Impact of Post-Implant SAPIEN XT Geometry and Position on Conduction Disturbances, Hemodynamic Performance, and Paravalvular Regurgitation

详细信息    查看全文

• 作者：Ronald K. Binder ; MD ; John G. Webb ; MD ; Stefan Toggweiler ; MD ; Melanie Freeman ; MBBS ; Marco Barbanti ; MD ; Alexander B. Willson ; MBBS ; MD ; Donya Alhassan ; MD ; Cameron J. Hague ; MD ; David A. Wood ; MD ; Jonathon Leipsic ; MD ; ^{JLeipsic@providencehealth.bc.ca}
• 关键词：left bundle branch block ; MDCT ; permanent pacemaker ; TAVR
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2013
• 出版时间：May, 2013
• 年：2013
• 卷：6
• 期：5
• 页码：462-468
• 全文大小：349 K

文摘

| Figures/TablesFigures/Tables | ReferencesReferences

Objectives

This report sought to study the impact of the balloon-expandable SAPIEN XT (Edwards Lifesciences, Irvine, California) transcatheter heart valve (THV) stent frame geometry and position on outcomes of transcatheter aortic valve replacement (TAVR).

Background

Post-implant THV geometry and position might impact atrioventricular conduction, hemodynamic performance, and annular sealing.

Methods

Eighty-nine consecutive patients who underwent TAVR with a Sapien XT THV had pre- and post-implant multidetector computed tomography, transthoracic echocardiography, and electrocardiograms performed to assess THV stent geometry, atrioventricular conduction, and hemodynamic performance.

Results

The THV Circularity (THV eccentricity <10 % [eccentricity = minimum stent diameter/maximum stent diameter]) and under-expansion (THV area/nominal THV area <90 % ) were present in 97.8 % (2 of 89) and 0 % , respectively. Low THV implantation was associated with new left bundle branch block and complete heart block (3.4 ¡À 2.0 mm vs. 5.5 ¡À 2.9 mm, p = 0.01) and with the need for permanent pacemaker implantation (3.5 ¡À 2.0 mm vs. 7.1 ¡À 2.5 mm, p = 0.001). In contrast, labeled THV size and THV area oversizing was not associated with atrioventricular conduction disturbances. The relation between inflow stent frame area and annular area was related to paravalvular regurgitation (p = 0.025). Labeled prosthesis size but not prosthesis expansion or eccentricity was related to valve gradient (p = 0.005) and effective orifice area (p < 0.001).

Conclusions

Low implantation depth of balloon-expandable THVs is associated with clinically significant new conduction disturbances and permanent pacemaker implantation. Importantly, annular area oversizing was not associated with these complications.