EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2017
Very low pacemaker rate following ACURATE neo transcatheter heart valve implantation.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Toggweiler Stefan, Nissen Henrik, Mogensen Brynjolfur, Cuculi Florim, Fallesen Christian, Veien Karsten Tange, Brinkert Miriam, Kobza Richard, Rück Andreas
Аннотация
AIMS: The aim of this study was to investigate whether minimising trauma to the aortic annulus and left ventricular outflow tract reduces the occurrence of new conduction disorders and the need for permanent pacemakers.
METHODS AND RESULTS: A total of 175 patients (58% female, mean age 83±6 years) underwent transfemoral TAVI with the Boston Scientific ACURATE neo at three centres in Europe. Prosthesis size selection was based on perimeter-derived annular diameter. Predilatation was performed in all with a balloon 1.9±0.9 mm smaller than the perimeter-derived annular diameter. Post-dilatation was performed in 46 (26.3%) with a balloon 1.2±0.9 mm smaller than the perimeter-derived annular diameter. Eighteen patients (10.3%) developed a new left bundle branch block, 13 (7%) a new first-degree AV block, and four (2.3%) received a new permanent pacemaker. Paravalvular regurgitation was none/trace in 66 (37.7%), mild in 101 (57.7%) and moderate in eight (4.6%). At 30 days, the rate of any stroke was 1.7% (3/175), and one patient (0.6%) had died.
CONCLUSIONS: With careful selection of the balloon and the ACURATE neo prosthesis size, very low rates of new conduction disorders and permanent pacemaker implantation may be achieved without increasing the amount of paravalvular regurgitation.
METHODS AND RESULTS: A total of 175 patients (58% female, mean age 83±6 years) underwent transfemoral TAVI with the Boston Scientific ACURATE neo at three centres in Europe. Prosthesis size selection was based on perimeter-derived annular diameter. Predilatation was performed in all with a balloon 1.9±0.9 mm smaller than the perimeter-derived annular diameter. Post-dilatation was performed in 46 (26.3%) with a balloon 1.2±0.9 mm smaller than the perimeter-derived annular diameter. Eighteen patients (10.3%) developed a new left bundle branch block, 13 (7%) a new first-degree AV block, and four (2.3%) received a new permanent pacemaker. Paravalvular regurgitation was none/trace in 66 (37.7%), mild in 101 (57.7%) and moderate in eight (4.6%). At 30 days, the rate of any stroke was 1.7% (3/175), and one patient (0.6%) had died.
CONCLUSIONS: With careful selection of the balloon and the ACURATE neo prosthesis size, very low rates of new conduction disorders and permanent pacemaker implantation may be achieved without increasing the amount of paravalvular regurgitation.
Предметные рубрики MeSH
AgedAged, 80 and overAortic ValveAortic Valve InsufficiencyAortic Valve StenosisAtrioventricular BlockBalloon ValvuloplastyBundle-Branch BlockCardiac Pacing, ArtificialEuropeFemaleHeart Valve ProsthesisHumansMalePacemaker, ArtificialProsthesis DesignRetrospective StudiesRisk FactorsStrokeTime FactorsTranscatheter Aortic Valve ReplacementTreatment Outcome