Risk of conduction disturbances following different transcatheter aortic valve prostheses: the role of aortic valve calcifications
Francesco Pollari1
Ferdinand Vogt1
Irena Gro?mann1
Jill Marianowicz1
Marie Claes1
Steffen Pfeiffer1
Johannes Schwab2
Theodor Fischlein1
1.Cardiac Surgery,Cardiovascular Center,Klinikum Nürnberg,Paracelsus Medical University,Nuremberg,Germany2.Cardiology,Cardiovascular Center,Klinikum Nürnberg,Paracelsus Medical University,Nuremberg,Germany;Radiology,Klinikum Nürnberg,Paracelsus Medical University,Nuremberg,Germany
摘要：OBJECTIVES To assess the impact of prosthesis choice and aortic valve calcifications on the occurrence of conduction disturb-ances after transcatheter aortic valve implantation (TAVI). METHODS We retrospectively analyzed the preoperative clinical characteristics, electrocardiograms, contrast-enhanced mul-tidetector 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 A total of 569 patients were included in the study. Six different prostheses were implanted (Edwards Sapien XT, n =162; Edwards Sapien 3, n = 240; Medtronic CoreValve, n = 27; Medtronic CoreValve Evolut R, n = 21; Symetis Acurate, n = 56; Sy-metis Acurate neo, n = 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-men-tioned 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.
机标关键词：differentroleriskaorticcalcificationsconductiondisturbancesfollowing
论文发表日期：2022-03-28
在线出版日期：2025-08-15（本平台首次上网日期，不代表文献的发表时间）
页数：10( 167-176 )