Pooled-Analysis of Association of Sievers Bicuspid Aortic Valve Morphology With New Permanent Pacemaker and Conduction Abnormalities After Transcatheter Aortic Valve Replacement

Jiajun Zhang; Xiaoxing Li; Feng Xu; Yuguo Chen; Chuanbao Li

doi:10.3389/fcvm.2022.884911

Pooled-Analysis of Association of Sievers Bicuspid Aortic Valve Morphology With New Permanent Pacemaker and Conduction Abnormalities After Transcatheter Aortic Valve Replacement

Front Cardiovasc Med. 2022 May 26:9:884911. doi: 10.3389/fcvm.2022.884911. eCollection 2022.

Authors

Jiajun Zhang^{1

2

3}, Xiaoxing Li⁴, Feng Xu^{1

2

3}, Yuguo Chen^{1

2

3}, Chuanbao Li^{1

2

3}

Affiliations

¹ Department of Emergency Medicine and Chest Pain Center, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Jinan, China.
² Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China.
³ Key Laboratory of Cardiovascular Remodeling and Function Research, Qilu Hospital of Shandong University, Jinan, China.
⁴ Department of Geriatrics, Qilu Hospital of Shandong University, Jinan, China.

Abstract

Background: Studies on the association of Sievers bicuspid aortic valve (BAV) morphology with conduction disorders after transcatheter aortic valve replacement (TAVR) have not reached consensus.

Methods: We here performed a pooled-analysis to explore whether Sievers type 1 BAV morphology increased the risk of post-TAVR conduction abnormalities and permanent pacemaker implantation (PPI) compared to type 0. Systematic literature searches through EMBASE, Medline, and Cochrane databases were concluded on 1 December 2021. The primary endpoint was post-TAVR new PPI and pooled as risk ratios (RRs) and 95% confidence intervals (CIs). Conduction abnormalities as the secondary endpoint were the composites of post-TAVR PPI and/or new-onset high-degree of atrial-ventricle node block and left-bundle branch block. Studies that reported incidence of outcomes of interest in both type 1 and type 0 BAV morphology who underwent TAVR for aortic stenosis were included.

Results: Finally, nine studies were included. Baseline characteristics were generally comparable, but type 1 population was older with a higher surgical risk score compared to type 0 BAV morphology. In the pooled-analysis type 1 BAV had significantly higher risk of post-TAVR new-onset conduction abnormalities (RR = 1.68, 95%CI 1.09-2.60, p = 0.0195) and new PPI (RR = 1.97, 95%CI 1.29-2.99, p = 0.0016) compared to type 0. Random-effects univariate meta-regression indicated that no significant association between baseline characteristics and PPI.

Conclusion: Sievers type 1 BAV morphology was associated with increased risk of post-TAVR PPI and conduction abnormalities compared to type 0. Dedicated cohort is warranted to further validate our hypothesis.

Keywords: Sievers classification; aortic stenosis (AS); bicuspid aortic valve; conduction abnormalities; pacemaker; transcatheter aortic valve replacement.

Publication types

Systematic Review