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Related Experiment Videos

A Highly Predictive Risk Model for Pacemaker Implantation After TAVR.

Yoshio Maeno1, Yigal Abramowitz1, Hiroyuki Kawamori1

  • 1Cedars-Sinai Heart Institute, Los Angeles, California.

JACC. Cardiovascular Imaging
|April 17, 2017
PubMed
Summary

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A new risk model predicts permanent pacemaker implantation (PPMI) after SAPIEN 3 transcatheter aortic valve replacement (TAVR). Calcification in the noncoronary cusp device-landing zone is a key predictor, improving model accuracy.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Biomedical Engineering

Background:

  • The association between aortic-valvular complex (AVC) calcification and permanent pacemaker implantation (PPMI) after third-generation balloon-expandable valve transcatheter aortic valve replacement (TAVR) is not well understood.
  • Accurate prediction of PPMI is crucial for optimizing patient outcomes post-TAVR.

Purpose of the Study:

  • To develop and validate a robust risk model for predicting new PPMI after SAPIEN 3 TAVR.
  • To identify specific predictors of PPMI, including AVC calcification patterns.

Main Methods:

  • A retrospective analysis of 240 patients who underwent SAPIEN 3 TAVR and contrast-enhanced computed tomography.
  • Precise characterization of AVC calcification by leaflet sector and region.
Keywords:
calcificationpacemakerpredictorstranscatheter aortic valve implantationtranscatheter aortic valve replacement

Related Experiment Videos

  • Multivariate logistic regression analysis to identify PPMI predictors.

    • Main Results:

    • The overall PPMI rate was 14.6%.
    • Independent predictors of PPMI included pre-procedure right bundle branch block (RBBB), shorter membranous septum (MS) length, and noncoronary cusp device-landing zone (NCC-DLZ) calcium volume.
    • A model incorporating pre-procedural factors achieved an AUC of 0.88; adding device implantation depth improved AUC to 0.92.

    Conclusions:

    • Noncoronary cusp device-landing zone calcium volume is an independent predictor of PPMI post-SAPIEN 3 TAVR.
    • Short MS length, pre-existing RBBB, and implantation depth are important synergistic PPMI risk factors.
    • The developed risk model requires prospective multicenter validation.