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Impact of Preprocedural Aortic Valve Calcification on Conduction Disturbances after Transfemoral Aortic Valve

Peter Stachon1, Johannes Steinfurt2, Tim van de Loo2

  • 1University Heart Center Freiburg, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany, peter.stachon@universitaets-herzzentrum.de.

Cardiology
|September 23, 2020
PubMed

Insights

Calcification patterns on the aortic annulus increase the risk of conduction disturbances after transcatheter aortic valve replacement (TAVR). This risk is higher with balloon-expandable valves, impacting pacemaker needs.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Imaging

Background:

  • Transcatheter aortic valve replacement (TAVR) is a common procedure for aortic stenosis.
  • Conduction disturbances, including atrioventricular block and pacemaker implantation, are known complications of TAVR.
  • The role of pre-procedural aortic valve calcification patterns in these complications requires further elucidation.

Purpose of the Study:

  • To investigate the impact of aortic valve calcification characteristics on conduction system disturbances following TAVR.
  • To determine if specific calcification patterns are associated with increased risks of atrioventricular block, QRS prolongation, or permanent pacemaker implantation.

Main Methods:

  • Retrospective analysis of 169 pre-procedural multislice computed tomography scans from transfemoral TAVR (TF-TAVR) patients.
  • Quantitative measurement of aortic annulus and valvular calcification volume, distribution, and orientation.
  • Statistical analysis using linear and logistic regression to correlate calcification patterns with postoperative conduction disturbances.

Main Results:

  • Total calcification volume and distribution did not significantly impact conduction.
  • Oval calcification of the left aortic cusp was linked to increased atrioventricular block degree.
  • Orthogonal annular calcifications were associated with QRS prolongation and higher rates of permanent pacemaker implantation.
  • These risks were significantly amplified in patients receiving balloon-expandable Edwards SAPIEN 3 valves.

Conclusions:

  • Orthogonal calcification at the aortic annulus is an independent predictor of conduction disturbances post-TAVR.
  • The risk of conduction disturbances is more pronounced with balloon-expandable valve implantation.
  • Pre-procedural imaging assessment of calcification patterns may aid in risk stratification for TAVR patients.
Abstract

Keywords:
Aortic valve stenosisCalcificationConduction disturbancesPermanent pacemakerTranscatheter aortic valve replacement

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