P244Right ventricular pacing has adverse effects on left ventricular remodeling after transcatheter aortic valve implantation with the Corevalve prothesis


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Abstract

Background: Transcatheter aortic valve implantation (TAVI) with the CoreValve prosthesis is an emerging technique. Despite good technical implantation-results, functional status of some patients remains unchanged or worsens after TAVI indicating on a relevant percentage of non-responders to this therapy. This prospective study was designed to evaluate the effects of right ventricular pacing on left ventricular function after TAVI.Methods: Between 2008 and 2010, 86 consecutive patients with severe symptomatic aortic valve stenosis and the indication for TAVI were included (38 male; Age: 80,6 ± 6,1 [years], creatinine 1,93 ± 1,62 [mg/dl], log. EuroScore: 28,5 ± 18,1%). 29 Patients (34%) had already a pacemaker before TAVI (16, 19%) or needed one due to post-interventional AV-Block III (13, 15%). These patients were compared with those without permanent pacemaker before or after TAVI. Follow up was 6 months with echocardiography.Results: Before TAVI both groups showed almost similar ejection fraction (49,21 ± 18,1% vs. 50,16 ± 14,2%, p=0,48). Left ventricular Tei-Index and systolic pulmonal artery pressure as well as left ventricular mass index and right ventricular indices (RV-Tei, TAPSE, TDI) did not differ before TAVI in both groups. 6 Months after TAVI left ventricular ejection fraction increased significantly in the group without permanent pacemaker from 49,13 ± 18,3% to 58,4 ± 13,2% (p=0,031) and was significantly different to the ejection fraction of the pacemaker group six months after TAVI (46,32 ± 13,8%, p=0,042). Systolic pulmonary artery pressure (sPAP) as well as left ventricular Tei Index (LV-Tei) were different between both groups after six months but failed to show statistical significance. Left ventricular mass index and right ventricular indices (RV-Tei, TAPSE, TDI) did not differ before and six months after TAVI in both groups.Conclusion: This Study indicates negative effects of right ventricular pacing on left ventricular remodeling after TAVI, diminishing the positive effect of valve implantation. Further studies with higher number of subjects and longer follow up are needed to confirm these preliminary findings.

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