Impact of aortic valve calcium score on conductive disturbances after transcatheter aortic valve implantation: a monocentre retrospective study

Abstract

Abstract Introduction Conductive disorders requiring permanent pacemaker implantation (PPI) remain an important issue after transcatheter aortic valve implantation (TAVI). Aims To assess the impact of aortic valve calcium score (AVCS) on conductive disorders requiring PPI after TAVI. Methods All patients who underwent TAVI with an available AVCS from the pre-procedural CT-scan report from 2016 to 2022 were included in this retrospective single-centre study. The primary endpoint was the occurrence of a conductive disorder requiring PPI at 30 days. The association between PPI and AVCS was analyzed using multivariable logistic regression and receiver operating characteristics (ROC) curves analyses. Results Seven hundred and sixty-one patients were included, of whom 125 (16%) patients required a PPI at 30 days. AVCS score was significantly higher in patients requiring PPI (3788 (2487-5218) vs. 3050 (2043-4367) AU, p<0.001). Using multivariable analysis, pre-procedural right bundle branch block (OR=6.61, 95%CI=3.82-11.5, p<0.001), first atrioventricular block (OR=1.71, 95%CI=1.03-2.83, p=0.037), the use of a self-expanding valve (OR=3.25, 95%CI=1.17-9.09, p=0.025), and AVCS >4510 AU (OR=1.83, 95%CI=1.04-3.20, p=0.035) were independently associated with PPI. The area under the curve for ACVS to predict PPI was 60.3% (95%CI=54.7%-65.9%), indicating moderate discrimination. Of note, AVCS had an incremental discriminative value (C-index 0.79 vs 0.77, LR test p=0.036) over and above traditional PPI risk factors. Conclusion The results of our study suggest that a high AVCS is associated with an increased risk of PPI after TAVI.Central illustration