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Risk of pacemaker implantation after TAVI: not all self-expandable valves are created equal
Session:
Posters (Sessão 6 - Écran 2) - Intervenção não coronária
Speaker:
Diogo De Almeida Fernandes
Congress:
CPC 2023
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:
Diogo De Almeida Fernandes; Joana Guimarães; Eric Monteiro; Gonçalo Costa; Ana Rita Gomes; Gustavo Campos; João Rosa; Ana Vera Marinho; João André Ferreira; Luís Leite; Joana Silva; Elisabete Jorge; Natália António; Marco Costa; Lino Gonçalves
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>INTRODUCTION</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of severe aortic stenosis. Nevertheless, the risk of significant conduction disturbances and need of definitive pacemaker implantation post-procedure is significant. Our aim was to compare the different self-expandable valves and the need of pacemaker implantation.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>METHODS</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Patients who underwent TAVI with self-expandable valves from March 2020 to October 2022 were included. Those with pacemaker prior to the procedure were excluded. Clinical, laboratory echocardiographic, cardiac computerized tomography (CT<sub>card</sub>) angiographic and procedural data were collected, with a special focus on known predictors of pacemaker implantation. Need of definitive pacemaker after implantation and pre-existing conduction disturbances were registered. Two groups were created according to need of pacemaker implantation post-TAVI. Multivariate analysis was performed to determine differences among valves. </span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>RESULTS</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A total of 243 patients were included. Mean age was 80.83 ± 6.04 years and 115 (47.3%) were male. Fifty-seven patients (23.5%) required pacemaker implantation post procedure, mainly due to complete atrioventricular block (75.9%). 125 patients (51.4%) had prior conduction disturbance, being left anterior hemiblock the most frequent (64, 26.3%) followed by first degree AV block (61, 32.4% of patients in sinus rhythm). Complete right bundle block was present 25 (10.3%) patients. Regarding CT<sub>Card</sub>, mean Agatston score was 3071 ± 1635 and left ventricular outflow tract (LVOT) calcium was present in 84 (34.6%) of patients. Mean prothesis/LVOT ratio was 1.20 ± 0.12.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The most utilized type of valve was EvolutPro (117; 48.1%), followed by Accurate Neo2 (53; 21.8%), Navitor (38; 15.6%), Portico (18; 7.4%) and Evolut R (17; 7.0%). 85 patients (35.0%) underwent balloon post-dilation (PD). There were significant differences between groups regarding PD (p 0.025) and mean prothesis/LVOT ratio (p < 0.001).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">On multivariate analysis, the Navitor valve had an odd almost 3 times higher of need of definite pacemaker after TAVI (odds-ratio [OR] 2.73, 95% CI 1.183-6.32), even after adjusting for confounding variates.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>CONCLUSION</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Use of Navitor valves appears to significantly increase rates of pacemaker implantation, even after considering other known risk factors. Careful patient selection is needed to ensure severe conduction abnormalities are minimized.</span></span></p>
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