title: Reduction of pacemaker implantation rates after CoreValve® implantation by moderate predilatation.
abstract: OBJECTIVE
  We investigated the impact of the diameter of the valvuloplasty balloon (VB) used for predilation before transcatheter aortic valve implantation (TAVI) on atrioventricular block formation with consecutive need for permanent pacemaker (PP) implantation.
  
  
  RESULTS
  TAVI was performed in 269 consecutive patients using the CoreValve prosthesis (Medtronic) via transfemoral access under local anaesthesia with mild analgesic medication. After exclusion of 32 patients with previously implanted PP, 237 patients were included in a retrospective analysis of the impact of VB size on subsequent PP incidence. Implantation success rate was 99.3%. Periprocedural mortality was 0%, and 30-day mortality was 5.9%. PP implantation after TAVI was required by 21.1%. Of 114 patients treated by 25 mm balloon valvuloplasty, a PP was implanted in 27.1%. In 123 patients, who were treated by VB with a ≤23 mm diameter, the PP implantation rate decreased to 15.4% (p=0.04). In univariate analysis, larger VB size resulted in a greater prevalence of PP implantation after TAVI. After adjustment by multivariate analysis for baseline clinical and operative characteristics, VB size remained an independent predictor of PP implantation.
  
  
  CONCLUSIONS
  Moderate balloon predilation in patients undergoing TAVI with the Medtronic CoreValve prosthesis reduces the PP rate without affecting procedural success.
authors.affiliation: Department of Cardiology, Klinikum Grosshadern, University Hospital of Munich, Munich, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Lange
authors.forename: Martin
authors.initials: M
authors.lastname: Greif
authors.forename: Armin
authors.initials: A
authors.lastname: Vogel
authors.forename: Antonia
authors.initials: A
authors.lastname: Thaumann
authors.forename: Susanne
authors.initials: S
authors.lastname: Helbig
authors.forename: Florian
authors.initials: F
authors.lastname: Schwarz
authors.forename: Christoph
authors.initials: C
authors.lastname: Schmitz
authors.forename: Christoph
authors.initials: C
authors.lastname: Becker
authors.forename: Melvin
authors.initials: M
authors.lastname: D'Anastasi
authors.forename: Peter
authors.initials: P
authors.lastname: Boekstegers
authors.forename: Tilmann
authors.initials: T
authors.lastname: Pohl
authors.forename: Ruediger P
authors.initials: RP
authors.lastname: Laubender
authors.forename: Gerhard
authors.initials: G
authors.lastname: Steinbeck
authors.forename: Christian
authors.initials: C
authors.lastname: Kupatt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D054537:Atrioventricular Block / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D063126:Balloon Valvuloplasty / Q000295:instrumentation / Q000379:methods*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006351:Heart Valves / Q000502:physiology / Q000601:surgery; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014664:Vasodilation