TCT-837 Effectiveness and possible complications of post dilatation in patients with residual...

TCT-835

Permanent Pacemaker Implantation After Transcatheter Aortic ValveImplantation: is There Any Impact on Survival?

Jérôme Van Rothem1, Thierry Lefèvre2, Didier Tchetche3, Kentaro Hayashida2,Didier Carrié4, Bernard Chevalier2, Jean Fajadet3, Marie-Claude Morice5,Nicolas Dumonteil61Cardiovascular and Metabolic Pole, Rangueil Hospital, Toulouse, Toulouse,France, 2ICPS, Massy, France, 3Clinique Pasteur, Toulouse, France, 4UniversityHospital of Toulouse, Toulouse, France, 5Institut Cardiovasculaire Paris Sud,Massy, France, 6Cardiovascular and Metabolic Pole, Rangueil Hospital, Toulouse,France

Background: Severe cardiac conduction disturbances requiring permanent pacemakerimplantation (PPI) are frequent complications following transcatheter aortic valveimplantation (TAVI). There is only limited information available about the prognosticimpact of this complication.Methods: 960 patients with severe symptomatic aortic stenosis underwent TAVI in 3tertiary centers. Both the balloon-expandable Edwards-Sapien valve (ES) (672, 70%) andthe self-expanding Medtronic CoreValve (MCV) (288, 30%) were used.Results: 51 patients treated with the ES (7.6%) and 61 with the MCV (21.2%) requireda PPI (p�0.0001). Patients who needed a PPI had a larger prosthesis diameter (26.9�2.1vs. 26.0�2.3mm, p�0.0001) and transfemoral approach was more frequently used (78.3vs. 69.0%, p�0.049). The other demographic and procedural characteristics did not differ(similar age 83�6.3 years and logistic Euroscore 22.9�11.1%). Hospital stay wasincreased in patients with PPI (12.2�7.0 vs. 10.5�8.0 days, p�0.032) but 30-daysurvival was similar in the global cohort (91.1 vs. 89.4%, p�0.578), with the ES (90.2 vs.88.5%, p�0.718) or the MCV (91.8 vs. 91.6%, p�0.965). The one-year survival rate waslower in patients who needed a PPI compared to those who did not, but the difference wasnot significant (55.3 vs. 60.9%, p�0.456). This holds true for both types of valve (ES 54.5vs. 61%, p�0.544; MCV 56 vs. 60.4%, p�0.688).Conclusions: In this large observational study, PPI after TAVI did not negatively impactearly and mid-term survival in patients treated with either the ES or MCV prosthesis.

TCT-836

Prediction of paravalvular leaks after transcatheter aortic valve implantationby valvular or annular calcification?

Gudrun Feuchtner1, Fabian Plank1, Thomas Bartel2, Nikos Bonaros2,Silvana Müller3, Jonathon Leipsic4, Guy Friedrich2

1Innsbruck Medical University, Innsbruck, Austria, 2Medical University Innsbruck,Innsbruck, Austria, 3Innsbruck Medical University, 6020, Austria, 4St PaulsHospital, Vancouver, British Columbia

Background: The nature of paravalvular leaks after transcatheter aortic valve implan-tation (TAVI) is not fully understood. Aortic annular or valvular calcification may becausative. Objective was to quantify and characterize aortic valve leaflet and annularcalcification with computed tomography angiography (CTA) and define whether theypredict leaks.Methods: 56 patients (age 83.1y�5.4) with severe aortic stenosis underwent CTA priorto TAVI: 1)Annular calcification were measured in 2 planes and characterized as“protruding”, “round” and “adherent” for the non-coronary (NC), right-coronary (RC) and

left-coronary (LC). 2)Leaflet calcification were scored regarding severity (S) (grade 1-4),and total S-, asymmetry (A-) and combined A/S-score calculated. 3) Annulus eccentricityindex was calculated. Transthoracic echocardiography was performed after, at 1 month, 3,6, 12, and 24 months after TAVI.Results: 41 patients had no or mild (AR ��grade I) and 15 patients “relevant”(moderate-to-severe paravalvular leaks AR��1.5). “Protruding annular calcification(PAC)�4mm or adherent annular calcification �6mm” predicted relevant leaks(p�0.01). Total and LC-annulus calcium size was higher in relevant leaks (p�0.03 andp�0.009, resp.) and an increasing size was the strongest predictor (p�0.001). TotalLC/NC- and LC-Calcium size score predicted relevant leaks (p�0.004 and p� 0.001,resp.) but not RC or NC. There was a tendency towards higher total S- and A/S- scoreswith increasing leak severity with a weak correlation (r�0.29, p�0.02) for S-score, whileA-score was not. Annulus eccentricity did not predict relevant leaks.Conclusions: Protruding annular calcification�4mm and adherent calcification�6mm;particularly left-sided, predict relevant paravalvular leaks after TAVI. Increasing annularcalcium size is another major predictor, while leaflet calcification severity, asymmetry andannulus eccentricity were not associated.

TCT-837

Effectiveness and possible complications of post dilatation in patients withresidual significant aortic regurgitation following valve implantation usingboth Edwards and Corevalve systems: A single center study

Ahmed Rezq1, Azeem Latib2, Sandeep Basavarajaiah3, Kensuke Takagi4,Tasuku Hasegawa5, Antonio Colombo6

1Department of cardiology, Ain Shams University, Cairo, Egypt, Cairo, Egypt,2San Raffaele Scientific Institute, Milan, Italy, 3EMO-GVM Centro CuoreColumbus, Milan, Italy, 4San Raffaele hospital, Milan, Italy, tokyo, Japan, 5SanRaffaele scientific institute, Milano, Milano, 6EMO GVM Centro Cuore Columbussrl, Milan, Italy

Background: Outcomes of postdilatation should be properly analysed in patientsundergoing TAVI. Hereby, results and complications of postdilatation in patients withresidual significant AR using both the Edwards and CoreValve systems are discussedthoroughly.Methods: From November 2007 to December 2011, 384 patients underwent TAVI in ourcenter [233 Edwards and 151 CoreValve]. 74 were treated with postdilatation for residualAR following valve implantation. In this study, 68 were analyzed after excluding 6patients due to unavailable data.Results: Mean age was 79�6.2 yrs and 42 (61.7%) were males. Mean logistic Euroscoreand STS score were 25.2�17.3 and 9.1�9.1, respectively. Mean grades of aorticregurgitation at baseline, before and after postdilatation were 1.3�1.1, 2.3�0.7 and0.8�0.6, respectively. Edwards valve was used in 13 (19.1%), while CoreValve in 55(80.8%). Mean valve size was 27.1�2.2 mm. Mean balloon size was 25.6�2.3mm. Meanvalve size/annulus diameter was 1.1�0.1, mean balloon diameter/valve size was 0.9�0.1.In 51 patients (75% of the ones who had postdilatation), postdilatation was effective inminimizing AR by at least 1 grade. A second valve was needed in 5 (7.4%) with residualsignificant AR after postdilatation. Overall, postdilatation was associated with complica-tions in 4 (5.9%): coronary obstruction occurred in 1(1.5%) with Edwards valve, LMdissection in 1 patient (1.5%) with Edwards valve, annular tear in 1 patient (1.5%) withEdwards valve, and valve embolization in 1(1.5%) with CoreValve. Two patients (3%)had AR�2 at the end of the procedure. At 30-days echocardiographic follow-up showedgrade 1.2�0.9 AR. The effectiveness of postdilatation for both Edwards and CoreValvewere similar (77% & 83% respectively, p�0.6).Conclusions: Postdilatation appears to be effective in reducing residual AR followingimplantation of both Edwards and CoreValve. However, postdilatation may be rarelyassociated with significant complications and thus correct patient and balloon sizeselection are essential.

TCT-838

Using Inferior Epigastric Artery For Vascular Access Optimization DuringTranscatheter Aortic Valve Implantation.

Manolis Vavuranakis1, Konstantinos Kalogeras1, Dimitrios Vrachatis2,Maria Kariori2, Konstantinos Aznauridis3, Carmen Moldovan3,Konstantina Masoura3, Georgios Lazaros3, Ourania Katsarou4,Christodoulos Stefanadis5

11st Dept. of Cardiology, Hippokration Hospital, Medical School of Athens,Athens, Greece, 21st Dept. of Cardiology, Hippokration Hospital, Medical Schoolof Athens, Athens, Greece, 31st Department of Cardiology, National andKapodistrian University of Athens, Hippokrateio Hospital, ATHENS, Greece, 41stDept of Cardiology, Hippokration Hospital, Athens, Greece, 5Athens MedicalCenter, Athens, Greece

Background: Vascular access complications during Transcatheter Aortic Valve Implan-tation (TAVI) have been associated with significant increase of morbidity and mortality.The need for establishment of reliable predictors for these serious events remains pivotal.The origin and course of inferior epigastric artery reliably defines the borders of inguinalligament. We hypothesize that we can reduce vascular access site complications duringTAVI, by using the course of inferior epigastric artery as a landmark for the upper safemargin for femoral puncture.

TUESDAY, OCTOBER 23, 8:00 AM–10:00 AMwww.jacc.tctabstracts2012.com

JACC Vol 60/17/Suppl B | October 22–26, 2012 | TCT Abstracts/POSTER/Aortic Valve Disease and TAVR B243

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