A new and easy parameter to predict the requirement for permanent pacemaker implantation after transaortic valve implantation: aortic knob calcification.

Introduction: One of the predictable and preventable complications that may occur after transaortic valve implantation (TAVI) is the requirement for permanent pacemaker (PPM) implantation.

Aim: To evaluate the relationship between aortic knob calcification (AKC) assessed by preoperative chest X-ray and the requirement for post-procedure PPM implantation for patients who underwent TAVI.

Material and methods: This study was conducted with 110 patients who underwent TAVI with a Myval transcatheter heart valve in our center between June 2020 and December 2022. The patients' electrocardiograms were monitored after the procedure. The patients were evaluated in two groups according to whether they required PPM. The AKC grading was performed by examining the routine posterior-anterior chest radiographs of all patients participating in the study.

Results: A PPM was placed in 17 (15.4%) patients after TAVI. The remaining 93 patients formed the control group. AKC (p = 0.002) and membranous septum (p = 0.013) statistically significantly differed between the PPM and control groups; however, no significant difference was detected in relation to the other parameters. In the univariable (p = 0.004) and multivariable (p = 0.024) regression analyses performed to identify predictors of PPM requirement after TAVI, AKC was found to be both a dependent and independent predictor.

Conclusions: AKC can be used as a cost-effective and easily accessible parameter for predicting the post-procedure PPM requirement in patients who have undergone TAVI.