Conflict of interest: Nothing to report.
Valvular and Structural Heart Diseases
Transcatheter aortic valve implantation with a self-expanding nitinol bioprosthesis†
Prediction of the need for permanent pacemaker using simple baseline and procedural characteristics
Article first published online: 10 JAN 2012
Copyright © 2011 Wiley Periodicals, Inc.
Catheterization and Cardiovascular Interventions
Volume 79, Issue 5, pages 712–719, 1 April 2012
How to Cite
Saia, F., Lemos, P. A., Bordoni, B., Cervi, E., Boriani, G., Ciuca, C., Taglieri, N., Mariani, J., Filho, R. K. and Marzocchi, A. (2012), Transcatheter aortic valve implantation with a self-expanding nitinol bioprosthesis. Cathet. Cardiovasc. Intervent., 79: 712–719. doi: 10.1002/ccd.23336
- Issue published online: 27 MAR 2012
- Article first published online: 10 JAN 2012
- Accepted manuscript online: 22 NOV 2011 02:19PM EST
- Manuscript Accepted: 7 AUG 2011
- Manuscript Revised: 1 AUG 2011
- Manuscript Received: 7 MAR 2011
- aortic stenosis;
- cardiac conduction disorders;
Objective: To ascertain incidence and predictors of new permanent pacemaker (PPM) following transcatheter aortic valve implantation (TAVI) with the self-expanding aortic bioprosthesis. Background: TAVI with the Medtronic Corevalve (MCV) Revalving System (Medtronic, Minneapolis, MN) has been associated with important post-procedural conduction abnormalities and frequent need for PPM. Methods: Overall, 73 consecutive patients with severe symptomatic AS underwent TAVI with the MCV at two institutions; 10 patients with previous pacemaker and 3 patients with previous aortic valve replacement were excluded for this analysis. Clinical, echocardiographic, and procedural data were collected prospectively in a dedicated database. A standard 12-lead ECG was recorded in all patients at baseline, after the procedure and predischarge. Decision to implant PPM was taken according to current guidelines. Logistic multivariable modeling was applied to identify independent predictors of PPM at discharge. Results: Patients exhibited high-risk features as evidenced by advanced age (mean = 82.1 ± 6.2 years) and high surgical scores (logistic EuroSCORE 23.0 ± 12.8%, STS score 9.4 ± 6.9%). The incidence of new PPM was 28.3%. Interventricular septum thickness and logistic Euroscore were the baseline independent predictors of PPM. When procedural variables were included, the independent predictors of PPM were interventricular septum thickness (OR 0.52; 95% CI 0.32–0.85) and the distance between noncoronary cusp and the distal edge of the prosthesis (OR 1.37; 95% CI 1.03–1.83). Conclusions: Conduction abnormalities are frequently observed after TAVI with self-expandable bioprosthesis and definitive pacing is required in about a third of the patients, with a clear association with depth of implant and small interventricular septum thickness. © 2011 Wiley Periodicals, Inc.