Impact of tapered-shape left ventricular outflow tract on pacemaker rate after transcatheter aortic valve replacement View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2022-01-07

AUTHORS

Kenichi Ishizu, Naoto Murakami, Takashi Morinaga, Masaomi Hayashi, Akihiro Isotani, Yoshio Arai, Nobuhisa Ohno, Shinichi Kakumoto, Shinichi Shirai, Kenji Ando

ABSTRACT

Mechanical compression of left ventricular outflow tract (LVOT) was reported to be a leading cause of conduction impairment requiring permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR). However, the association between tapered-shape LVOT and PPI after TAVR has not been elucidated. Of 272 consecutive patients treated with SAPIEN 3 in our institute, we retrospectively analyzed the clinical data of 256 patients without previous PPI or bicuspid valve. In-hospital PPI was performed in 20 (7.8%) patients at 8.2 ± 2.9 days after TAVR. Patients requiring PPI had smaller LVOT area (356.3 vs. 399.4 mm2, p ≤ 0.011). Moreover, receiver operating characteristic statistics showed that LVOT area /annulus area possessed significantly higher predictive ability than LVOT area (c-statistic: 0.91 [95% confidence interval [CI]: 0.84–0.95] vs. 0.67 [95% CI: 0.57–0.77], p < 0.001). Multivariable analysis revealed that LVOT area /annulus area (odds ratio [OR]: 1.93 [95% CI: 1.38–2.71]; p < 0.001 per % of decreasing), the difference between membranous septum length and implantation depth (ΔMSID) (OR: 6.82 [95% CI 2.39–19.48]; p < 0.001 per mm of decreasing) and pre-existing complete right bundle branch block (CRBBB) (OR: 32.38 [95% CI2.30–455.63]; p ≤ 0.002) were independently associated with PPI. In our study, tapered-shape LVOT as well as short ΔMSID and pre-existing CRBBB were identified as independent predictors for PPI after TAVR. Higher valve implantation is required to minimize the risk of post-procedural PPI especially for patients with short MS length, pre-procedural CRBBB, or tapered-shape LVOT. More... »

PAGES

1055-1065

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00380-021-01999-5

DOI

http://dx.doi.org/10.1007/s00380-021-01999-5

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1144474610

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/34993586


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