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Non-coronary cusp asymmetrical calcification as a predictor of complete atrioventricular block post-TAVI
Session:
Sessão de Posters 23 - Pacing após TAVI
Speaker:
Marta Paralta De Figueiredo
Congress:
CPC 2024
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Cartazes
FP Number:
---
Authors:
Marta Paralta De Figueiredo; Miguel Carias; Diogo Brás; David Neves; Rita Rocha; Renato Fernandes; Ângela Bento; Gustavo Sá Mendes; Lino Patrício
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background:</strong> Conduction disturbances are an important complication after transcatheter aortic valve implantation (TAVI), frequently requiring permanent pacemaker (PPM) implantation. Mechanical injury of atrioventricular node (AV) and/or membranous septum (MS) is a described mechanism for AV block post-TAVI. Predictors of AV block requiring PPM are extensively studied. However, distribution of calcium at aortic annulus as a protective or harmful factor for AV or MS injury is understudied and not homogenous for type of valve (self-expandable vs balloon-expandable). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose</strong>: This study aims to determine if asymmetrical non-coronary cusp (NCC) calcification is related to the need of PPM after TAVI with self-expandable valves.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: We performed a single-centre retrospective analysis of consecutive data collected prospectively of patients submitted to TAVI. To avoid bias we excluded those who received other than Medtronic Evolut® valve and those with prior PPM. We collected demographic factors, personal history and ECG data before the procedure. We analyzed data derived from contrast-enhanced CT scan and TAVI procedure. Development of conduction disorders and PPM implantation was recorded, and univariate and multivariate analysis was performed to identify independent predictors. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>: Out of 231 patients that undergone TAVI, 47 patients were excluded. We selected those who developed complete AV block and required PPM implantation. Demographic factors between groups weren’t significantly different and overall median aortic valve calcium score was 2547 AU (IQR 1867-3684). Univariate analysis revealed that prior RBBB (52,9% vs 19,6%, p=0,02), pre-dilation (30,7% vs 17,7%; p=0,039) and deeper prosthesis implantation (>15mm: 30,8% vs 15 to 5mm: 29,6% vs <5mm: 11,7%, p=0,025) were associated with higher odds of complete AV block. Asymmetrical NCC calcification was significantly more associated with complete AV block than symmetrical calcification of all cusps (36,2% vs 20,5%; p= 0,044). In multivariate logistic regression analysis only prosthesis depth >15mm remained significant (p=0,034).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions</strong>: In patients submitted to TAVI with self-expandable valves besides the prior well-known predictors (RBBB, predilation and prosthesis depth >15mm), asymmetrical NCC calcification is associated with PPM implantation post-TAVI. Further studies are necessary to evaluate the real impact of NCC calcium volume and ratio of MS height/NCC calcium height.</span></span></p>
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