Calcium distribution patterns of the aortic valve as a risk factor for the need of permanent pacemaker implantation after transcatheter aortic valve implantation
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Calcium distribution patterns of the aortic valve as a risk factor for the need of permanent pacemaker implantation after transcatheter aortic valve implantation. / Fujita, Buntaro; Kütting, Maximilian; Seiffert, Moritz; Scholtz, Smita; Egron, Sandrine; Prashovikj, Emir; Börgermann, Jochen; Schäfer, Timm; Scholtz, Werner; Preuss, Rainer; Gummert, Jan; Steinseifer, Ulrich; Ensminger, Stephan M.
In: EUR HEART J-CARD IMG, Vol. 17, No. 12, 12.2016, p. 1385-1393.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Calcium distribution patterns of the aortic valve as a risk factor for the need of permanent pacemaker implantation after transcatheter aortic valve implantation
AU - Fujita, Buntaro
AU - Kütting, Maximilian
AU - Seiffert, Moritz
AU - Scholtz, Smita
AU - Egron, Sandrine
AU - Prashovikj, Emir
AU - Börgermann, Jochen
AU - Schäfer, Timm
AU - Scholtz, Werner
AU - Preuss, Rainer
AU - Gummert, Jan
AU - Steinseifer, Ulrich
AU - Ensminger, Stephan M
N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.
PY - 2016/12
Y1 - 2016/12
N2 - AIMS: New-onset conduction disturbances still represent a considerable problem after transcatheter aortic valve implantation (TAVI). The aim of this study was to identify calcification patterns with an elevated risk for permanent pacemaker implantation (PPI) after TAVI and investigate underlying mechanisms in an ex vivo setting.METHODS AND RESULTS: One hundred and sixty-two patients who underwent TAVI with the Edwards SAPIEN XT® or Medtronic CoreValve® at our institution were analysed. The calcium load of the device landing zone was quantified with 3mensio®, and calcium patterns with an elevated risk for PPI were identified. Ex vivo simulations of balloon valvuloplasty were performed in 3D-printed silicone annuli of patients matching the identified risk profile. Patients with a calcium load of the left coronary cusp (LCC) above 209 mm3 had a higher rate of PPI than patients below this threshold (16.7 vs. 2.6%, P = 0.003). Multivariate regression revealed pre-existing right bundle branch block (RBBB) and increased LCC calcification as independent predictors for PPI. Simulation of the TAVI procedure in a silicone annulus revealed an off-centreline shift of the valvuloplasty balloon and transcatheter heart valve away from the LCC towards the commissure between right- and non-coronary cusp.CONCLUSION: Pre-existing RBBB and elevated LCC calcification were identified as independent predictors for PPI. These two risk factors enabled us to distinguish between patients according to their risk for PPI after TAVI. Ex vivo simulations suggested an off-centreline shift of the balloon as a possible explanation.
AB - AIMS: New-onset conduction disturbances still represent a considerable problem after transcatheter aortic valve implantation (TAVI). The aim of this study was to identify calcification patterns with an elevated risk for permanent pacemaker implantation (PPI) after TAVI and investigate underlying mechanisms in an ex vivo setting.METHODS AND RESULTS: One hundred and sixty-two patients who underwent TAVI with the Edwards SAPIEN XT® or Medtronic CoreValve® at our institution were analysed. The calcium load of the device landing zone was quantified with 3mensio®, and calcium patterns with an elevated risk for PPI were identified. Ex vivo simulations of balloon valvuloplasty were performed in 3D-printed silicone annuli of patients matching the identified risk profile. Patients with a calcium load of the left coronary cusp (LCC) above 209 mm3 had a higher rate of PPI than patients below this threshold (16.7 vs. 2.6%, P = 0.003). Multivariate regression revealed pre-existing right bundle branch block (RBBB) and increased LCC calcification as independent predictors for PPI. Simulation of the TAVI procedure in a silicone annulus revealed an off-centreline shift of the valvuloplasty balloon and transcatheter heart valve away from the LCC towards the commissure between right- and non-coronary cusp.CONCLUSION: Pre-existing RBBB and elevated LCC calcification were identified as independent predictors for PPI. These two risk factors enabled us to distinguish between patients according to their risk for PPI after TAVI. Ex vivo simulations suggested an off-centreline shift of the balloon as a possible explanation.
KW - Aged
KW - Analysis of Variance
KW - Aortic Valve Stenosis/diagnostic imaging
KW - Calcium/metabolism
KW - Cardiac Pacing, Artificial/methods
KW - Cohort Studies
KW - Confidence Intervals
KW - Echocardiography, Three-Dimensional/methods
KW - Electrocardiography/methods
KW - Female
KW - Humans
KW - Image Interpretation, Computer-Assisted
KW - Male
KW - Multivariate Analysis
KW - Odds Ratio
KW - Pacemaker, Artificial
KW - Postoperative Complications/diagnostic imaging
KW - Prognosis
KW - Prospective Studies
KW - Risk Assessment
KW - Survival Rate
KW - Transcatheter Aortic Valve Replacement/adverse effects
U2 - 10.1093/ehjci/jev343
DO - 10.1093/ehjci/jev343
M3 - SCORING: Journal article
C2 - 26758411
VL - 17
SP - 1385
EP - 1393
JO - EUR HEART J-CARD IMG
JF - EUR HEART J-CARD IMG
SN - 2047-2404
IS - 12
ER -
