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Predictors of permanent pacemaker implantation after transcatheter aortic valve implantation with a self-expanding valve
Session:
CO8 - Doença Valvular
Speaker:
Tiago Mendonça
Congress:
CPC 2019
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.4 Valvular Heart Disease – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Tiago Mendonça; Lino Patrício ; Dra. Inês Rodrigues; Tânia Branco Mano; Ana Abreu; Duarte Cacela; Ruben Ramos; Hagen Kahlbau; Isabel Fragata; António Valentim Gonçalves; Madalena Coutinho Cruz; Mário Martins Oliveira; Rui Cruz Ferreira; José Fragata
Abstract
<p><strong>Purpose</strong>: Transcatheter aortic valve implantation (TAVI) is an established treatment in patients with aortic stenosis with intermediate to high surgical risk. Despite the continuous developments of this procedure, high-grade conduction disturbance requiring permanent pacemaker (PPM) implantation is still a major complication of TAVI. Our aim was to determine the predictors of PPM implantation in patients submitted to TAVI with a self-expanding valve.</p> <p><strong>Methods:</strong> We retrospectively examined 292 patients who underwent TAVI with a self-expanding valve from 2009 to 2018 at our institution. All patients had pre-procedural clinical evaluation, cardiac computed tomographic angiography, transthoracic echocardiography and electrocardiography performed. Patients with previous PPM were excluded.</p> <p><strong>Results: </strong>265 patients, 57% male, mean age 81.36 years, were analysed. Mean STS score and mean Euroscore II were, respectively, 6.33% and 7.07%. Mean gradient was 52.78 mmHg and mean aortic valve area 0.67 cm<sup>2</sup>. 47 patients (17%) required PPM implantation after TAVI. The most frequently used valve was Corevalve Evolut R (34.9%), followed by Corevalve (28.4%), Portico (19.4%), Corevalve Evolut Pro (8.3%), Lotus (5.9%) and Direct Flow (3.1%). New PPM implantation rate was higher with Lotus and Direct Flow (37.5% with both valves) and lower with Corevalve Evolut Pro (10.5%). Patients requiring PPM implantation had higher prevalence of diabetes mellitus (DM), chronic renal disease (CKD), atrial fibrillation (AF) and right bundle branch block (RBBB).</p> <p>Predictors of PPM implantation in logistic regression were the presence of RBBB (OR 5.74, 95% IC 1.92-17.15, p < 0.01), AF (OR 2.14, 95% IC 1.01-4.50, p = 0.04), diabetes mellitus (OR 2.17, 95% IC 1.02-4.58, p = 0.04) and balloon post-dilatation (OR 2.77, 95% IC 1.24-6.17, p = 0.01)</p> <p><strong>Conclusions:</strong> In patients submitted to TAVI with a self-expanding valve the presence of RBBB, AF, DM and balloon post-dilatation were predictors of PPM implantation.</p>
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