Abstract 18940: Severity and Pattern of Aortic Valve Calcification by Cardiac CT Does Not Predict the Need for Permanent Pacemaker Implantation or Development of Left Bundle Branch Block After Transcatheter Aortic Valve Replacement

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Introduction: Transcatheter aortic valve implantation (TAVI) with self-expanding prosthetic aortic valve (CoreValve) has been noted to have an increased incidence of new persistent left bundle branch block (LBBB) and conduction abnormalities requiring permanent pacemaker implantation (PPI).

Hypothesis: We hypothesized that the severity and/or pattern of aortic valve calcification is directly associated with development of LBBB or conduction abnormalities after CoreValve implantation requiring PPI.

Methods: We performed a prospective study to evaluate the relationship between aortic valve calcification and clinical outcomes after CoreValve implantation between 2009 and 2016. Prior to CoreValve implantation, a cardiac CT was performed for quantitation of aortic valve calcification by Agatston score (AgS). Total AgS as well as AgS for each aortic valve cusp was measured. We previously described association of aortic valve calcification and paravalvular aortic regurgitation after CoreValve implantation. In this report, we included patients without a pre-existing permanent pacemaker or LBBB (n=66).

Results: The mean age was 78 ± 10 years with 50% males. 35% (19/66) developed a new persistent LBBB while 18.5% (12/66) required PPI. The mean total aortic valve AgS, left coronary cusp (LCC) AgS, right coronary cusp (RCC) AgS, and non-coronary cusp (NCC) AgS are listed in Table1. Patients who developed a LBBB had similar total AgS compared to patients who did not. LCC, RCC, and NCC Agatston scores were not different between those who developed a LBBB compared to those who did not (Table 1). Total AgS for patients who required PPI was not significantly different from patients who did not. LCC, RCC, and NCC Agatston scores were not different between both groups (Table 1).

Conclusions: In our study, severity and pattern of calcification of the aortic valve measured on cardiac CT was not associated with development of conduction abnormalities causing LBBB or requiring PPI.

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