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Cusp-Overlap Technique to reduce Permanent Pacemaker implantation rate after Transcatheter Aortic Valve Implantation
Session:
Sessão de Posters 53 - Complicações de TAVI
Speaker:
Miguel Eduardo Caramelo Abrantes de Figueiredo
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:
Miguel Abrantes de Figueiredo; Inês Rodrigues; Bárbara Teixeira; André Grazina; Francisco Albuquerque; Ricardo Carvalheiro; Duarte Cacela; Rúben Ramos; António Fiarresga; Tiago Mendonça; Rui Cruz Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Background:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"> Persistent conduction disturbances requiring permanent pacemaker (PPM) implantation are one of the most common complications after Transcatheter Aortic Valve Implantation (TAVI). Cusp-Overlap Technique (COT) is a novel approach for self-expandable valve implantation to minimize the rate of procedural complications, mainly PPM implantation.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Purpose:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"> To determine if the COT during TAVI with self-expandable valves leads to a reduction of PPM implantation rate in the real-world setting. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Methods:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"> A retrospective analysis of consecutive patients undergoing TAVI between January 2020 and November 2023 in one high-volume tertiary care center in Portugal was conducted. Two groups were defined, the COT group and the control group based on the fluoroscopic approach. A baseline comparison between the 2 groups was made using independent-samples t-test and chi-square analysis to determine if there was a difference between the prevalence of known risk factors for PPM implantation after TAVI. Afterwards, chi-square analysis was used to determine if COT led to a reduction in the PPM implantation rate. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Results:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"> Of the 539 completed procedures in this timeframe, 289 were excluded due to previous pacemaker implantation, use of a valve not amenable to COT or valve-in-valve implantation. COT was used in 57.6% of eligible cases. Baseline comparison did not show a significant difference in the prevalence of several known risk factors for PPM implantation, including complete right bundle branch block, atrio-ventricular block, calcium score, aortic ring dimensions and pre/post-dilation. PPM implantation after TAVI was required in 31.6% of cases. In the COT group the PPM implantation rate was 22.9% and in the control group 43.4%. Chi-square analysis showed a very statistically significant difference between the 2 analyzed groups (p-value = 0.001).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Conclusion:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"> PPM implantation remains a frequent complication of TAVI. However, this study showed that the utilization of COT leads to a reduction of the PPM implantation rate.</span></span></span></span></p>
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