Abstract
Abstract 9606: Prognostic Significance of Interventricular and Mitral Calcification on Permanent Pacemaker Implantation Post Tavr. Is All That Glitters Gold?
Circulation (New York, N.Y.), v 144(Suppl_1)
16 Nov 2021
Abstract
Abstract only
Background:
Despite growing demand, TAVR implantation is not free of complications, conduction defects being one of the major barriers to its widespread usage. We sought to evaluate the prognostic implications of interventricular (IVS) and mitral annular calcification (MAC) on post-TAVR conduction abnormalities.
Methods:
We performed a retospective chart review on patients who underwent TAVR at our center (Pittsburgh, PA) during the year 2016-2020 and identified two groups ranked via presence or absence of permanent pacemaker (PPM) implantation post-TAVR. These groups were compared based on baseline demographics, comorbidities, transthoracic echocardiogram (TTE) parameters, and evidence of IVS/MAC calcification via TTE.
Results:
Extracted from a database of >2500 pts, an aged-matched cohort of 75 pts requiring a post-TAVR PPM were identified along with 53 patients undergoing TAVR with no post-procedure conduction defects that were utilized as the control group. In the former group, 66 patients had on-site echocardiographic imaging of which 36 had evidence of IVS calcification (54%). The latter group had 51 patients with imaging of which 22 had evidence of IVS calcification (43%); p=NS; Table 1). Although via a binary logistic model, association of post-TAVR PPM with IVS confirmed no relation with PPM, MAC was strongly associated with PPM with a sensitivity of 82% and specificity of 81%; area under the ROC curve of 0.91. The coefficients in the model are <0.1 level; p<0.001 (Fig 1). PPM placement was directly related to MAC presence and inversely related to LVEF.
Conclusion:
Inherently, IVS calcification should predict post-TAVR PPM given its' proximity to the conduction system. Unexpectedly, however, MAC was a very strong predictor of post-TAVR 30d PPM placement. Moreover, once MAC is present there is ~3-fold increase in PPM while for every 1%
increase
in LVEF, there is a 1.2% increase in PPM. This simple predictor may have relevance in prognostication even more than EKG.
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Details
- Title
- Abstract 9606: Prognostic Significance of Interventricular and Mitral Calcification on Permanent Pacemaker Implantation Post Tavr. Is All That Glitters Gold?
- Creators
- Kirtivardhan Vashistha - Allegheny Health NetworkAmel Tobaa - Allegheny Health NetworkMark Doyle - Allegheny Health NetworkSusan Bartley - Allegheny Health NetworkStephen Bailey - Allegheny Health NetworkRobert W Biederman - Allegheny Health Network
- Publication Details
- Circulation (New York, N.Y.), v 144(Suppl_1)
- Resource Type
- Abstract
- Language
- English
- Academic Unit
- Cardiothoracic Surgery; Medicine (Graduate)
- Other Identifier
- 991021960810104721