Impact of implantation technique on conduction disturbances for TAVR with the self-expanding portico/navitor valve
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Impact of implantation technique on conduction disturbances for TAVR with the self-expanding portico/navitor valve. / Wang, Xi; Wong, Ivan; Bajoras, Vilhelmas; Vanhaverbeke, Maarten; Nuyens, Philippe; Bieliauskas, Gintautas; Jørgensen, Troels Højsgaard; Chen, Mao; De Backer, Ole; Sondergaard, Lars.
I: Catheterization and Cardiovascular Interventions, Bind 101, Nr. 2, 2023, s. 431-441.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Impact of implantation technique on conduction disturbances for TAVR with the self-expanding portico/navitor valve
AU - Wang, Xi
AU - Wong, Ivan
AU - Bajoras, Vilhelmas
AU - Vanhaverbeke, Maarten
AU - Nuyens, Philippe
AU - Bieliauskas, Gintautas
AU - Jørgensen, Troels Højsgaard
AU - Chen, Mao
AU - De Backer, Ole
AU - Sondergaard, Lars
N1 - Publisher Copyright: © 2022 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.
PY - 2023
Y1 - 2023
N2 - Background: Use of a right−left (R−L) cusp overlap view for transcatheter aortic valve replacement (TAVR) with self-expanding valves has recently been proposed aiming to reduce permanent pacemaker implantation (PPMI). An objective, data-driven explanation for this observation is missing. Aims: To assess the impact of different implantation techniques on the risk of PPMI following TAVR with the Portico/NavitorTM transcatheter heart valve (THV; Abbott). Methods: A TAVR-population treated with Portico/NavitorTM had the THV implanted in a right versus left anterior oblique (RAO/LAO) fluoroscopic view with no parallax in the delivery system. The impact of these different implantation views on the spatial relationship between THV and native aortic annulus and the risk of conduction disturbances and PPMI after TAVR was studied. Results: A total of 366 matched TAVR patients were studied: 183 in the RAO group and 183 in the LAO group. The degree of aortic annulus plane tilt was significantly smaller in the RAO versus LAO group (median: 0° vs. 23°, p < 0.001), with no plane tilt in 105 out of 183 cases (57.3%) in the RAO group. At 30 days after TAVR, the overall PPMI and guideline-directed PPMI rates were 12.6% versus 18.0% (p = 0.15) and 8.2% versus 15.3% (p = 0.04) in the RAO versus LAO group, respectively. Conclusions: Use of a R−L cusp overlap (RAO-caudal) view for implantation of the Portico/NavitorTM valve results in less tilt of the native aortic annulus plane and a clear trend toward a lower 30-day PPMI rate as compared to TAVR using the conventional LAO implantation view.
AB - Background: Use of a right−left (R−L) cusp overlap view for transcatheter aortic valve replacement (TAVR) with self-expanding valves has recently been proposed aiming to reduce permanent pacemaker implantation (PPMI). An objective, data-driven explanation for this observation is missing. Aims: To assess the impact of different implantation techniques on the risk of PPMI following TAVR with the Portico/NavitorTM transcatheter heart valve (THV; Abbott). Methods: A TAVR-population treated with Portico/NavitorTM had the THV implanted in a right versus left anterior oblique (RAO/LAO) fluoroscopic view with no parallax in the delivery system. The impact of these different implantation views on the spatial relationship between THV and native aortic annulus and the risk of conduction disturbances and PPMI after TAVR was studied. Results: A total of 366 matched TAVR patients were studied: 183 in the RAO group and 183 in the LAO group. The degree of aortic annulus plane tilt was significantly smaller in the RAO versus LAO group (median: 0° vs. 23°, p < 0.001), with no plane tilt in 105 out of 183 cases (57.3%) in the RAO group. At 30 days after TAVR, the overall PPMI and guideline-directed PPMI rates were 12.6% versus 18.0% (p = 0.15) and 8.2% versus 15.3% (p = 0.04) in the RAO versus LAO group, respectively. Conclusions: Use of a R−L cusp overlap (RAO-caudal) view for implantation of the Portico/NavitorTM valve results in less tilt of the native aortic annulus plane and a clear trend toward a lower 30-day PPMI rate as compared to TAVR using the conventional LAO implantation view.
KW - conduction disturbance
KW - fluoroscopic view
KW - implantation technique
KW - pacemaker implantation
KW - transcatheter aortic valve replacement
U2 - 10.1002/ccd.30517
DO - 10.1002/ccd.30517
M3 - Journal article
C2 - 36542648
AN - SCOPUS:85144417925
VL - 101
SP - 431
EP - 441
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
SN - 1522-1946
IS - 2
ER -
ID: 335678818