“Device landing zone” calcification, assessed by MSCT, as a predictive factor for pacemaker implantation after TAVI
- 24 August 2010
- journal article
- valvular and-structural-heart-diseases
- Published by Wiley in Catheterization and Cardiovascular Interventions
- Vol. 76 (3), 431-439
- https://doi.org/10.1002/ccd.22563
Abstract
Background: After trans-catheter aortic valve implantation (TAVI), the need for postinterventional pacemaker (PM) implantation can occur in as many as 10–50% of cases, but it is not yet clear, how this need can be predicted. The aim of this study was to assess the possible predictive factors of post TAVI PM implantation based on Computed Tomography (CT) measured aortic valve calcification and its distribution. Methods: We prospectively analyzed 81 consecutive symptomatic patients with severe AS scheduled for TAVI using the CoreValve prosthesis (Medtronic, Minneapolis, USA). In all patients, a native and contrast-enhanced multislice cardiac CT was performed preinterventionally, estimating calcification load of the native valve cusps and of the adjacent outflow tract (so called “device landing zone”, DLZ) by the Agatston Score (AgS). Objective, computer-evaluated, preprocedural ECG-analysis was performed with regards to pre-existing conduction abnormalities. Transthoracic echocardiography was performed pre and post TAVI. Results: TAVI was successful in all cases. PM implantation was deemed necessary in altogether 32 patients, out of 67 without a PM pre-TAVI (32/67, 47%). Various parameters were tested as predictors of post TAVI PM in a multivariate logistic regression analysis model. Female sex (P = 0,005) and depressed EF (P = 0,023) showed a significant correlation. PM implantation correlated also to the DLZ calcification, as assessed by CT (P = 0,004). This model leads to an AUC (area under the ROC—receiver operator characteristics—curve) of 0.83. Conclusion: Calcium amount in the CoreValve DLZ in combination with clinical data could predict the need for post TAVI PM implantation.Keywords
This publication has 23 references indexed in Scilit:
- Progress and Current Status of Percutaneous Aortic Valve Replacement: Results of Three Device Generations of the CoreValve Revalving SystemCirculation: Cardiovascular Interventions, 2008
- Anatomy of the Aortic Valvar Complex and Its Implications for Transcatheter Implantation of the Aortic ValveCirculation: Cardiovascular Interventions, 2008
- Permanent Pacemaker Implantation After Isolated Aortic Valve Replacement: Incidence, Indications, and PredictorsThe Annals of Thoracic Surgery, 2008
- Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI)European Heart Journal, 2008
- Percutaneous Implantation of the CoreValve Self-Expanding Valve Prosthesis in High-Risk Patients With Aortic Valve DiseaseCirculation, 2006
- Risk Factors for Requirement of Permanent Pacemaker Implantation After Aortic Valve ReplacementJournal of Cardiac Surgery, 2006
- ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices: Summary ArticleCirculation, 2002
- Predictors of Outcome in Severe, Asymptomatic Aortic StenosisNew England Journal of Medicine, 2000
- Calcification of aortic valve detected incidentally on CT scans: prevalence and clinical significance.American Journal of Roentgenology, 1995
- Quantification of coronary artery calcium using ultrafast computed tomographyJournal of the American College of Cardiology, 1990