Transcatheter aortic valve replacement

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Editors-in-Chief: Roger Laham, M.D., C. Michael Gibson, M.S., M.D.; Jeffrey J. Popma, M.D.

Assistant Editor-In-Chief: Saleh El Dassouki, MD [1]

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Valve types

CoreValve

The CoreValve device was first inserted in 2005.

Complications

Following CoreValve implantation:

• QRS duration: In one observational study of 270 patients, the QRS duration increased from 105±23 milliseconds at baseline to 135±29 milliseconds following TAVI. (P<0.01).
• Left Bundle Branch Block (LBBB): The incidence of left bundle-branch block increased from 13% at baseline to 61% following TAVI (P<0.001).
• Permanent pacemaker implantation: Approximately one third of patients will require a permanent pacemaker be implanted by 30 days with a median time to insertion of 4 days (interquartile range, 2.0 to 7.75 days).
• Multivariate predictors of permanent pacemaker implantation included:

1. Periprocedural atrioventricular block (odds ratio, 6.29; 95% confidence interval, 3.55 to 11.15)
2. Balloon pre-dilatation (odds ratio, 2.68; 95% confidence interval, 2.00 to 3.47)
3. Use of a larger 29 mm CoreValve prosthesis (odds ratio, 2.50; 95% confidence interval, 1.22 to 5.11)
4. The interventricular septum diameter (odds ratio, 1.18; 95% confidence interval, 1.10 to 3.06)
5. A prolonged QRS duration (odds ratio, 3.45; 95% confidence interval, 1.61 to 7.40)