Impact of implantation depth and calcium burden on infranodal conduction delay after transcatheter aortic valve replacement

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Andrea Papa MD, Teodor Serban MD, Ivo Strebel PhD, Sven Knecht DSc, PhD, Corinne Isenegger MMed, Thomas Nestelberger MD, Christoph Kaiser MD, Gregor Leibundgut MD, Philipp Haaf MD, Beat Schaer MD, Philipp Krisai MD, Stefan Osswald MD, Christian Sticherling MD, Michael Kühne MD, Patrick Badertscher MD
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引用次数: 0

Abstract

Background

Infranodal conduction disorders are common after transcatheter aortic valve replacement (TAVR). Risk factors are incompletely understood.

Objective

The purpose of this study was to assess the impact of valve implantation depth and calcium burden of the device landing zone on infranodal conduction intraprocedure pre- and post-TAVR.

Methods

In all patients undergoing TAVR between June 2020 and June 2021, the His-ventricle (HV) interval was measured pre- and post-valve deployment. The difference between the 2 measurements defined delta HV, whereas infranodal conduction delay was defined as HV interval >55 ms. Valve implantation depth was measured as the distance between the aortic annular plane and the ventricular prosthesis end. Calcium burden was quantified as the volume of calcium in 6 regions of interest: the non-, right, and left coronary cusps (NCC, RCC, and LCC, respectively) and the corresponding regions of the left ventricular outflow tract (LVOT) underlying each cusp (LVOTNCC, LVOTRCC, LVOTLCC, respectively).

Results

Of 101 patients (mean age 81 ± 5.7 years; 47% women), 37 demonstrated infranodal conduction delay intraprocedure post-TAVR. Overall, mean implantation depth was 5 ± 3.1 mm, median calcium volume was 2080 mm3 [interquartile range 632–2400]. Delta HV showed no correlation with implantation depth or calcium burden (r = –0.08 and r = 0.12, respectively). However, LVOTNCC calcification was a significant predictor for infranodal conduction delay post-valve deployment in a multivariable logistic regression model (odds ratio 1.62 per 100-mm3 increase (95% confidence interval 1.06–2.69; P = .04).

Conclusion

Assessment of LVOTNCC calcification may identify patients at risk for infranodal conduction delay after TAVR, whereas implantation depth did not predict infranodal conduction delay.

经导管主动脉瓣置换术后植入深度和钙负荷对瓣下传导延迟的影响
背景经导管主动脉瓣置换术(TAVR)后常见颅内传导障碍。本研究旨在评估瓣膜植入深度和装置着床区的钙负荷对经导管主动脉瓣置换术(TAVR)前后术中下叶传导的影响。方法在 2020 年 6 月至 2021 年 6 月期间接受 TAVR 的所有患者中,测量瓣膜部署前后的 His-ventricle (HV) 间期。两个测量值之间的差值定义为δHV,而下叶传导延迟定义为HV间期>55 ms。瓣膜植入深度以主动脉瓣环平面与心室假体末端之间的距离来衡量。钙负荷量化为 6 个相关区域的钙量:非、右和左冠状动脉尖(分别为 NCC、RCC 和 LCC)以及每个尖下方左室流出道 (LVOT) 的相应区域(分别为 LVOTNCC、LVOTRCC 和 LVOTLCC)。总体而言,平均植入深度为 5 ± 3.1 毫米,中位钙容量为 2080 立方毫米[四分位间范围为 632-2400] 。Delta HV与植入深度或钙负荷无相关性(r = -0.08 和 r = 0.12)。然而,在多变量逻辑回归模型中,LVOTNCC钙化是预测瓣膜置入后瓣下传导延迟的重要因素(每增加100立方毫米的几率为1.62(95%置信区间为1.06-2.69;P = .04))。
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来源期刊
Heart Rhythm O2
Heart Rhythm O2 Cardiology and Cardiovascular Medicine
CiteScore
3.30
自引率
0.00%
发文量
0
审稿时长
52 days
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