Impact of the repositionable Evolut R CoreValve system on the need for a permanent pacemaker after transcatheter aortic valve implantation in patients with severe aortic stenosis.
Catheter Cardiovasc Interv
; 95(4): 783-790, 2020 03 01.
Article
em En
| MEDLINE
| ID: mdl-31062927
ABSTRACT
OBJECTIVES:
To compare the incidence of permanent pacemaker implantation (PPI) with the CoreValve and Evolut R prostheses, to evaluate the implantation depth with both types of prostheses, and to study factors predicting the need for PPI.BACKGROUND:
The Evolut R CoreValve can be recaptured and repositioned during deployment, allowing a more precise implantation.METHODS:
A total of 208 patients treated with CoreValve and 137 patients treated with Evolut R were analyzed. The depth of the prosthesis in the LVOT was measured by angiography in the annular perpendicular view projection after deploymen in all patients.RESULTS:
Baseline conduction abnormalities were comparable between the groups (85/208, 40.9% vs. 53/137, 38.7%; p = 0.69). The mean prosthesis depth was 10.3 ± 8.6 mm in the CoreValve group and 5.5 ± 2.7 mm in the Evolut R group; p < 0.0001. Conduction disturbances after valve implantation were more frequent with the CoreValve (new-onset left bundle branch block 93, 44.7% vs. 16, 11.7%; p < 0.05, first-degree atrioventricular block 23, 11.1% vs. 5, 3.6%; p < 0.05). In addition, the incidence of PPI was significantly lower with Evolut R (45, 21.6% vs. 15, 10.9%; p = 0.01). The predictors of the need for PPI were the mean depth of the prosthesis (OR 1.13, 95% CI 1.06-1.21; p < 0.0001) and prior right bundle branch block (OR 10.22, 95% CI 4.62-22.63; p < 0.0001).CONCLUSIONS:
The recapturable capability of the Evolut R system allowed for higher and precise valve implantation. This fact had an impact on the reduction in the need for PPI.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Valva Aórtica
/
Estenose da Valva Aórtica
/
Marca-Passo Artificial
/
Arritmias Cardíacas
/
Próteses Valvulares Cardíacas
/
Estimulação Cardíaca Artificial
/
Substituição da Valva Aórtica Transcateter
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Aged80
/
Female
/
Humans
/
Male
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article