Impact of tapered-shape left ventricular outflow tract on pacemaker rate after transcatheter aortic valve replacement

Ishizu, Kenichi; Murakami, Naoto; Morinaga, Takashi; Hayashi, Masaomi; Isotani, Akihiro; Arai, Yoshinori; Ohno, Nobuhisa; Kakumoto, Shinichi; Shirai, Shinichi; Ando, Kenji

doi:10.1007/s00380-021-01999-5

Cited by 6 publications

(10 citation statements)

References 28 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%

“…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: Discussionmentioning

confidence: 99%

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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“…The use of MS length as an anatomic surrogate of the distance between the aortic annulus and the bundle of His was first reported by Hamdan et al in 2015, 18 and many studies since then have supported its importance. 8, 19, 20 In particular, Jilaihawi et al demonstrated that the approach aiming for implantation depth in relation to the non-coronary cusp less than MS length achieved very low and predictable PPI rates (3.0%) after self-expandable TAVI. However, in fact, the MS length may approach the minimum resolution of CT, particularly in cases with shorter MS lengths, which can potentially lead to measurement errors.…”

Section: Discussionmentioning

confidence: 99%

Impact of Transjugular Intracardiac Echocardiography-Guided Self-Expandable Transcatheter Aortic Valve Implantation on Reduction of Conduction Disturbances

Ishizu¹,

Shirai²,

Miyawaki³

et al. 2023

Preprint

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Background: A high permanent pacemaker implantation (PPI) risk remain a concern of self-expandable transcatheter aortic valve implantation (TAVI), despite continued improvements in implantation methodology. We aimed to assess the impact of real-time direct visualization of the membranous septum using transjugular intracardiac echocardiography (ICE) during TAVI on reducing the rates of conduction disturbances including the need for PPI. Methods: Consecutive patients treated with Evolut R and Evolut PRO/PRO+ from February 2017 to September 2022 were included in this study. We compared outcomes between the conventional implantation method using the 3-cusps view ("3-cusps without ICE" group), the recent method using cusp-overlap view ("cusp-overlap without ICE" group), and our novel method using ICE ("cusp-overlap with ICE" group). Results: Of the 446 patients eligible for analysis, 211 (47.3%) were categorized as the "3-cusps without ICE" group, 129 (28.9%) were in the "cusp-overlap without ICE" group, and 106 (23.8%) comprised the "cusp-overlap with ICE" group. Compared with the "3-cusps without ICE" group, the "cusp-overlap without ICE" group had a smaller implantation depth (2.2 [IQR 1.0-3.5] mm vs 4.3 [IQR: 3.3-5.4], P <0.001) and lower 30-day PPI rates (7.0% vs 14.2%, P = 0.035). Compared with the "cusp-overlap without ICE" group, the "cusp-overlap with ICE" group had lower 30-day PPI rates (1.0%, P = 0.014), albeit with comparable implantation depths (1.9 [IQR 0.9-2.9] mm, P = 0.150). Multivariable analysis showed that our novel method using ICE with the cusp-overlap view was independently associated with a 30-day PPI rate reduction. There were no group differences in 30-day all-cause mortality (1.4% vs 1.6% vs 0%; P = 0.254). Conclusions: Our novel implantation method using transjugular ICE, which enabled a real-time direct visualization of the membranous septum, achieved a predictably high position of prostheses, resulting in a substantial reduction of conduction disturbances requiring PPI after TAVI.

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“…Despite TAVI has been successfully employed over the past two decades, many complications have been reported such as conduction problems, leading to pacemaker dependency after treatment, and aortic regurgitation (AR). [4][5][6] TAVI devices, that is, the prosthetic valves, are subject to continuous development to improve current devices and overcome these complications. In silico trials could possibly speed up the clinical introduction of improved TAVI devices.…”

mentioning

confidence: 99%

Generation of synthetic aortic valve stenosis geometries for in silico trials

Verstraeten,

Hoeijmakers,

Tonino

et al. 2023

Numer Methods Biomed Eng

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In silico trials are a promising way to increase the efficiency of the development, and the time to market of cardiovascular implantable devices. The development of transcatheter aortic valve implantation (TAVI) devices, could benefit from in silico trials to overcome frequently occurring complications such as paravalvular leakage and conduction problems. To be able to perform in silico TAVI trials virtual cohorts of TAVI patients are required. In a virtual cohort, individual patients are represented by computer models that usually require patient‐specific aortic valve geometries. This study aimed to develop a virtual cohort generator that generates anatomically plausible, synthetic aortic valve stenosis geometries for in silico TAVI trials and allows for the selection of specific anatomical features that influence the occurrence of complications. To build the generator, a combination of non‐parametrical statistical shape modeling and sampling from a copula distribution was used. The developed virtual cohort generator successfully generated synthetic aortic valve stenosis geometries that are comparable with a real cohort, and therefore, are considered as being anatomically plausible. Furthermore, we were able to select specific anatomical features with a sensitivity of around 90%. The virtual cohort generator has the potential to be used by TAVI manufacturers to test their devices. Future work will involve including calcifications to the synthetic geometries, and applying high‐fidelity fluid–structure‐interaction models to perform in silico trials.

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Impact of tapered-shape left ventricular outflow tract on pacemaker rate after transcatheter aortic valve replacement

Cited by 6 publications

References 28 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

Impact of Transjugular Intracardiac Echocardiography-Guided Self-Expandable Transcatheter Aortic Valve Implantation on Reduction of Conduction Disturbances

Generation of synthetic aortic valve stenosis geometries for in silico trials

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