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Impact of the use of Cusp Overlap projection technique in the incidence of post-TAVR permanent pacemaker implantation with Self-Expanding Valves
Session:
Posters (Sessão 5 - Écran 7) - Intervenção Cardíaca Coronária e Estrutural 3 - Foco na Válvula Aórtica
Speaker:
Ana Rita Moura
Congress:
CPC 2022
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Ana Rita Moura; Alberto Rodrigues; Pedro Braga; Cláudio Guerreiro; Gustavo Pires de Morais; Lino Santos; Bruno Melica; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong>: Current rates of new Permanent Pacemaker (PPM) Implantations in the context of Transcatheter Aortic Valve Replacement (TAVR) range from 2-36% and that necessity is related to worse prognosis. The use of self-expanding valves and a lower valve implantation depth are two factors associated with an increased risk of conduction disturbances post-TAVR. Theoretically, cusp overlap implantation technique has the potential to enable a higher valve deployment by eliminating parallax of the delivery catheter. <strong>Aim</strong>: to compare the in-hospital incidence of PPM post-TARV using self-expandable valve according to the fluoroscopic guidance technique.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: retrospective, single-centre study, with evaluation of patients consecutively submitted to TAVR with self-expanding CoreValve<sup>TM</sup> between July 2020 and July 2021 <span style="color:#222222">dichotomized according to the use of cusp overlap implantation technique for fluoroscopic valve implantation guidance. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:#222222">Results: </span></strong><span style="color:#222222">97 patients were included, predominantly women (55.7%), with a mean age of 78.6</span><span style="font-family:Symbol"><span style="color:#222222">±</span></span><span style="color:#222222">8.1 years old, with severe aortic stenosis of the native valve being the most common indication for TAVI (86.6%). Cusp overlap view technique was applied in 50.5% of the patients (n=49). Frailty and co-morbidities were the most common cause for surgical refusal (54.6%). There was a significantly higher percentage of previous medication with </span><span style="font-family:Symbol"><span style="color:#222222">b</span></span><span style="color:#222222">-blockers in the group of patients in whom was used the standard fluoroscopic technique (43.8% vs. 20.8%, p=0.02); there were no other relevant differences related to the baseline characteristics. First degree atrioventricular block was present in 20.8% and complete right bundle block in 13.0% of the patients. Incidence of in-hospital p</span>ost-TAVR PPM implantation wasn’t significantly different between the two cohorts of patients (cusp overlap vs. standard approach: 22.4% vs. 25%, p=0.77) (78.3% implanted in the context of complete heart block). Likewise, there were similar proportions of in-hospital<span style="color:#222222"> new-onset of complete left bundle branch block (27.5% vs. 33.3%, p=0.95), volume of contrast used (145.4±41.6 mL vs. 148.7±76.7 mL, p=0.25), fluoroscopy time (16.6±10.1 min vs. 19.5±10.8 min, p=0.54) and radiation dose (561.9±426.8 mGy vs. 815.1±537.8 mGy, p=0.07). </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:#222222">Conclusions: </span></strong><span style="color:#222222">this study shows that using the cusp overlap view for </span>self-expanding valve <span style="color:#222222">implantation does not seem to achieve a significant reduction in in-hospital PPM implantation rate in comparison with the traditional 3 cusp co-planar fluoroscopic view. A larger and probably randomized clinical trial is needed to confirm these results.</span></span></span></p>
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