Incidence, Predictors, and Outcome of Conduction Disorders After Transcatheter Self-Expandable Aortic Valve Implantation
| Autor: | Massimo Napodano, Valeria Gasparetto, Renato Razzolini, Gino Gerosa, Domenico Corrado, Loira Leoni, Sabino Iliceto, Gaetano Thiene, Gianfranco Buja, Cristina Basso, Chiara Fraccaro, Raffaele Bonato, Giuseppe Tarantini, Giambattista Isabella |
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| Rok vydání: | 2011 |
| Předmět: |
Male
Aortic valve Bundle of His Cardiac Catheterization medicine.medical_specialty Bundle-Branch Block Prosthesis Implantation Electrocardiography Postoperative Complications Dystrophic calcification Internal medicine medicine Humans Aged Retrospective Studies Aged 80 and over Heart Valve Prosthesis Implantation medicine.diagnostic_test business.industry Incidence Retrospective cohort study Aortic Valve Stenosis Middle Aged Right bundle branch block Prognosis medicine.disease Surgery Stenosis medicine.anatomical_structure Italy Echocardiography Cardiology Female Tomography X-Ray Computed Cardiology and Cardiovascular Medicine business Atrioventricular block Follow-Up Studies |
| Zdroj: | The American Journal of Cardiology. 107:747-754 |
| ISSN: | 0002-9149 |
| DOI: | 10.1016/j.amjcard.2010.10.054 |
| Popis: | The aims of the present study were to investigate the incidence and characteristics of conduction disorders (CDs) after transcatheter aortic valve implantation (TAVI), to analyze the predictors of permanent pacemaker (PPM) implantation, and to evaluate the outcomes of CDs over time. In particular, we sought to investigate whether the depth of deployment and other technical aspects of valve implantation might predict the need for PPM implantation after TAVI. TAVI has been reported to favor the onset or worsening of CDs often requiring PPM implantation. A total of 70 patients with aortic stenosis due to dystrophic calcification underwent TAVI with third-generation CoreValve Revalving System from May 2007 to April 2009. We collected electrocardiograms at baseline, during TAVI, during hospitalization and at the 1-, 3-, 6-, and 12-month follow-up visits thereafter. The clinical, anatomic, and procedural variables were tested to identify the predictors of PPM implantation. The PPM dependency at follow-up was analyzed. Six patients were excluded from the analysis because of a pre-existing PPM. Of the 64 patients, 32 (50%) had one or more atrioventricular-intraventricular CDs at baseline. TAVI induced a worsening in the CDs in 49 (77%) of the 64 patients, with 25 (39%) requiring in-hospital PPM implantation. On multivariate analysis, the independent predictors of PPM implantation were the depth of the prosthesis implantation (p = 0.039) and the pre-existing right bundle branch block (p = 0.046). A trend in the recovery of the CDs over time was recorded, although 2 patients required PPM implantation 1 month after discharge for late complete atrioventricular block. In conclusion, TAVI often induces or worsens CDs, requiring PPM in more than one third of patients, although a trend in the recovery of CDs during the midterm was recorded. The independent predictors of PPM implantation were the depth of prosthesis implantation and pre-existing right bundle branch block. |
| Databáze: | OpenAIRE |
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