Abstract
Background and aims: To assess the contribution of aortic valve calcification to the occurrence of transient or permanent atrioventricular (AV) block and the need for permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) in a large single-center cohort. Methods: We retrospectively analyzed preoperative contrast-enhanced multidetector computed tomography (MDCT) scans of patients who underwent TAVI in our center between 2012 and 2016. Calcium volume was calculated for each aortic cusp above (aortic valve), and below (left ventricular outflow tract, LVOT) the basal plane. Clinical and procedural data as well as preoperative ECGs were evaluated. Multivariate analysis was performed to evaluate risk factors for AV block and need for PPI. Results: A total of 470 patients were included in the study (Edwards SapienXT, n = 157; Edwards Sapien3, n = 185; Medtronic CoreValve, n = 27; Medtronic CoreValve EvolutR, n = 12; Medtronic Engager, n = 5; Symetis Acurate, n = 84). Overall incidence of post-procedural AV block was 12.5% (n = 59) and 8.9% (n = 42) of patients underwent PPI. On multiple linear regression analysis, preprocedural right bundle branch block (RBBB), QRS duration and LVOT calcification beneath the non-coronary cusp were found to be independently associated both with new-onset AV block and PPI. Considering only patients with postprocedural AV block, RBBB was the only predictor of postoperative PPI (odds ratio 8.82, 95% confidence interval 1.008–77.25; p = 0.049). Conclusions: LVOT non-coronary cusp calcification is independently associated with both AV block and PPI after TAVI. RBBB may play a role in discriminating transient from permanent AV block.
Published Version
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