title: Transcatheter aortic valve implantation with a self-expanding nitinol bioprosthesis: prediction of the need for permanent pacemaker using simple baseline and procedural characteristics.
abstract: OBJECTIVE
  To ascertain incidence and predictors of new permanent pacemaker (PPM) following transcatheter aortic valve implantation (TAVI) with the self-expanding aortic bioprosthesis.
  
  
  BACKGROUND
  TAVI with the Medtronic Corevalve (MCV) Revalving System (Medtronic, Minneapolis, MN) has been associated with important post-procedural conduction abnormalities and frequent need for PPM.
  
  
  METHODS
  Overall, 73 consecutive patients with severe symptomatic AS underwent TAVI with the MCV at two institutions; 10 patients with previous pacemaker and 3 patients with previous aortic valve replacement were excluded for this analysis. Clinical, echocardiographic, and procedural data were collected prospectively in a dedicated database. A standard 12-lead ECG was recorded in all patients at baseline, after the procedure and predischarge. Decision to implant PPM was taken according to current guidelines. Logistic multivariable modeling was applied to identify independent predictors of PPM at discharge.
  
  
  RESULTS
  Patients exhibited high-risk features as evidenced by advanced age (mean = 82.1 ± 6.2 years) and high surgical scores (logistic EuroSCORE 23.0 ± 12.8%, STS score 9.4 ± 6.9%). The incidence of new PPM was 28.3%. Interventricular septum thickness and logistic Euroscore were the baseline independent predictors of PPM. When procedural variables were included, the independent predictors of PPM were interventricular septum thickness (OR 0.52; 95% CI 0.32-0.85) and the distance between noncoronary cusp and the distal edge of the prosthesis (OR 1.37; 95% CI 1.03-1.83).
  
  
  CONCLUSIONS
  Conduction abnormalities are frequently observed after TAVI with self-expandable bioprosthesis and definitive pacing is required in about a third of the patients, with a clear association with depth of implant and small interventricular septum thickness.
authors: Institute of Cardiology, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy. francescosaia@hotmail.com
authors: Francesco
authors: F
authors: Saia
authors: Pedro A
authors: PA
authors: Lemos
authors: Barbara
authors: B
authors: Bordoni
authors: Elena
authors: E
authors: Cervi
authors: Giuseppe
authors: G
authors: Boriani
authors: Cristina
authors: C
authors: Ciuca
authors: Nevio
authors: N
authors: Taglieri
authors: Jose
authors: J
authors: Mariani
authors: Roberto
authors: R
authors: Kalil Filho
authors: Antonio
authors: A
authors: Marzocchi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D000704:Analysis of Variance; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods; D002304:Cardiac Pacing, Artificial / Q000379:methods* / Q000706:statistics & numerical data; D015331:Cohort Studies; D015150:Echocardiography, Doppler / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000503:physiopathology / Q000628:therapy; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D011474:Prosthesis Design; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000497:Alloys; C013616:nitinol