ABSTRACT
BACKGROUND: Conduction disturbances are common complications of transcatheter aortic valve implantation (TAVI). One influencing factor is implantation depth (ID) of the TAVI prosthesis. Since this should be standardized, a differentiated consideration of ID is necessary. OBJECTIVE: Examination of the impact of ID at different anatomical regions of the left ventricular outflow tract on new conduction disturbances, new permanent pacemaker implantation (PPI) and survival. MATERIALS AND METHODS: The retrospective cohort study included 420 patients who underwent transfemoral TAVI with new-generation devices, including 352 patients without pre-existing pacemakers, for analyses on new pacemaker implantation. Of them, 46 patients underwent PPI. ID at non- (NCC) and left-coronary cusp (LCC) were measured using fluoroscopy after valve implantation. Deep ID was defined as the 4th quartile of each prosthesis' ID. Survival was determined from the two-year follow-up. RESULTS AND CONCLUSIONS: Deep ID was associated with higher PPI rate only at NCC (pâ¯= 0.013). At LCC deep ID resulted in more frequent permanent left bundle branch block (pâ¯= 0.014). DI, preexisting pacemaker or new PPI did not affect 2year survival. No patients with new PPI suffered moderate to severe paravalvular leak. ID at NCC could be a predictor for PPI after TAVI. A detailed consideration of ID in intervention planning might predict outcome after TAVI and common complications. PPI after TAVI and deep ID at NCC and LCC can be considered safe regarding survival in absence of moderate-to-severe paravalvular leak.
Subject(s)
Aortic Valve Stenosis , Heart Valve Prosthesis , Pacemaker, Artificial , Transcatheter Aortic Valve Replacement , Aortic Valve Stenosis/surgery , Electrocardiography , Fluoroscopy , Humans , Retrospective Studies , Transcatheter Aortic Valve Replacement/adverse effects , Treatment OutcomeABSTRACT
Background Cardiovascular biomarkers constitute promising tools for improved risk stratification and prediction of outcome in patients undergoing transcatheter aortic valve implantation. We examined the association of periprocedural changes of NT-proBNP (N-terminal pro-B-type natriuretic peptide) with survival after transcatheter aortic valve implantation. Methods and Results NT-proBNP levels were measured in 704 patients before transcatheter aortic valve implantation and at discharge. Patients were grouped as responders and nonresponders depending on an NT-proBNP-based ratio (postprocedural NT-proBNP at discharge/preprocedural NT-proBNP). Overall, 376 of 704 patients showed a postprocedural decrease in NT-proBNP levels (NT-proBNP ratio <1). Responders and nonresponders differed significantly regarding median preprocedural (2822 versus 1187 pg/mL, P<0.001) and postprocedural (1258 versus 3009 pg/mL, P<0.001) NT-proBNP levels. Patients in the nonresponder group showed higher prevalence of atrial fibrillation (47.0% versus 39.4%, P=0.042), arterial hypertension (94.2% versus 87.5%, P=0.002), renal impairment (77.4% versus 69.1%, P=0.013), and peripheral artery disease (24.4% versus 14.6%, P=0.001). In contrast, patients in the responder group had higher prevalence of moderately reduced left ventricular ejection fraction (17.3% versus 11.0%, P=0.017), lower calculated aortic valve area (0.7 versus 0.8 cm2, P<0.001), and higher mean pressure gradient (41 versus 35 mm Hg, P<0.001). Median follow-up was 22.6 months. Kaplan-Meier analysis showed a highly significant survival benefit for the responder group compared with the nonresponder group (log-rank test, P<0.001). Conclusions A ratio based on periprocedural changes of NT-proBNP is a simple tool for better risk stratification and is associated with survival in patients after transcatheter aortic valve implantation.