Predictors of paravalvular regurgitation and permanent pacemaker implantation after TAVR with a next-generation self-expanding device
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Predictors of paravalvular regurgitation and permanent pacemaker implantation after TAVR with a next-generation self-expanding device. / Mauri, Victor; Deuschl, Florian; Frohn, Thomas; Schofer, Niklas; Linder, Matthias; Kuhn, Elmar; Schaefer, Andreas; Rudolph, Volker; Madershahian, Navid; Conradi, Lenard; Rudolph, Tanja K; Schäfer, Ulrich.
In: CLIN RES CARDIOL, Vol. 107, No. 8, 08.2018, p. 688-697.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Predictors of paravalvular regurgitation and permanent pacemaker implantation after TAVR with a next-generation self-expanding device
AU - Mauri, Victor
AU - Deuschl, Florian
AU - Frohn, Thomas
AU - Schofer, Niklas
AU - Linder, Matthias
AU - Kuhn, Elmar
AU - Schaefer, Andreas
AU - Rudolph, Volker
AU - Madershahian, Navid
AU - Conradi, Lenard
AU - Rudolph, Tanja K
AU - Schäfer, Ulrich
PY - 2018/8
Y1 - 2018/8
N2 - 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 (LVOTLC) 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 LVOTLC 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%.
AB - 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 (LVOTLC) 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 LVOTLC 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%.
KW - Aged, 80 and over
KW - Aortic Valve/diagnostic imaging
KW - Aortic Valve Insufficiency/etiology
KW - Aortic Valve Stenosis/diagnosis
KW - Female
KW - Humans
KW - Male
KW - Multidetector Computed Tomography
KW - Pacemaker, Artificial
KW - Retrospective Studies
KW - Risk Factors
KW - Self Expandable Metallic Stents/adverse effects
KW - Severity of Illness Index
KW - Transcatheter Aortic Valve Replacement/adverse effects
U2 - 10.1007/s00392-018-1235-1
DO - 10.1007/s00392-018-1235-1
M3 - SCORING: Journal article
C2 - 29667013
VL - 107
SP - 688
EP - 697
JO - CLIN RES CARDIOL
JF - CLIN RES CARDIOL
SN - 1861-0684
IS - 8
ER -