Abstract
Methods and Results We retrospectively compared 257 consecutive patients undergoing TAVR with self-expandable valves using either CON (n = 101) or COVL (n = 156) in four intermediate/low volume centers. There were no significant differences in baseline characteristics between the groups. The 30-day incidence of new-onset LBBB (12.9% vs. 5.8%; p=0.05) and PPMI rate (17.8% vs. 6.4%; p=0.004) was significantly lower when using the COVL implantation view. There was no difference between the CON and COVL groups in 30-day incidence of death (4.9% vs. 2.6%), any stroke (0% vs. 0.6%), and the need for surgical aortic valve replacement (0% for both groups). Conclusion Using the COVL view for implantation, we achieved a significant reduction of the LBBB and PPMI rate after TAVR in comparison with the traditional CON view, without compromising the TAVR outcomes when using self-expandable prostheses.
Highlights
Transcatheter aortic valve replacement (TAVR) is recommended for intermediate and high-risk surgical patients with severe aortic stenosis, and new evidence is supporting its use for low-risk patients
Periprocedural complications have been decreasing over time, conduction disturbances leading to permanent pacemaker implantation (PPMI) remains a common complication which has been related to a higher 1-year mortality. is complication would be even more relevant in low-risk and younger patients receiving TAVR [1]
Conduction disturbances requiring PPMI after TAVR even for self-expandable valves have been decreasing with newer devices, operator’s experience and new deployment techniques still remain as a significant limitation which should be addressed [2]
Summary
Transcatheter aortic valve replacement (TAVR) is recommended for intermediate and high-risk surgical patients with severe aortic stenosis, and new evidence is supporting its use for low-risk patients. Conduction disturbances leading to permanent pacemaker implantation (PPMI) remains a common complication for TAVR procedures, when self-expanding valves are used. We compared the 30-day incidence of newonset left bundle branch block (LBBB) and permanent pacemaker implantation (PPMI) rate between two consecutive groups using either conventional 3-cusp coplanar view (CON) and right/left cusp-overlap view (COVL) for implantation. We retrospectively compared 257 consecutive patients undergoing TAVR with self-expandable valves using either CON (n 101) or COVL (n 156) in four intermediate/low volume centers. E 30-day incidence of new-onset LBBB (12.9% vs 5.8%; p 0.05) and PPMI rate (17.8% vs 6.4%; p 0.004) was significantly lower when using the COVL implantation view. Using the COVL view for implantation, we achieved a significant reduction of the LBBB and PPMI rate after TAVR in comparison with the traditional CON view, without compromising the TAVR outcomes when using self-expandable prostheses
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