Implantation depth and its influence on complications after TAVI with self-expanding valves

Abstract

Prior studies in patients with transcatheter aortic valve implantation (TAVI) demonstrated an influence of transcatheter heart valve (THV) position on the occurrence of new conductions disturbances (CD) and paravalvular leakage (PVL) post TAVI in balloon-expandable valves (BEV). Purpose of this study was to investigate the THV implantation depth and its influence on the occurrence of CD and PVL in self-expanding valves (SEV). We performed fusion imaging of pre- and post-procedural computed tomography angiography in 104 TAVI-patients (all with Evolut R) to receive a 3-D reconstruction of the THV within the native annulus region. The THV length below the native annulus was measured for assessment of implantation depth. Electrocardiograms pre-discharge were assessed for conduction disturbances (CD), PVL was determined in transthoracic echocardiography. The mean implantation depth of the THV in the whole cohort was 4.3 ± 3.0 mm. Using the best cut-off of ≥ 4 mm in receiver operating characteristic curve analysis (sensitivity 83.3%, specificity 60.0%) patients with lower THV position developed more new CD after TAVI (68.2 vs. 23.7%, P < 0.001). A deep THV position was identified as the only predictor for new CD after TAVI (odds ratio [CI] 1.312[1.119–1.539], P = 0.001). The implantation depth showed no influence on the grade of PVL (r = 0.052, P = 0.598). In patients with TAVI using the Evolut R SEV, a lower THV positioning (≥ 4 mm length below annulus) was a predictor for new conduction disturbances. In contrast, implantation depth was not associated with the extent of PVL. Graphic abstract Prostheses positions of self-expanding valves and their influence on the occurrence of new conduction disturbances and the grade of paravalvular leakage after TAVI.

Analysis of fibrocalcific aortic valve stenosis: computational pre-and-post TAVR haemodynamics behaviours

“…As the TAVR outcomes are tightly coupled to the complex interaction between the patient's AV and the anatomy of the surrounding diseased tissue, those need to be considered on a case-by-case basis. The effect of different TAVR sizes, different implantation depths and device types (balloon- or self-expandable) should be considered in optimizing the different outcomes for each patient [ 22 , 51 ]. In this study, our objective was to conduct a comparative analysis rather than proposing a specific procedure or optimized outcomes.…”

“…Three-dimensional printing techniques were used to assess the flow patterns and haemodynamics of PVL post-TAVR severity and were evaluated using computational fluid dynamics (CFD), and verified by utilizing four-dimensional flow magnetic resonance imaging (MRI) [ 20 ] or patient-specific in vitro replicas [ 21 ]. No correlation was found between the implantation depth and the extent of PVL [ 22 ]. In previous studies, we have investigated PVL for self- and balloon-expandable devices in BAV patients, including anchoring forces [ 23 ] and thrombogenicity potential calculations [ 24 ].…”

Impact of New‐Onset Right Bundle‐Branch Block After Transcatheter Aortic Valve Replacement on Permanent Pacemaker Implantation

“…Moreover, implantation depth is associated with new conduction disturbances after TAVR. 47 , 48 , 49 In particular, the interaction of MS length with implantation depth (ΔMSID [MS length – implantation depth]) may be an important factor of PPI. Low ΔMSID has been reported to be associated with higher risk of conduction abnormalities and PPI.…”

Factors Influencing Implantation Depth During Transcatheter Aortic Valve Replacement

“…[ 34 ] However, studies on newer generation THV devices and implantation techniques show no influence of the ID on the grade of PVL, which is currently considered to be very low. [ 35 ] This might be due to the fact that newer generation devices are generally designed to be either repositionable and/or to have a better sealing capacity.…”