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CoreValve Prosthesis Depth: What is the Optimal Measurement Target?
Rafael Wolff1,2, Sam Radhakrishnan1,3, Hirotsugu Mitsuhashi1,3
1Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Canada|.
The Journal of Heart Valve Disease
|December 24, 2016
Summary
Improper implantation depth of the Medtronic CoreValve (MCV) during transcatheter aortic valve replacement (TAVR) increases risks of heart conduction problems and permanent pacemaker (PPM) need. Angiographic measurements of prosthesis depth are key predictors for these complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Transcatheter aortic valve replacement (TAVR) using the Medtronic CoreValve (MCV) is associated with significant conduction disturbances.
- Permanent pacemaker (PPM) implantation is a common complication following MCV TAVR.
- Prosthesis implantation depth is a potential factor influencing these adverse events.
Purpose of the Study:
- To investigate the relationship between MCV prosthesis implantation depth and the incidence of conduction disturbances.
- To determine if angiographic measurements of prosthesis depth predict the need for PPM after TAVR.
Main Methods:
- Retrospective analysis of 157 patients undergoing MCV TAVR (2009-2013).
- Exclusion of patients with pre-existing pacemakers (n=27).
- Definition of prosthesis depth using non-coronary cusp (NCcD) and left coronary cusp (LCcD) angiographic measurements.
Main Results:
- Higher rates of new atrioventricular block (AVB) and left ventricular bundle branch block (LBBB) were observed.
- 10% of patients required PPM implantation within 30 days.
- Significantly lower rates of conduction disturbances and PPM need were found with NCcD <6 mm or LCcD <8 mm (90-89%) compared to deeper implants (53-54%) (p <0.0001).
Conclusions:
- Prosthesis depth is a strong predictor of conduction disturbances after MCV TAVR.
- Angiographic measurement of prosthesis depth relative to the NCcD or LCcD can identify patients at higher risk.
- Optimizing implantation depth may reduce the need for PPM post-TAVR.
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