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

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.

Development of atrioventricular and intraventricular conduction disturbances in patients undergoing transcatheter aortic valve replacement with new generation self-expanding valves: A real world multicenter analysis

“…The close anatomical relationship between the aortic annulus and the conduction system explains the occurrence of post-TAVR CD. However, a detailed description of the dynamic ECG changes after TAVR with SE-newer generation devices has not been widely reported, and mostly has been limited to one device (Corevalve system) [17], older generation devices [18] or only to reports on new PPM and LBBB rates [19]. Less attention has been given to the importance of the post-TAVR ECG changes and the duration of the PR and QRS intervals.…”

Patient-Specific Computer Simulation to Predict Conduction Disturbance With Current-Generation Self-Expanding Transcatheter Heart Valves

“…28 Furthermore, mean CPI in this study (20%) was lower than in previous studies, possibly reflecting the ability for operators to achieve a higher implantation depth with recapturable devices. 29 The optimal CPMax for predicting major conduction disturbance (CPMax !0.40 MPa) was similar in this study, confirming the important role that this variable plays in predicting conduction disturbance. Indeed, on a multivariate analysis, CPMax remained an independent predictor of major conduction disturbance.…”

Choice of transcatheter heart valve: should we select the device according to each patient’s characteristics or should it be “one valve fits all”?

“…The valve design accounts for the low gradients and increased procedural safety and may facilitate optimal positioning (31). The latter may allow for higher positioning, which contributes to lower PPI rates (32). Refinements include improved sealing, especially the addition of a sealing skirt in the PRO model that has led to decreased PVL rates (14).…”