Risk of conduction disturbances following different transcatheter aortic valve prostheses:the role of aortic valve calcifications

OBJECTIVES To assess the impact of prosthesis choice and aortic valve calcifications on the occurrence of conduction disturb-ances after transcatheter aortic valve implantation(TAVI).METHODS We retrospectively analyzed the preoperative clinical characteristics,electrocardiograms,contrast-enhanced mul-tidetector computed tomography scans and procedural strategies of patients who underwent TAVI in our center between January 2012 and June 2017.Quantification of calcium volume was performed for each aortic cusp above(aortic valve)and below(left ventricular outflow tract,LVOT)the basal plane.Multivariate analysis was performed to evaluate risk factors for the onset of new bundle branch block(BBB),transient and permanent atrioventricular block(tAVB,pAVB).RESULTS A total of 569 patients were included in the study.Six different prostheses were implanted(Edwards Sapien XT,n=162;Edwards Sapien 3,n=240;Medtronic CoreValve,n=27;Medtronic CoreValve Evolut R,n=21;Symetis Acurate,n=56;Sy-metis Acurate neo,n=63).The logistic regression analysis for BBB showed association with baseline left anterior hemiblock.The logistic regression for tAVB,found the prior valvuloplasty and the balloon post-dilatation associated with the outcome.Baseline left and right BBB,degree of oversizing,and LVOT calcification beneath the non-coronary cusp were associated with pAVB.Neither the prosthesis model,nor the use of a self-expandable prosthesis showed statistical significance with the above-men-tioned outcomes on univariate analysis.CONCLUSIONS LVOT calcification beneath the non-coronary cusp,baseline left anterior hemiblock,right BBB,balloon post-dilatation,prior valvuloplasty and oversizing are independently associated with postprocedural conduction disturbances after TAVI.Use of a self-expandable prosthesis may show a lower incidence of AVB,if applied in lower calcified aortic valves.

Posthorax^®Prevents Sternal Dehiscence and Instability: Preliminary Results of a Prospective Randomized Multicenter Trial

Aim: A Prospective Randomized Multicenter Trial is ongoing to evaluate Posthorax and prevention of sternal dehiscence/instability: clinical percept is optimistic for Posthorax use. The aim of this mono-center analysis is to give a preliminary result of Posthorax support vest after sternotomy. Methods: One hundred and eighty three cases elective patients were consecutive operated and included in this study conducted in our department since June 2009. Patients were randomized as following: 68 patients were treated with the Posthorax support vest and 115 received a standard bandage postoperatively. The primary endpoints were the Infective Events. Secondary endpoints included a composite of postoperative clinical variables and mortality. Results: The two groups are homogeneous for these characteristic except sex (more women in Control Group, p = 0.022). Operative data were comparable in both groups. Deep sternal infections occurred in four patients, all in Control Group (3.5% vs 0%, p = 0.153). At Follow up, we recorded 2 cases of superficial infection in the control group versus 0 (1.7%, p = 0.394) and 1 case of wound dehiscence always in Control Group versus 0 (0.9%, p = 0.628). Cumulative Infective Events are statistically more in Control Group (7 cases 6.1% versus 0 cases, p = 0.036*). According to the secondary endpoints, there were also no differences between the two compared groups except length of hospitalization (10.6 ± 4 days versus 13.4 ± 9.5, p = 0.019*). Conclusion: Preliminary results show the Posthorax sternum support vest as a valuable adjunct to prevent sternum-related complications: We record a statistical reduction of length of hospital stay and infective events using the support vest in a 3-month follow-up.