez E.¹  Paelinck, Bernard P.¹  Vrints, Christiaan J.¹  Bosmans, Johan M.¹ 

[1] Univ Antwerp Hosp, B-2650 Edegem, Belgium

[2] Hosp Univ Virgen de la Victoria, Malaga, Spain

[3] CHU Liege, Liege, Belgium

[4] Hadassah Hebrew Univ, Med Ctr, Jerusalem, Israel

[5] Amphia Hosp, Breda, Netherlands

关键词: Transcatheter Aortic Valve Implantation (TAVI);    Left Bundle Branch Block (LBBB);    Pacemaker;    Depth of valve implantation;   

DOI  :  10.1016/j.ijcard.2014.07.092

来源: Elsevier

【 摘 要 】

Background: Transcatheter Aortic Valve Implantation (TAVI) is now considered an indispensable treatment strategy in high operative risk patients with severe, symptomatic aortic stenosis. However, conduction disturbances and the need for Permanent Pacemaker (PPM) implantation after TAVI with the CoreValve prosthesis still remain frequent. Methods and results: We aimed to evaluate the implantation depth, the incidence and predictors of new conduction disturbances, and the need for PPM implantation within the first month after TAVI, using the new Accutrak CoreValve delivery system (ACV), compared to the previous generation CoreValve (non-ACV). In 5 experienced TAVI-centers, a total of 120 consecutive non-ACV and 112 consecutive ACV patients were included (n = 232). The mean depth of valve implantation (DVI) was 8.4 +/- 4.0 mm in the non-ACV group and 7.1 +/- 4.0 mm in the ACV group (p = 0.034). The combined incidence of new PPM implantation and new LBBB was 71.2% in the non-ACV group compared to 50.5% in the ACV group (p = 0.014). DVI (p = 0.002), first degree AV block (p = 0.018) and RBBB (p < 0.001) were independent predictors of PPM implantation. DVI (p < 0.001) and pre-existing first degree AV-block (p = 0.021) were identified as significant predictors of new LBBB. Conclusion: DVI is an independent predictor of TAVI-related conduction disturbances and can be reduced by using the newer CoreValve Accutrak delivery system, resulting in a significantly lower incidence of new LBBB and new PPM implantation. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

【 授权许可】

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