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17.04.2018 | Original Paper

Predictors of paravalvular regurgitation and permanent pacemaker implantation after TAVR with a next-generation self-expanding device

verfasst von: Victor Mauri, Florian Deuschl, Thomas Frohn, Niklas Schofer, Matthias Linder, Elmar Kuhn, Andreas Schaefer, Volker Rudolph, Navid Madershahian, Lenard Conradi, Tanja K. Rudolph, Ulrich Schäfer

Erschienen in: Clinical Research in Cardiology | Ausgabe 8/2018

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Abstract

Aims

To identify predictors of paravalvular regurgitation (PVR) and permanent pacemaker implantation (PPI) following TAVR with a next-generation self-expanding device.

Methods and results

Device landing zone (DLZ) calcification, angiographic implantation depth, and baseline and procedural characteristics were analyzed in 212 patients being treated with the ACURATE neo aortic bioprosthesis. PVR was none/trace in 57.1% and ≥ mild in 42.9% (37% mild, 6% moderate). DLZ calcification (705 (IQR 240–624) vs. 382 (IQR 240–624) mm³; P < 0.001) as well as absolute calcium asymmetry (233 ± 159 vs. 151 ± 151 mm³; P < 0.001) was significantly higher in patients with PVR ≥ mild. On multivariate analysis, calcification of the aortic valve cusps (AVC) > 410.6 mm³ was independently associated with PVR ≥ mild. PPI rate was 10.3% (n = 20). Patients with and without need for PPI had similar total DLZ calcium volume (740 (IQR 378–920) vs. 536 (IQR 315–822) mm³; P = 0.263), but exhibited different calcium distribution patterns: LVOT calcium > 41.4 mm³ in the sector below the left coronary cusp (LVOT_LC) was associated with increased PPI risk (26.9 vs. 7.7%; P = 0.008).

Conclusions

The quantity of AVC calcium predicts residual PVR. Multivariable analysis identified LVOT_LC calcium, pre-existing RBBB, and age > 82.7 years as independent predictors of PPI. Based on these risk factors, a patient’s individual PPI risk can be stratified ranging from 3.8 to 100%.

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Titel: Predictors of paravalvular regurgitation and permanent pacemaker implantation after TAVR with a next-generation self-expanding device
verfasst von: Victor Mauri
Florian Deuschl
Thomas Frohn
Niklas Schofer
Matthias Linder
Elmar Kuhn
Andreas Schaefer
Volker Rudolph
Navid Madershahian
Lenard Conradi
Tanja K. Rudolph
Ulrich Schäfer
Publikationsdatum: 17.04.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Clinical Research in Cardiology / Ausgabe 8/2018
Print ISSN: 1861-0684
Elektronische ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-018-1235-1

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Springer Medizin

Predictors of paravalvular regurgitation and permanent pacemaker implantation after TAVR with a next-generation self-expanding device

Abstract

Aims

Methods and results

Conclusions

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Springer Medizin

Abstract

Aims

Methods and results

Conclusions

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