Risk of conduction disturbances following different transcatheter aortic valve prostheses:the role of aortic valve calcifications

作     者：Francesco Pollari Ferdinand Vogt Irena Großmann Jill Marianowicz Marie Claes Steffen Pfeiffer Johannes Schwab Theodor Fischlein 

作者机构：Cardiac SurgeryCardiovascular CenterKlinikum NürnbergParacelsus Medical UniversityNurembergGermany CardiologyCardiovascular CenterKlinikum NürnbergParacelsus Medical UniversityNurembergGermany RadiologyKlinikum NürnbergParacelsus Medical UniversityNurembergGermany 

出 版 物：《Journal of Geriatric Cardiology》 (老年心脏病学杂志（英文版）)

年 卷 期：2022年第19卷第3期

页      面：167-176页

核心收录：

学科分类：1002[医学-临床医学] 10[医学] 

主　　题：aortic balloon conduction 

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.