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Balloon vs self-expandable valves – AV conduction disturbance
Session:
SESSÃO DE POSTERS 51 - DIAGNÓSTICO E PROGNÓSTICO NA INTERVENÇÃO VALVULAR AÓRTICA PERCUTÂNEA
Speaker:
Miguel Azaredo Raposo
Congress:
CPC 2025
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.4 Valvular Heart Disease – Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Miguel Azaredo Raposo; Ana Abrantes; Catarina Gregório; Daniel Cazeiro; Diogo Ferreira; Marta Vilela; João Cravo; Miguel Nobre Menezes; Cláudia Jorge; Pedro Carrilho Ferreira; João Silva Marques; Fausto J. Pinto
Abstract
<p><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt">Intro:</span></strong><span style="font-size:11pt"> As transcatheter aortic valve implantation (TAVI) procedure becomes an increasingly ubiquitous solution for severe aortic stenosis, the choice of valve type - balloon expandable (BEV) vs self-expandable (SEV) – remains variable among centers and operators. Post-procedure permanent-pacemaker implantation is one of the most common complications of TAVI and the vale type may impact outcome.</span></span></span></span></p> <div> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt">Aim:</span></strong><span style="font-size:11pt"> to compare permanent pacemaker implantation rates of BEV and SEV.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt">Methods</span></strong></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-size:11pt">We conducted a<strong> </strong><span style="color:black">single center study, including patients (pts) who underwent TAVI between 2014 and 2023. Two cohorts were derived based on valve type – BEV vs SEV. Groups were compared regarding baseline comorbidities, ECG, post procedural conduction disturbances and permanent pacemaker implantation. For statistical analysis, independent T-student and Chi-square tests were used. Kaplan Meier curves were drawn and Cox-regressions conducted to compare PMK need at FUP and mortality between groups. </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt">Results: </span></strong><span style="font-size:11pt">We included </span><span style="font-size:11pt">709 pts submitted to TAVI from 09/2012 to 12/2023, 56,3% of which were female, with a mean age of 82</span><span style="font-size:11pt">± 6,5 years</span><span style="font-size:11pt">. Regarding valve type, 50,2% were balloon expandable (BEV) and 49,8% self-expandable (SEV).</span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-size:11pt">Cardiovascular risk factor burden was significant: hypertension in 91%, dyslipidemia in 73%, diabetes in 36%, CKD in 30%, 20% were smokers. Baseline EKG was sinus rhythm for 76% of pts and AF for 24% but 36% had history of AF. Regarding conduction disturbances, 17% had LBBB and 9% RBBB. There were no significant differences in these baseline characteristics between treatment groups.</span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-size:11pt">Upon valve implantation, pre-dilatation was performed in 36,4% of pts (29% in BEV vs 44% in SEV, p<.001) and post-dilatation in 20,7% (15% in BEV vs 26% in SEV p<.001).</span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-size:11pt">Immediately after implantation, 21% of pts developed complete AV block (18% in BEV vs 24,7% in SEV p.034 OR 1,47), 6% LBBB and 1% RBBB. 24% of pts received a PMK during index hospitalization (21% in BEV vs 27% in SEV p=NS), 67% of which for complete AV block, 15,4% for QRS prolongation, 8,8% for SND.</span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-size:11pt">Regarding device implantation at a mean FUP of 38.8</span><span style="font-size:11pt"><span style="font-family:Symbol">±</span></span><span style="font-size:11pt">months, pts with BEV had a 31,4% lower risk of requiring a device for pacing when compared with SEV pts (HR 0.686 p=0.05). When all cause death at FUP was compared between pts who received a device and those who didn’t, there was no significative difference (p=NS).</span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt">Conclusion:</span></strong></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-size:11pt">In our pt cohort, differences in new-onset conduction disturbances requiring in-hospital device implantation were not significatively different between BEV and SEV. However, over a mean FUP of 38.8 months, there was a 31,4% risk reduction for BEV pts to require a device comparing to SEV. These outcomes had no impact on overall mortality. Special attention should to be given to SEV pts regarding conduction disturbances during follow-up.</span></span></span></span></p> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div> </div> <div id="accel-snackbar" style="left:50%; top:50px; transform:translate(-50%, 0px)"> </div>
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