Association between implantation depth assessed by computed tomography and new-onset conduction disturbances after transcatheter aortic valve implantation.
J Cardiovasc Comput Tomogr. 2017 Sep - Oct;11(5):332-337. doi: 10.1016/j.jcct.2017.08.003. Epub 2017 Aug 18. Almeida JG1, Ferreira SM2, Fonseca P3, Dias T3, Guerreiro C3, Barbosa AR3, Teixeira P3, Carvalho M3, Ferreira W3, Ferreira ND3, Oliveira M3, Gonçalves H3, Braga P3, Ribeiro J3, Primo J3, Ribeiro VG3.
BACKGROUND: Transcatheter aortic valve replacement (TAVR) is often associated with intraventricular conduction disturbances. We aimed to determine the association between implantation depth assessed by multidetector computed tomography (MDCT) and new-onset conduction abnormalities after TAVR.
METHODS: Retrospective single-center study including patients consecutively submitted to TAVR, between August/2007 and October/2016, who underwent routine MDCT 3 months after the procedure. The endpoint of conduction disturbances included permanent pacemaker implantation and/or new-onset left bundle-branch block. Implantation depth was determined as the distance between the ventricular end of the prothesis and the native ring, at the level of the non-coronary cusp.
RESULTS: 138 patients were included (female gender 52.2%, mean age 78.7 ± 6.9 years). The EuroSCORE II was 4.0 ± 3.9% and 57.2% were treated with self-expanding prosthesis. The endpoint of conduction abnormalities was found in 45.7% (n = 63). The implantation depth was greater in the group with conduction disturbances (7.7 vs 6.4 mm, p = 0.006). Chronic obstructive pulmonary disease, oversizing and implantation depth were independent predictors of conduction abnormalities. Implantation depth had an AUC of 0.64 (p = 0.004) for the prediction of conduction abnormalities and a cut-off value of 7.1 mm predicted the composed endpoint with a sensitivity and specificity of 65% and 70%, respectively.
CONCLUSIONS: Implantation depth assessed by MDCT is associated with new-onset conduction disturbances after TAVR. In patients with conduction abnormalities, which do not qualify for the immediate implantation of pacemaker, the assessment of implantation depth by MDCT may be an additional marker of risk to aid decision-making.