Impact of membranous septum length on pacemaker need with different transcatheter aortic valve replacement systems: The INTERSECT registry

Hokken, Thijmen W.; Muhemin, Mohammed; Okuno, Taishi; Veulemans, Verena; Lopes, Bernardo B.C.; Beneduce, Alessandro; Vittorio, Romano; Ooms, Joris F.; Adrichem, Rik; Neleman, Tara; Kardys, Isabella; Daemen, Joost; Chieffo, Alaide; Montorfano, Matteo; Cavalcante, João L.; Zeus, Tobias; Pilgrim, Thomas; Toggweiler, Stefan; Mieghem, Nicolás M. Van

doi:10.1016/j.jcct.2022.07.003

Cited by 23 publications

(19 citation statements)

References 17 publications

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“…The absence of observation of any modulating effect of pre‐existing RBBB on the impact of short MS length and low ΔMSID on the incidence of CA/PPI does not mean necessarily the absence of an independent impact of RBBB on the incidence of PPI after TAVI. Several studies recently published 20–23 have shown RBBB as an independent predictor of PPI after TAVI and should not be neglected as such. As stated by Ishizu et al, 21 as new LBBB in patients with pre‐existing RBBB is substantially equal to CAVB, comparatively mild mechanical compression of conduction tissues on the left ventricle outflow tract by THVs result in the requirement of PPI after TAVI.…”

Section: Discussionmentioning

confidence: 99%

“…After excluding duplicates and noneligible studies, 18 studies 4,6,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] met our eligibility criteria (Supporting Information: Figure 1). All the studies were nonrandomized and observational, while four studies were multicentric and five studies included matched populations (Table 1).…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

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Computed tomography‐derived membranous septum length as predictor of conduction abnormalities and permanent pacemaker implantation after TAVI: A meta‐analysis of observational studies

Sá

Eynde

Jacquemyn

et al. 2023

Cathet Cardio Intervent

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Background Permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) is associated with higher risk of mortality and rehospitalization for heart failure. Efforts to prevent conduction abnormalities (CA) requiring PPI after TAVI should be made. The membranous septum (MS) length and its interaction with implantation depth (ID–ΔMSID) could provide useful information about the risk of CA/PPI following TAVI. Objectives To identify MS length and ΔMSID as predictors of CA/PPI following TAVI. Methods Study‐level meta‐analysis of studies published by September 30, 2022. Results Eighteen studies met our eligibility including 5740 patients. Shorter MS length was associated with a significantly higher risk of CA/PPI (per 1 mm decrease: odds ratio [OR] 1.60, 95% confidence interval [CI] 1.28–1.99, p < 0.001). Similarly, lower ΔMSID was associated with a significantly higher risk of CA/PPI (per 1 mm decrease: OR 1.75, 95% CI 1.32–2.31, p < 0.001). Meta‐regression analyses revealed a statistically significant modulation of the effect of shorter MS length and lower ΔMSID on the outcome (CA/PPI) by balloon postdilatation (positive regression coefficients with p < 0.001); with increasing use of balloon postdilatation, the effect of shorter MS length and lower ΔMSID on the outcome increased. MS length and ΔMSID demonstrated excellent discriminative abilities, with diagnostic ORs equaling 9.49 (95% CI 4.73–19.06), and 7.19 (95% CI 3.31–15.60), respectively. Conclusion Considering that short MS length and low ΔMSID are associated with higher risk of CA and PPI, we should include measurement of MS length in the pre‐TAVI planning with MDCT and try to establish optimal ID values before the procedure to avoid CA/PPI.

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Section: Discussionmentioning

confidence: 99%

Section: Study Selection and Characteristicsmentioning

confidence: 99%

Computed tomography‐derived membranous septum length as predictor of conduction abnormalities and permanent pacemaker implantation after TAVI: A meta‐analysis of observational studies

Sá

Eynde

Jacquemyn

et al. 2023

Cathet Cardio Intervent

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“…In particular a short MS (< 3mm) is associated with a higher PPI because there is a higher likelihood of contact interference between the THV frame and the His Bundle. (24) FEops HEARTguide TM not only considers MS length but also accounts for the interaction of the THV with the surrounding anatomical structures resulting in contact pressure on the region of the conduction system. This contact pressure may correlate better with PPI than MS length per se.…”

Section: Discussionmentioning

confidence: 99%

“…In particular a short MS (< 3mm) is associated with a higher PPI because there is a higher likelihood of contact interference between the THV frame and the His Bundle. (24)…”

Section: Discussionmentioning

confidence: 99%

Clinical Value Of CT-Derived Simulations Of Transcatheter-Aortic-Valve-Replacement In Challenging Anatomies The PRECISE-TAVR Trial

Hokken

Wienemann

Dargan

et al. 2023

Preprint

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Background Pre-procedural computed tomography planning improves procedural safety and efficacy of transcatheter aortic valve replacement(TAVR). However, contemporary imaging modalities do not account for device-host interactions. This study evaluates the value of pre-procedural computer simulation with FEops HEARTguideTM on overall device success in patients with challenging anatomies undergoing TAVR with a contemporary self-expanding supra-annular transcatheter heart valve. Methods This prospective multicenter observational study included patients with a challenging anatomy defined as bicuspid aortic valve, small annulus or severely calcified aortic valve. We compared the heart team's transcatheter heart valve(THV) planning decision based on 1) conventional multislice computed tomography(MSCT) and 2) MSCT imaging with FEops HEARTguideTM simulations. Clinical outcomes and THV performance were followed up to 30 days. Results A total of 77 patients were included(Median age 79.9 years (IQR 74.2-83.8), 42% male). In 35% of the patients, pre-procedural planning changed after FEops HEARTguideTM simulations(change in valve size selection(12%) or target implantation height(23%)). A new permanent pacemaker implantation(PPI) was implanted in 13% and >trace paravalvular leakage (PVL) occurred in 28.5%. The contact pressure index(i.e. simulation output indicating the risk of conduction abnormalities) was significantly higher in patients with a new PPI, compared to those without(16.0%(25th-75th percentile 12.0-21.0) vs. 3.5%(25th-75th percentile 0-11.3), p<0.01) The predicted PVL was 5.7mL/s(25th-75th percentile 1.3-11.1) in patients with none-trace PVL, 12.7(25th-75th percentile 5.5-19.1) in mild PVL and 17.7(25th-75th percentile 3.6-19.4) in moderate PVL(p=0.04). Conclusion FEops HEARTguideTM simulations may provide enhanced insights in the risk for PVL or PPI after TAVR with a self-expanding supra-annular THV in complex anatomies.

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“…[4][5][6] However, long-term data on the prognostic impact of post-TAVR PPI remain controversial. [7][8][9] We now report the impact of new PPI on clinical outcomes in patients undergoing TAVR at our center.…”

Section: Introductionmentioning

confidence: 99%

Prognostic impact of new permanent pacemaker implantation following transcatheter aortic valve replacement

Zheng

Yan

Lin

et al. 2023

Cathet Cardio Intervent

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BackgroundConduction disturbances requiring permanent pacemaker implantation (PPI) are common following transcatheter aortic valve replacement (TAVR). There were conflicting data regarding the impact of new PPI on clinical outcomes after TAVR.ObjectivesThe study sought to evaluate the impact of new PPI on clinical outcomes in patients undergoing TAVR.MethodsThis study was a retrospective analysis of prospectively collected data. Data were from 210 consecutive patients without prior PPI who underwent TAVR due to severe symptomatic aortic stenosis at our center between June 2018 and July 2020. Clinical, echocardiographic, and pacing data were assessed at 30‐day, 1‐ and 2‐year follow‐up.ResultsNew PPI was required in 35 (16.7%) patients within 30 days after TAVR. The median time from TAVR to PPI was 3 days. The most common indication for PPI was high‐degree or complete atrioventricular block. The median follow‐up was 798.0 (interquartile range, 669.0–1115.0) days. There were no differences in all‐cause mortality (adjusted hazard ratio [HR]: 1.18; 95% confidence interval [CI]: 0.85–2.36; p = 0.415) and cardiovascular mortality (adjusted HR: 0.92; 95% CI: 0.57–1.89; p = 0.609) between groups. However, PPI group had a higher risk of heart failure (HF) rehospitalization (adjusted HR: 1.53; 95% CI: 1.26–2.28; p = 0.027). Echocardiography showed no significant improvement of LVEF over time in patients with PPI. At the latest follow‐up, 31.3% of patients exhibited low (≤10%) pacing burdens, whereas 28.1% of patients had near constant (>90%) right ventricular pacing.ConclusionsNew PPI within 30 days following TAVR was not associated with an increased risk of all‐cause or cardiovascular mortality. However, patients with PPI had a higher risk of HF rehospitalization and lack of LVEF improvement.

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Impact of membranous septum length on pacemaker need with different transcatheter aortic valve replacement systems: The INTERSECT registry

Cited by 23 publications

References 17 publications

Computed tomography‐derived membranous septum length as predictor of conduction abnormalities and permanent pacemaker implantation after TAVI: A meta‐analysis of observational studies

Computed tomography‐derived membranous septum length as predictor of conduction abnormalities and permanent pacemaker implantation after TAVI: A meta‐analysis of observational studies

Clinical Value Of CT-Derived Simulations Of Transcatheter-Aortic-Valve-Replacement In Challenging Anatomies The PRECISE-TAVR Trial

Prognostic impact of new permanent pacemaker implantation following transcatheter aortic valve replacement

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