title: Depth of valve implantation, conduction disturbances and pacemaker implantation with CoreValve and CoreValve Accutrak system for Transcatheter Aortic Valve Implantation, a multi-center study.
abstract: BACKGROUND
  Transcatheter Aortic Valve Implantation (TAVI) is now considered an indispensable treatment strategy in high operative risk patients with severe, symptomatic aortic stenosis. However, conduction disturbances and the need for Permanent Pacemaker (PPM) implantation after TAVI with the CoreValve prosthesis still remain frequent.
  
  
  RESULTS
  We aimed to evaluate the implantation depth, the incidence and predictors of new conduction disturbances, and the need for PPM implantation within the first month after TAVI, using the new Accutrak CoreValve delivery system (ACV), compared to the previous generation CoreValve (non-ACV). In 5 experienced TAVI-centers, a total of 120 consecutive non-ACV and 112 consecutive ACV patients were included (n=232). The mean depth of valve implantation (DVI) was 8.4±4.0 mm in the non-ACV group and 7.1±4.0 mm in the ACV group (p=0.034). The combined incidence of new PPM implantation and new LBBB was 71.2% in the non-ACV group compared to 50.5% in the ACV group (p=0.014). DVI (p=0.002), first degree AV block (p=0.018) and RBBB (p<0.001) were independent predictors of PPM implantation. DVI (p<0.001) and pre-existing first degree AV-block (p=0.021) were identified as significant predictors of new LBBB.
  
  
  CONCLUSIONS
  DVI is an independent predictor of TAVI-related conduction disturbances and can be reduced by using the newer CoreValve Accutrak delivery system, resulting in a significantly lower incidence of new LBBB and new PPM implantation.
authors.affiliation: University Hospital Antwerp, Edegem, Belgium. Electronic address: guy.lenders@gmail.com.
authors.forename: Guy D
authors.initials: GD
authors.lastname: Lenders
authors.affiliation: University Hospital Antwerp, Edegem, Belgium.
authors.forename: Valérie
authors.initials: V
authors.lastname: Collas
authors.affiliation: Hospital Universitario Virgen de la Victoria, Malaga, Spain.
authors.forename: José Maria
authors.initials: JM
authors.lastname: Hernandez
authors.affiliation: CHU de Liege, Liege, Belgium.
authors.forename: Victor
authors.initials: V
authors.lastname: Legrand
authors.affiliation: Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Haim D
authors.initials: HD
authors.lastname: Danenberg
authors.affiliation: Amphia Hospital, Breda, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: den Heijer
authors.affiliation: University Hospital Antwerp, Edegem, Belgium.
authors.forename: Inez E
authors.initials: IE
authors.lastname: Rodrigus
authors.affiliation: University Hospital Antwerp, Edegem, Belgium.
authors.forename: Bernard P
authors.initials: BP
authors.lastname: Paelinck
authors.affiliation: University Hospital Antwerp, Edegem, Belgium.
authors.forename: Christiaan J
authors.initials: CJ
authors.lastname: Vrints
authors.affiliation: University Hospital Antwerp, Edegem, Belgium.
authors.forename: Johan M
authors.initials: JM
authors.lastname: Bosmans
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects; D011474:Prosthesis Design / Q000009:adverse effects; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
keywords: Depth of valve implantation; Left Bundle Branch Block (LBBB); Pacemaker; Transcatheter Aortic Valve Implantation (TAVI)