The Conundrum of Permanent Pacemaker Implantation After Transcatheter Aortic Valve Implantation.

Content Provider	Semantic Scholar
Author	Franzone, Anna Windecker, Stephan W.
Copyright Year	2017
Abstract	Transcatheter aortic valve implantation (TAVI) has matured into the preferred treatment modality for patients with severe aortic stenosis at extreme or high risk for conventional surgery and a valuable alternative for those at intermediate risk in view of similar or superior clinical outcomes and decreased rates of periprocedural adverse events.1–3 In this context, it remains unclear whether other procedure-related events—including atrioventricular conduction disturbances that require permanent pacemaker (PPM) implantation—are of prognostic relevance. See Article by Mohananey et al In the natural history of aortic stenosis, variable degrees of heart block may occur with calcium deposits expanding progressively from the left ventricular outflow tract to the atrioventricular conduction system. As matter of fact, a PPM is already present in ≈10% to ≈20% of patients with severe aortic stenosis at the time of transcatheter or surgical intervention.4 Because of its proximity to the aortic root, iatrogenic injury to the atrioventricular conduction system also occurs after surgical bioprosthesis implantation, with comparable PPM rates for TAVI and surgery reported in the PARTNER trials (Placement of Aortic Transcatheter Valves).2,5 Several patient- and procedure-related factors have been associated with PPM implantation after TAVI and include advanced age, male gender, atrial fibrillation, calcification of aortic and mitral annulus, small left ventricular outflow tract, pre-procedural or intraprocedural conduction disorders, balloon pre-dilation, and depth of prosthesis implantation.6,7 In addition, the type of transcatheter bioprosthesis plays an important role with rates of PPM implantation progressively increasing from balloon-expandable prostheses over self-expanding prostheses to mechanically deployed prostheses.8 Along this line, outer skirts and adaptive seals surrounding the inflow portion, designed to reduce paravalvular leaks, as well as features that allow for repositionability of the device within the aortic annulus, may modify the risk of atrioventricular conduction disturbances after TAVI. Despite …
File Format	PDF HTM / HTML
DOI	10.1161/CIRCINTERVENTIONS.117.005514
PubMed reference number	28698293
Journal	Medline
Volume Number	10
Issue Number	7
Alternate Webpage(s)	http://circinterventions.ahajournals.org/content/circcvint/10/7/e005514.full.pdf?download=true
Alternate Webpage(s)	http://circinterventions.ahajournals.org/content/circcvint/10/7.toc.pdf
Alternate Webpage(s)	https://doi.org/10.1161/CIRCINTERVENTIONS.117.005514
Journal	Circulation. Cardiovascular interventions
Language	English
Access Restriction	Open
Content Type	Text
Resource Type	Article