SPC365

Post- TAVI care: Assessing the Need for Cardiac Device Implantation

Session: Sessão de Posters 53 - Complicações de TAVI
Speaker: João Mendes Cravo

Congress: CPC 2024
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Cartazes
FP Number: ---
Authors: João Mendes Cravo; Marta Miguez Vilela; Ana Margarida Martins; Catariana Simões de Oliveira; Miguel Nobre Menezes; João Silva Marques; Cláudia Jorge; Pedro Carrilho Ferreira; João de Sousa; Pedro Marques; Pedro Cardoso; Fausto J. Pinto

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Introduction: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Despite advancements in technical procedure, new-onset conduction abnormalities following transcatheter aortic valve implantation (TAVI) remain a common complication. The need&nbsp; for cardiac device (CD) implantation is a crucial consideration, with reported rates varying across studies.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Purpose: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">To evaluate predictors of cardiac device implantation in patients (pts) submitted to&nbsp; TAVI.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Methods:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"> <span style="font-family:Arial,Helvetica,sans-serif">Single center retrospective study of consecutive pts submitted to TAVI for severe aortic stenosis without prior history of cardiac device implantation, from September 2012 to November 2022. Clinical and electrocardiography (ECG) data was collected. Chronic kidney disease (CKD) was defined as creatinine clearance below 60 ml/min/1.73m2. For statistical analysis T-student, Chi-square tests and logistic regression were performed.&nbsp;</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Results: </strong></span></span></span><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><span style="color:#000000">We included 687 pts, 55% females, mean age 84</span></span><span style="font-size:12pt"><span style="color:#000000">&plusmn;7 years, with high burden of cardiovascular risk factors (hypertension: 90%, dyslipidemia: 74%, diabetes: 37%, CKD: 31%, smoking habits: 20%), 53% of pts with a NYHA functional class above III. Prior diagnosis of atrial fibrillation (AF) and stroke was present in 40% and 14% of pts, respectively. ECG at baseline showed sinus rhythm in 74% of pts, AF in 26%, a median PQ and QRS interval duration was 170 and 101 ms, respectively. Self-expanding valves were implanted in the majority of pts (65%), pre and post dilatation ballooning was performed in 31% and 19% of pts, respectively. During a mean follow-up of 2.5 years, 30% of pts required a CD (pacemaker in 96% of pts), and the reason for implantation was high degree atrioventricular block (AVB) in 68% of pts followed by QRS enlargement in 16% and brady AF in 7% of pts. Early new-onset conduction disturbances (&lt;24h) occurred in 57% of pts and 82% of devices were implanted before discharge. On bivariate analysis, history of AF and use of self-expanding valves were associated with a 1.7 and 1.5 fold higher odds for the requirement of CD. Furthermore, valve size (CD: 27&plusmn;3 mm vs non-CD: 26&plusmn;3mm, p=&lt;0.001), pre and post procedure QRS duration (pre CD: 113&plusmn;23 vs non-CD: 103&plusmn;21 ms, p=0.019; post CD 140&plusmn;27 vs non-CD: 124&plusmn;37mm, p= 0.032) and post-TAVI PQ duration (CD: 200&plusmn;55 vs non-CD: 183&plusmn;43ms, p=&lt;0.001) were associated with higher risk of CD implantation. On multivariate analysis, prior history of AF was the only independent predictor for CD implantation (OR 2.2, CI 1.12-4.9).&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"><span style="color:black">Conclusion:</span></span></span></strong> <span style="font-family:&quot;Arial&quot;,sans-serif"><span style="color:black">Within our pt cohort, AF, valve characteristics, and pre-existing conduction abnormalities emerged as predictors for CD implantation predictors. These factors should be considered to optimize post-TAVI care.&nbsp;</span></span></span></span></p>

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