Abstract
Incidence and predictors of permanent pacemaker implantation after transcatheter aortic valve implantation with a balloon-expandable biosprosthesis in patients with bicuspid aortic valves
- Department of Cardiology, Faculty of Medicine, Karamanoğlu Mehmetbey University, Karaman Training and Research Hospital, Karaman, Turkey
- Department of Cardiology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara Bilkent City Hospital, Ankara, Turkey
- Department of Cardiology, Faculty of Medicine, Atılım University, Medicana International Ankara Hospital, Ankara, Turkey
- Department of Cardiology, Medicana International Ankara Hospital, Ankara, Turkey
Introduction:
There are few data on permanent pacemaker implantation (PPMI) in patients who have undergone transcatheter aortic valve implantation (TAVI) for bicuspid aortic valve (BAV) stenosis.
Aim:
The purpose of this study was to evaluate the predictors and incidence of PPMI in bicuspid patients using a balloon-expandable (BE) TAVI device.
Material and methods:
A total of 62 patients with bicuspid morphology who had undergone successful TAVI using a BE device without previous PPMI were included (retrospectively). Their baseline clinical, electrocardiographic (ECG), echocardiographic, and multislice computed tomography (MSCT) details were collected.
Results:
The incidence of PPMI after TAVI in this BAV cohort was 12.9%. All eight patients with PPMs were found to have type 1 left-right (L-R) fusion morphology. In univariate analysis, the presence of right bundle branch block (RBBB) in preprocedural ECG (p < 0.0001), short membranous septum (MS) evaluated in MSCT (p < 0.0001), and increased annulus-left main coronary artery distance (p = 0.02) were statistically significant for PPMI. Among these parameters included in the model using multivariate Firth logistic regression analysis, the presence of preprocedural RBBB (p = 0.001) and shortness of the MS in MSCT (p = 0.004) were independent risk factors for predicting postprocedural PPMI in patients who underwent TAVI among those with BAV.
Conclusions:
Preprocedural RBBB on ECG and shorter MS are independent risk factors for PPMI after TAVI in BAV patients and these parameters should be considered before the procedure to guide clinical decision making. Type 1 L-R patients may be considered at increased risk of PPMI.
Keywords
aortic valve stenosis, bicuspid aortic valve, transcatheter aortic valve implantation, transcatheter aortic valve replacement, pacemaker
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