Top

Published in:

Open Access 01-12-2021 | Original Paper

Factors associated with a high or low implantation of self-expanding devices in TAVR

Authors: Verena Veulemans, Oliver Maier, Kerstin Piayda, Kira Lisanne Berning, Stephan Binnebößel, Amin Polzin, Shazia Afzal, Lisa Dannenberg, Patrick Horn, Christian Jung, Ralf Westenfeld, Malte Kelm, Tobias Zeus

Published in: Clinical Research in Cardiology | Issue 12/2021

Abstract

Objectives

Optimizing valve implantation depth (ID) plays a crucial role in minimizing conduction disturbances and achieving optimal functional integrity. Until now, the impact of intraprocedural fast (FP) or rapid ventricular pacing (RP) on the implantation depth has not been investigated. Therefore, we aimed to (1) evaluate the impact of different pacing maneuvers on ID, and (2) identify the independent predictors of deep ID.

Methods

473 TAVR patients with newer-generation self-expanding devices were retrospectively enrolled and one-to-one propensity-score-matching was performed, resulting in a matching of 189 FP and RP patients in each cohort. The final ID was analyzed, and the underlying functional, anatomical, and procedural conditions were evaluated by univariate and multivariate analysis.

Results

The highest ID was reached under RP in severe aortic valve calcification and valve size 26 mm. Multivariate analysis identified left ventricular outflow (LVOT) calcification [OR 0.50 (0.31–0.81) p = 0.005*], a “flare” aortic root [OR 0.42 (0.25–0.71), p = 0.001*], and RP (OR 0.49 [0.30–0.79], p = 0.004*) as independent highly preventable predictors of a deep ID. In a model of protective factors, ID was significantly reduced with the number of protective criteria (0–2 criteria: − 5.7 mm ± 2.6 vs. 3–4 criteria − 4.3 mm ± 2.0; p < 0.0001*).

Conclusion

Data from this retrospective analysis indicate that RP is an independent predictor to reach a higher implantation depth using self-expanding devices. Randomized studies should prove for validation compared to fast and non-pacing maneuvers during valve delivery and their impact on implantation depth.

Trail registration

Clinical Trial registration: NCT01805739.

Graphic abstract

Study design: Evaluation of the impact of different pacing maneuvers (fast ventricular pacing—FP vs. rapid ventricular pacing—RP) on implantation depth (ID). After one-to-one-propensity-score-matching, independent protective and risk factors for a very deep ID beneath 6 mm toward the LVOT (< − 6 mm) were identified. Stent frame pictures as a courtesy by Medtronic^®. AVC aortic valve calcification.

Available only for authorised users

Falk V, Baumgartner H, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Rodriguez Muñoz D et al (2017) ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg 52:616–664. https://doi.org/10.5603/KP.2018.0013CrossRefPubMed

Grube E, Van Mieghem NM, Bleiziffer S, Modine T, Bosmans J, Manoharan G, Linke A, Scholtz W, Tchétché D, Finkelstein A et al (2017) Clinical outcomes with a repositionable self-expanding transcatheter aortic valve prosthesis: the international FORWARD study. J Am Coll Cardiol 70:845–853. https://doi.org/10.1016/j.jacc.2017.06.045CrossRefPubMed

Hellhammer K, Piayda K, Afzal S, Kleinebrecht L, Makosch M, Henning I, Quast C, Jung C, Polzin A, Westenfeld R et al (2018) The latest evolution of the medtronic corevalve system in the era of transcatheter aortic valve replacement: matched comparison of the Evolut PRO and Evolut R. JACC Cardiovasc Interv 11:2314–2322. https://doi.org/10.1016/j.jcin.2018.07.023CrossRefPubMed

Manoharan G, Van Mieghem NM, Windecker S, Bosmans J, Bleiziffer S, Modine T, Linke A, Scholtz W, Chevalier B, Gooley R et al (2018) 1 year outcomes with the Evolut R self-expanding transcatheter aortic valve: from the international FORWARD study. JACC Cardiovasc Interv 11:2326–2334. https://doi.org/10.1016/j.jcin.2018.07.032CrossRefPubMed

Jilaihawi H, Zhao Z, Du R, Staniloae C, Saric M, Neuburger PJ, Querijero M, Vainrib A, Hisamoto K, Ibrahim H et al (2019) Minimizing permanent pacemaker following repositionable self-expanding transcatheter aortic valve replacement. JACC Cardiovasc Interv 12:1796–1807. https://doi.org/10.1016/j.jcin.2019.05.056CrossRefPubMed

Piayda K, Hellhammer K, Veulemans V, Sievert H, Gafoor S, Afzal S, Henning I, Makosch M, Polzin A, Jung C et al (2020) Navigating the “Optimal Implantation Depth” with a self-expanding TAVR device in daily clinical practice. JACC Cardiovasc Interv 13:679–688. https://doi.org/10.1016/j.jcin.2019.07.048CrossRefPubMed

Veulemans V, Frank D, Seoudy H, Wundram S, Piayda K, Maier O, Jung C, Polzin A, Frey N, Malte K et al (2020) New insights on potential permanent pacemaker predictors in TAVR using the largest self-expanding device. Cardiovasc Diagn Ther 10:1816–1826. https://doi.org/10.21037/cdt-20-680CrossRefPubMedPubMedCentral

Axell RG, White PA, Giblett JP, Williams L, Rana BS, Klein A, O’Sullivan M, Davies WR, Densem CG, Hoole SP et al (2017) Rapid pacing-induced right ventricular dysfunction is evident after balloon-expandable transfemoral aortic valve replacement. J Am Coll Cardiol 69:903–904. https://doi.org/10.1016/j.jacc.2016.12.011CrossRefPubMed

Kapadia S, Agarwal S, Miller DC, Webb JG, Mack M, Ellis S, Herrmann HC, Pichard AD, Tuzcu EM, Svensson LG et al (2016) Insights into timing, risk factors, and outcomes of stroke and transient ischemic attack after transcatheter aortic valve replacement in the PARTNER trial (placement of aortic transcatheter valves). Circ Cardiovasc Interv 9:e002981. https://doi.org/10.1161/CIRCINTERVENTIONS.115.002981CrossRefPubMed

10.

Fefer P, Bogdan A, Grossman Y, Berkovitch A, Brodov Y, Kuperstein R, Segev A, Guetta V, Barbash IM (2018) Impact of rapid ventricular pacing on outcome after transcatheter aortic valve replacement. J Am Heart Assoc 7:e009038. https://doi.org/10.1161/JAHA.118.009038CrossRefPubMedPubMedCentral

11.

Kappetein AP, Head SJ, Généreux P et al (2012) Updated standardized endpoint definitions for transcatheter aortic valve implantation: the valve academic research consortium-2 consensus document. J Am Coll Cardiol 60:1438–1454. https://doi.org/10.1016/j.jacc.2012.09.001CrossRefPubMed

12.

Achenbach S, Delgado V, Hausleiter J, Schoenhagen P, Min JK, Leipsic JA (2012) SCCT expert consensus document on computed tomography imaging before transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR). J Cardiovasc Comput Tomogr 6:366–380. https://doi.org/10.1016/j.jcct.2012.11.002CrossRefPubMed

13.

Siontis GCM, Overtchouk P, Cahill TJ, Modine T, Prendergast B, Praz F, Pilgrim T, Petrinic T, Nikolakopoulou A, Salanti G et al (2019) Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of symptomatic severe aortic stenosis: an updated meta-analysis. Eur Heart J 40:3143–3153. https://doi.org/10.1093/eurheartj/ehz275CrossRefPubMed

14.

Latsios G, Gerckens U, Buellesfeld L, Mueller R, John D, Yuecel S, Syring J, Sauren B, Grube E (2010) “Device landing zone” calcification, assessed by MSCT, as a predictive factor for pacemaker implantation after TAVI. Catheter Cardiovasc Interv 76:431–439. https://doi.org/10.1002/ccd.22563CrossRefPubMed

15.

Maeno Y, Abramowitz Y, Kawamori H, Kazuno Y, Kubo S, Takahashi N, Mangat G, Okuyama K, Kashif M, Chakravarty T et al (2017) A highly predictive risk model for pacemaker implantation after TAVR. JACC Cardiovasc Imaging 10:1139–1147. https://doi.org/10.1016/j.jcmg.2016.11.020CrossRefPubMed

16.

Siontis GCM, Praz F, Lanz J, Vollenbroich R, Roten L, Stortecky S, Räber L, Windecker S, Pilgrim T (2018) New-onset arrhythmias following transcatheter aortic valve implantation: a systematic review and meta-analysis. Heart 104:1208–1215. https://doi.org/10.1136/heartjnl-2017-312310CrossRefPubMed

17.

Hamdan A, Guetta V, Klempfner R, Konen E, Raanani E, Glikson M, Goitein O, Segev A, Barbash I, Fefer P et al (2015) Inverse relationship between membranous septal length and the risk of atrioventricular 1 block in patients undergoing transcatheter aortic valve implantation. JACC Cardiovasc Interv 8:1218–1228. https://doi.org/10.1016/j.jcin.2015.05.010CrossRefPubMed

Title: Factors associated with a high or low implantation of self-expanding devices in TAVR
Authors: Verena Veulemans
Oliver Maier
Kerstin Piayda
Kira Lisanne Berning
Stephan Binnebößel
Amin Polzin
Shazia Afzal
Lisa Dannenberg
Patrick Horn
Christian Jung
Ralf Westenfeld
Malte Kelm
Tobias Zeus
Publication date: 01-12-2021
Publisher: Springer Berlin Heidelberg
Published in: Clinical Research in Cardiology / Issue 12/2021
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-021-01901-3

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Factors associated with a high or low implantation of self-expanding devices in TAVR

Abstract

Objectives

Methods

Results

Conclusion

Trail registration

Graphic abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Trail registration

Graphic abstract

Please log in to get access to this content

Other articles of this Issue 12/2021

Non-invasive predictors for infranodal conduction delay in patients with left bundle branch block after TAVR

Impact of implantation depth on outcomes of new-generation balloon-expandable transcatheter heart valves

Transcatheter aortic valve implantation in patients with a small aortic annulus: performance of supra-, intra- and infra-annular transcatheter heart valves

In-hospital outcomes of self-expanding and balloon-expandable transcatheter heart valves in Germany

Periinterventional inflammation and blood transfusions predict postprocedural delirium after percutaneous repair of mitral and tricuspid valves

Prevention of coronary obstruction in patients at risk undergoing transcatheter aortic valve implantation: the Hamburg BASILICA experience

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page