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Gabani R, Brugaletta S, Bujak K, Pèrez-Vizcayno MJ, Jiménez-Quevedo P, Arévalos V, Muñoz-García E, Trillo-Nouche R, Del Valle R, de la Torre Hernández JM, Salido L, Gutiérrez E, Pan M, Sánchez-Gila J, García Del Blanco B, Moreno R, Blanco Mata R, Oteo JF, Amat-Santos I, Regueiro A, Ten F, Nogales JM, Fernández-Nofrerías E, Andraka L, Ferrer MC, Pinar E, Romaguera R, Cuellas Ramón C, Alfonso F, García-Blas S, Piñero A, Ignasi J, Díaz Mèndez R, Bordes P, Meseguer J, Nombela-Franco L, Sabaté M. Impact of gender on in-hospital and long-term outcomes after transcatheter aortic valve implantation: an analysis of the Spanish TAVI registry. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024:S1885-5857(24)00252-4. [PMID: 39187234 DOI: 10.1016/j.rec.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 08/02/2024] [Indexed: 08/28/2024]
Abstract
INTRODUCTION AND OBJECTIVES Impact of gender on long-term outcomes after transcatheter aortic valve implantation (TAVI) remains uncertain. We aimed to investigate gender-specific differences in TAVI and its impact on outcomes. METHODS This analysis used data from the prospective Spanish TAVI registry, which included consecutive TAVI patients treated in 46 Spanish centers from 2009 to 2021. The primary endpoint was all-cause mortality at 12 months. Secondary endpoints included in-hospital and 30-day mortality and TAVI-related complications. Adjusted logistic and Cox regression analyses were performed. RESULTS The study included 12 253 consecutive TAVI patients with a mean age of 81.2±6.4 years. Women (53.9%) were older, and had a higher STS-PROM score (7.0±7.0 vs 6.2±6.7; P < .001) than men. Overall, the TAVI-related complication rate was similar between women and men, with specific gender-related complications. While women more frequently developed in-hospital vascular complications (13.6% vs 9.8%; P <.001) and cardiac tamponade (1.5% vs 0.6%; P=.009), men showed a higher incidence of permanent pacemaker implantation (14.5% vs 17.4%; P=.009). There was no difference in all-cause mortality either in hospital (3.6% vs 3.6%, adjusted OR, 1.01; 95%CI, 0.83-1.23; P=.902), at 30 days (4.2% vs 4.2%, adjusted OR, 0.90; 95%CI, 0.65-1.25; P=.564) or at 1 year (11% vs 13%, adjusted HR, 0.94; 95%CI, 0.80-1.11; P=.60). CONCLUSIONS Women treated with TAVI are older and have more comorbidities than men, leading to distinct complications between genders. Nevertheless, all-cause mortality in the short-term and at 1-year was similar between men and women.
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Affiliation(s)
- Rami Gabani
- Hospital Clínic, Institut Clínic Cardiovascular, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Salvatore Brugaletta
- Hospital Clínic, Institut Clínic Cardiovascular, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.
| | - Kamil Bujak
- Hospital Clínic, Institut Clínic Cardiovascular, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain; 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - María José Pèrez-Vizcayno
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain; Fundación Interhospitalaria para la Investigación Cardiovascular, Madrid, Spain
| | - Pilar Jiménez-Quevedo
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Víctor Arévalos
- Hospital Clínic, Institut Clínic Cardiovascular, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Erika Muñoz-García
- Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Ramiro Trillo-Nouche
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Raquel Del Valle
- Servicio de Cardiología, Hospital Central de Asturias, Oviedo, Asturias, Spain
| | | | - Luisa Salido
- Servicio de Cardiología, Hospital Ramón y Cajal, Madrid, Spain
| | - Enrique Gutiérrez
- Servicio de Cardiología, Hospital Gregorio Marañón, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Manuel Pan
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Joaquín Sánchez-Gila
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - Raúl Moreno
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - Roberto Blanco Mata
- Servicio de Cardiología, Hospital General Universitario de Valencia, Valencia, Spain
| | - Juan Francisco Oteo
- Servicio de Cardiología, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Ignacio Amat-Santos
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ander Regueiro
- Servicio de Cardiología, Hospital Clínic, Barcelona, Spain
| | - Francisco Ten
- Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | - Leire Andraka
- Servicio de Cardiología, Hospital Universitario de Basurto, Bilbao, Vizcaya, Spain
| | - María Cruz Ferrer
- Servicio de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Eduardo Pinar
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Rafael Romaguera
- Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Fernando Alfonso
- Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, Spain
| | - Sergio García-Blas
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Antonio Piñero
- Servicio de Cardiología, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Julia Ignasi
- Servicio de Cirugía Cardiaca, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Rocío Díaz Mèndez
- Servicio de Cirugía Cardiaca, Hospital Central de Asturias, Oviedo, Asturias, Spain
| | - Pascual Bordes
- Servicio de Cardiología y Cirugía Cardiaca, Hospital General Universitario de Alicante, Alicante, Spain
| | - Juan Meseguer
- Servicio de Cardiología y Cirugía Cardiaca, Hospital General Universitario de Alicante, Alicante, Spain
| | - Luis Nombela-Franco
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Manel Sabaté
- Hospital Clínic, Institut Clínic Cardiovascular, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
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Singh SK, Levine D, Norton EL, Patel P, Kurlansky P, Rajesh K, Chung M, Olakunle O, Leshnower B, Chen EP, Takayama H. Incidence, risk factors, and long-term outcomes associated with permanent pacemaker implantation after aortic root replacement. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00624-X. [PMID: 39038780 DOI: 10.1016/j.jtcvs.2024.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 06/19/2024] [Accepted: 07/06/2024] [Indexed: 07/24/2024]
Abstract
OBJECTIVE Permanent pacemaker implantation (PPI) after aortic valve replacement is associated with long-term mortality. However, data regarding PPI after aortic root replacement (ARR) is lacking. Herein we describe the incidence, risk factors, and long-term outcomes of PPI after ARR. METHODS Consecutive patients undergoing ARR from 2005 to 2020 were selected after excluding those with endocarditis, type A dissection, or preoperative PPI. Patients requiring PPI after ARR were identified, along with the indication and timing. Independent factors associated with PPI after ARR were identified and long-term survival was assessed. RESULTS The incidence of PPI was 3.8% (n = 85) among 2240 patients undergoing ARR. PPI was performed a median of 7 days (interquartile range, 5-12 days) after ARR most commonly for complete heart block (73%). Bicuspid aortic valve (odds ratio [OR], 1.89; P = .02), female sex (OR, 1.74; P = .04), preoperative heart block (OR, 2.70; P = .02), and prior aortic valve replacement (OR, 2.18; P = .01) were independently associated with PPI while preoperative aortic insufficiency (OR, 0.52; P = .01) and valve-sparing root replacement procedure compared with bio-Bentall (OR, 0.40; P = .01) were protective. Patients requiring PPI after ARR were not at increased risk of operative or long-term mortality compared with patients not requiring PPI (P = .26); however, those undergoing PPI experienced significantly longer hospital length of stay (13 vs 7 days; P < .001). CONCLUSIONS The incidence of PPI after ARR remains low, particularly after VSRR. Preoperative conduction disturbance, prior AVR, and bicuspid aortic valve are all associated with increased risk of PPI. Although PPI is associated with longer length of stay, it is not associated with early or late mortality.
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Affiliation(s)
- Sameer K Singh
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Dov Levine
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | | | - Parth Patel
- Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Paul Kurlansky
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Kavya Rajesh
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Megan Chung
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Oreoluwa Olakunle
- Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Bradley Leshnower
- Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Edward P Chen
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Hiroo Takayama
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY.
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Nakashima M, Jilaihawi H, He Y, Williams D, Pushkar I, Williams M, Hisamoto K. Membranous Septum Length Predicts New Conduction Abnormalities in Surgical Aortic Valve Replacement: A Novel Predictor for Permanent Pacemaker Implantation After Surgical Aortic Valve Replacement. J Surg Res 2024; 295:385-392. [PMID: 38070251 DOI: 10.1016/j.jss.2023.11.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 11/02/2023] [Accepted: 11/12/2023] [Indexed: 02/25/2024]
Abstract
INTRODUCTION The membranous septum (MS) length measured by cardiac computed tomography (CT) is useful for the prediction of permanent pacemaker implantation (PPMI) and new left bundle branch block (LBBB) after transcatheter aortic valve replacement. However, its predictive value for patients undergoing surgical aortic valve replacement (SAVR) is unknown. METHODS A total of 2531 consecutive patients were registered in the institutional Society of Thoracic Surgeons database between July 2017 and June 2020. Patients who underwent non-SAVR procedures, had prior pacemaker/implantable cardioverter defibrillator, prior SAVR, no preprocedural CT assessment, or suboptimal CT imaging were excluded. RESULTS A total of 126 SAVR with preprocedural CT assessment were analyzed. Bicuspid aortic valve morphology was confirmed on CT in 59.5% of patients. There were three new PPMIs and five new LBBBs observed after SAVR at the time of discharge. In-hospital mortality was 0.8%. Low left ventricular (LV) ejection fraction (<50%), LV mass index >120 g/m2, large right coronary artery height, and MS length <1.5 mm predicted new PPMI/LBBB. Multivariate analysis showed LV mass index >120 g/m2 (odds ratio: 9.165; 95% confidence interval: 1.644-51.080; P = 0.011) and MS length <1.5 mm (odds ratio: 14.449; 95% confidence interval: 1.632-127.954; P = 0.016) were independent predictors for new PPMI/LBBB. CONCLUSIONS Short MS length on preoperative cardiac CT is a powerful and novel predictor for the risk of new PPMI/LBBB after SAVR. Special care should be taken in patients with short MS length to avoid suture-mediated trauma.
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Affiliation(s)
| | | | - Yuxin He
- Heart Valve Center, NYU Langone Health, New York, New York
| | - David Williams
- Heart Valve Center, NYU Langone Health, New York, New York
| | - Illya Pushkar
- Heart Valve Center, NYU Langone Health, New York, New York
| | | | - Kazuhiro Hisamoto
- Heart Valve Center, NYU Langone Health, New York, New York; Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, New York.
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Fallon JM, Malenka DJ, Ross CS, Ramkumar N, Seshasayee SM, Westbrook BM, Hirashima F, Quinn RD. The Northern New England Rapid Deployment Valve Experience: Survival and Procedural Outcomes From 2015 to 2021. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2024; 19:54-63. [PMID: 38318656 DOI: 10.1177/15569845231223504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
OBJECTIVE The optimal approach and choice of initial aortic valve replacement (AVR) is evolving in the growing era of transcatheter AVR. Further survival and hemodynamic data are needed to compare the emerging role of rapid deployment (rdAVR) versus stented (sAVR) valve options for AVR. METHODS The Northern New England Cardiovascular Database was queried for patients undergoing either isolated AVR or AVR + coronary artery bypass grafting (CABG) with rdAVR or sAVR aortic valves between 2015 and 2021. Exclusion criteria included endocarditis, mechanical valves, dissection, emergency case status, and prior sternotomy. This resulted in a cohort including 1,616 sAVR and 538 rdAVR cases. After propensity weighting, procedural characteristics, hemodynamic variables, and survival outcomes were examined. RESULTS The breakdown of the overall cohort (2,154) included 1,164 isolated AVR (222 rdAVR, 942 sAVR) and 990 AVR + CABG (316 rdAVR, 674 sAVR). After inverse propensity weighting, cohorts were well matched, notable only for more patients <50 years in the sAVR group (4.0% vs 1.9%, standardized mean difference [SMD] = -0.12). Cross-clamp (89 vs 64 min, SMD = -0.71) and cardiopulmonary bypass (121 vs 91 min, SMD = -0.68) times were considerably longer for sAVR versus rdAVR. Immediate postreplacement aortic gradient decreased with larger valve size but did not differ significantly between comparable sAVR and rdAVR valve sizes or overall (6.5 vs 6.7 mm Hg, SMD = 0.09). Implanted rdAVR tended to be larger with 51% either size L or XL versus 37.4% of sAVR ≥25 mm. Despite a temporal decrease in pacemaker rate within the rdAVR cohort, the overall pacemaker frequency was less in sAVR versus rdAVR (4.4% vs 7.4%, SMD = 0.12), and significantly higher rates were seen in size L (10.3% vs 3.7%, P < 0.002) and XL (15% vs 5.6%, P < 0.004) rdAVR versus sAVR. No significant difference in major adverse cardiac events (4.6% vs 4.6%, SMD = 0.01), 30-day survival (1.5% vs 2.6%, SMD = 0.08), or long-term survival out to 4 years were seen between sAVR and rdAVR. CONCLUSIONS Rapid deployment valves offer a safe alternative to sAVR with significantly decreased cross-clamp and cardiopulmonary bypass times. Despite larger implantation sizes, we did not appreciate a comparative difference in immediate postoperative gradients, and although pacemaker rates are improving, they remain higher in rdAVR compared with sAVR. Longer-term hemodynamic and survival follow-up are needed.
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Affiliation(s)
- John M Fallon
- Department of Cardiac Surgery, Maine Medical Center, Portland, ME, USA
| | - David J Malenka
- Department of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Cathy S Ross
- Department of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Niveditta Ramkumar
- Department of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | | | | | - Reed D Quinn
- Department of Cardiac Surgery, Maine Medical Center, Portland, ME, USA
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Stephan T, Krohn-Grimberghe M, von Lindeiner genannt von Wildau A, Buck C, Baumhardt M, Mörike J, Gonska B, Rottbauer W, Buckert D. Cusp-overlap view reduces conduction disturbances and permanent pacemaker implantation after transcatheter aortic valve replacement even with balloon-expandable and mechanically-expandable heart valves. Front Cardiovasc Med 2023; 10:1269833. [PMID: 38107259 PMCID: PMC10722163 DOI: 10.3389/fcvm.2023.1269833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/30/2023] [Indexed: 12/19/2023] Open
Abstract
Background Conduction disturbances demanding permanent pacemaker implantation (PPI) remain a common complication after transcatheter aortic valve replacement (TAVR). Optimization of the implantation depth (ID) by introducing the cusp-overlap projection (COP) technique led to a reduced rate of PPI when self-expanding valves were used. Objectives The aim of the present study was to determine if using the novel COP view is applicable for all types of TAVR prosthesis and results in a higher ID and reduced incidence of new conduction disturbances and PPI. Methods In this prospective case-control study 586 consecutive patients undergoing TAVR with either balloon-expandable Edwards SAPIEN S3 (n = 280; 47.8%), or mechanically expandable Boston LOTUS Edge heart valve prostheses (n = 306; 52.2%) were included. ID as well as rates of periprocedural PPI and left bundle branch block (LBBB) were compared between the conventional three-cusp coplanar (TCC) projection and the COP view for implantation. Results Of 586 patients, 282 (48.1%) underwent TAVR using COP, whereas in 304 patients (51.9%) the TCC view was applied. Using COP a significantly higher ID was achieved in Edwards SAPIEN S3 TAVR procedures (ID mean difference -1.0 mm, 95%-CI -1.9 to -0.1 mm; P = 0.029), whereas the final platform position did not differ significantly between both techniques when a Boston LOTUS Edge valve was used (ID mean difference -0.1 mm, 95%-CI -1.1 to +0.9 mm; P = 0.890). In Edwards SAPIEN S3 valves, higher ID was associated with a numerically lower post-procedural PPI incidence (4.9% vs. 7.3%; P = 0.464). Moreover, ID was significantly deeper in patients requiring PPI post TAVR compared to those without PPI [8.7 mm (6.8-10.6 mm) vs. 6.5 mm (6.1-7.0 mm); P = 0.005]. In Boston LOTUS Edge devices, COP view significantly decreased the incidence of LBBB post procedure (28.1% vs. 47.9%; P < 0.001), while PPI rates were similar in both groups (21.6% vs. 25.7%; P = 0.396). Conclusion The present study demonstrates the safety, efficacy and reproducibility of the cusp-overlap view even in balloon-expandable and mechanically-expandable TAVR procedures. Application of COP leads to significantly less LBBB in repositionable Boston LOTUS Edge valves and a numerically lower PPI rate in Edwards SAPIEN S3 valves post TAVR compared to the standard TCC projection. The results should encourage to apply the COP view more widely in clinical practice.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Dominik Buckert
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
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Madanat L, Seeley E, Mando R, Shah K, Hanson I, Renard BM, Abbas AE, Keeley J, Haines DE, Mehta NK. Mortality Outcomes in Patients With Cardiac Implantable Electronic Devices Before and After Transcatheter Aortic Valve Replacement. Am J Cardiol 2023; 205:1-9. [PMID: 37573632 DOI: 10.1016/j.amjcard.2023.07.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 08/15/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) carries a risk of high-grade AV block requiring cardiac implantable electronic device (CIED) implantation, which has been associated with a higher mortality rate. However, the outcomes of TAVR in patients with preexisting CIEDs are not well understood. We conducted a retrospective analysis of consecutive patients who underwent TAVR from December 2014 to December 2019 at our institution. Patients were categorized into 3 groups: preexisting CIED pre-TAVR (group 1), CIED implanted within 30 days after TAVR (group 2), and no CIED implanted (group 3). Cox proportional hazard was conducted to determine the primary end point of all-cause mortality. A total of 366 patients were included, of whom 93 (25.4%), 51 (13.9%), and 222 (60.7%) comprised group 1, 2, and 3, respectively. The median follow-up time was 2.3 years. The all-cause mortality rate was higher in group 1 than group 2 (hazard ratio [HR] 2.60, 95% confidence interval [CI] 1.09 to 6.18, p = 0.03) and group 3 (HR 1.96, 95% CI 1.24 to 3.08, p = 0.004). On the multivariate analysis, there was no statistically significant difference in mortality among the groups (group 1 vs group 2: HR 1.95, 95% CI 0.70 to 5.44, p = 0.20 and group 1 vs group 3: HR 1.27, 95% CI 0.66 to 2.43, p = 0.47). Preoperative hemoglobin ≤12 g/100 ml was an independent predictor of all-cause mortality (HR 1.75, 95% CI 1.10 to 2.80, p = 0.02). Group 1 had a higher 1 year congestive heart failure readmission rate (29%) than group 2 (17.6%) and group 3 (8.1%; p <0.0001). In conclusion, there was no difference in the adjusted long-term survival based on the CIED grouping. However, patients with preexisting CIEDs had higher all-cause mortality and 1-year congestive heart failure readmission rates owing to their higher co-morbidity burden, irrespective of their Society of Thoracic Surgeons score. This can be taken into account for preoperative risk stratification.
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Affiliation(s)
- Luai Madanat
- Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan
| | - Elizabeth Seeley
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Ramy Mando
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, Michigan
| | - Kuldeep Shah
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, Michigan
| | - Ivan Hanson
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, Michigan
| | - Brian M Renard
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, Michigan
| | - Amr E Abbas
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, Michigan
| | - Jacob Keeley
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - David E Haines
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, Michigan
| | - Nishaki K Mehta
- Oakland University William Beaumont School of Medicine, Rochester, Michigan; Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, Michigan; Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia.
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7
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Pollari F, Berretta P, Albertini A, Carrel T, Teoh K, Meuris B, Villa E, Kappert U, Andreas M, Solinas M, Misfeld M, Savini C, Fiore A, Shrestha M, Santarpino G, Martinelli GL, Mignosa C, Glauber M, Yan T, Fischlein T, Di Eusanio M. Pacemaker after Sutureless and Rapid-Deployment Prostheses: A Progress Report from the SURD-IR. Thorac Cardiovasc Surg 2023; 71:557-565. [PMID: 36257545 DOI: 10.1055/s-0042-1757778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the need for postoperative permanent pacemaker implantation (PPI) following sutureless and rapid-deployment aortic valve replacement (SuRD-AVR) in the context of a progress report from a large multicenter international registry (SURD-IR). METHODS We retrospectively analyzed 4,166 patients who underwent SuRD-AVR between 2008 and 2019. The primary outcome was the need for PPI before discharge. The study population was analyzed separately according to the implanted prostheses (Su cohort and RD cohort). Each cohort was divided into two groups based on the operation date: an early group ("EG" = 2008-2016) and a late group ("LG" = 2017-2019). RESULTS The rate of PPI decreased significantly in the Su cohort over time (EG = 10.8% vs LG = 6.3%, p < 0.001). In the Su cohort, a decrease in age, risk profile, and incidence of bicuspid aortic valve, increased use of anterior right thoracotomy, reduction of cardiopulmonary bypass time and of associated procedures, and more frequent use of smaller prostheses were observed over time. In the RD cohort, the rate of PPI was stable over time (EG = 8.8% vs LG = 9.3%, p = 0.8). In this cohort, a younger age, lower risk profile, and higher incidence of concomitant septal myectomy were observed over time. CONCLUSION Our analysis showed a significant decrease in the PPI rate in patients who underwent Su-AVR over time. Patient selection as well as surgical improvements and a more accurate sizing could be correlated with this phenomenon. The RD cohort revealed no significant differences either in patient's characteristics or in PPI rate between the two time periods.
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Affiliation(s)
- Francesco Pollari
- Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Paolo Berretta
- Department of Cardiac Surgery, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Alberto Albertini
- Department of Cardiovascular Surgery, Maria Cecilia Hospital GVM Care and Research, Cotignola, Italy
| | - Thierry Carrel
- Department of Cardiovascular Surgery, Inselspital University Hospital Bern, Bern, Switzerland
| | - Kevin Teoh
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Bart Meuris
- KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Emmanuel Villa
- Poliambulanza Foundation Hospital Institute, Brescia, Lombardia, Italy
| | - Utz Kappert
- Heart Centre Dresden University Hospital of the University of Technology Dresden, Dresden, Sachsen, Germany
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Marco Solinas
- Heart Hospital Pasquinucci Hospital of Massa, Massa, Toscana, Italy
| | - Martin Misfeld
- Department of Cardiac Surgery, Heart Centre, University of Leipzig, Leipzig, Germany
| | - Carlo Savini
- Alma Mater Studiorum University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Antonio Fiore
- Centre Hospitalier Universitaire Henri Mondor, Creteil, Île-de-France, France
| | - Malakh Shrestha
- Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany
| | | | | | | | | | | | - Theodor Fischlein
- Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Marco Di Eusanio
- Azienda Ospedaliero Universitaria Ospedali Riuniti Umberto I G M Lancisi G Salesi, Ancona, Marche, Italy
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8
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Ballantyne BA, Chew DS, Vandenberk B. Paradigm Shifts in Cardiac Pacing: Where Have We Been and What Lies Ahead? J Clin Med 2023; 12:jcm12082938. [PMID: 37109274 PMCID: PMC10146747 DOI: 10.3390/jcm12082938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/07/2023] [Accepted: 04/09/2023] [Indexed: 04/29/2023] Open
Abstract
The history of cardiac pacing dates back to the 1930s with externalized pacing and has evolved to incorporate transvenous, multi-lead, or even leadless devices. Annual implantation rates of cardiac implantable electronic devices have increased since the introduction of the implantable system, likely related to expanding indications, and increasing global life expectancy and aging demographics. Here, we summarize the relevant literature on cardiac pacing to demonstrate the enormous impact it has had within the field of cardiology. Further, we look forward to the future of cardiac pacing, including conduction system pacing and leadless pacing strategies.
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Affiliation(s)
- Brennan A Ballantyne
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Derek S Chew
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Bert Vandenberk
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium
- Department of Cardiology, University Hospitals Leuven, 3000 Leuven, Belgium
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9
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Wang X, Wong I, Bajoras V, Vanhaverbeke M, Nuyens P, Bieliauskas G, Jørgensen TH, Chen M, De Backer O, Sondergaard L. Impact of implantation technique on conduction disturbances for TAVR with the self-expanding portico/navitor valve. Catheter Cardiovasc Interv 2023; 101:431-441. [PMID: 36542648 DOI: 10.1002/ccd.30517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/06/2022] [Accepted: 11/27/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Use of a right-left (R-L) cusp overlap view for transcatheter aortic valve replacement (TAVR) with self-expanding valves has recently been proposed aiming to reduce permanent pacemaker implantation (PPMI). An objective, data-driven explanation for this observation is missing. AIMS To assess the impact of different implantation techniques on the risk of PPMI following TAVR with the Portico/NavitorTM transcatheter heart valve (THV; Abbott). METHODS A TAVR-population treated with Portico/NavitorTM had the THV implanted in a right versus left anterior oblique (RAO/LAO) fluoroscopic view with no parallax in the delivery system. The impact of these different implantation views on the spatial relationship between THV and native aortic annulus and the risk of conduction disturbances and PPMI after TAVR was studied. RESULTS A total of 366 matched TAVR patients were studied: 183 in the RAO group and 183 in the LAO group. The degree of aortic annulus plane tilt was significantly smaller in the RAO versus LAO group (median: 0° vs. 23°, p < 0.001), with no plane tilt in 105 out of 183 cases (57.3%) in the RAO group. At 30 days after TAVR, the overall PPMI and guideline-directed PPMI rates were 12.6% versus 18.0% (p = 0.15) and 8.2% versus 15.3% (p = 0.04) in the RAO versus LAO group, respectively. CONCLUSIONS Use of a R-L cusp overlap (RAO-caudal) view for implantation of the Portico/NavitorTM valve results in less tilt of the native aortic annulus plane and a clear trend toward a lower 30-day PPMI rate as compared to TAVR using the conventional LAO implantation view.
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Affiliation(s)
- Xi Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ivan Wong
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Vilhelmas Bajoras
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maarten Vanhaverbeke
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Philippe Nuyens
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gintautas Bieliauskas
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ole De Backer
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Sondergaard
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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10
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Onishi T, Komori O, Ando T, Fukutomi M, Tobaru T. Effectiveness of high implantation of SAPIEN 3 in preventing pacemaker implantation: A propensity score analysis. Arch Cardiovasc Dis 2023; 116:79-87. [PMID: 36641243 DOI: 10.1016/j.acvd.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND In transcatheter aortic valve implantation, high implantation on the aortic annulus may prevent conduction pathway injury, leading to a decrease in the rate of permanent pacemaker implantation. AIM To assess the impact of high implantation of SAPIEN 3 on the prevention of permanent pacemaker implantation. METHODS Since August 2020, we have performed high implantation by fluoroscopically positioning the lower part of the lucent line at the virtual basal ring line on a coplanar view before valve implantation. Patients treated before the adoption of this method were defined as the conventional group. We compared the high implantation group with the conventional group using propensity score analysis. RESULTS Overall, the high implantation group (n=95) showed a significantly shorter ventricular strut length than the conventional group (n=85): median 1.3 (interquartile range 0.2-2.4) mm vs 2.8 (1.8-4.1) mm (P<0.001). The permanent pacemaker implantation rate was significantly lower in the high implantation group than in the conventional group (2.1% vs 11.8%; P=0.009). According to 100 propensity score analyses based on multiple imputation and the selection of appropriate covariates, the median P value for the comparison of permanent pacemaker implantation rates after transcatheter aortic valve implantation between the high implantation group and the conventional group ranged between 0.001 and 0.017, indicating a more significant reduction in the permanent pacemaker implantation rate in the high implantation group than in the conventional group. Neither valve dislodgement nor the need for a second valve was observed in either group. CONCLUSIONS The high implantation of SAPIEN 3 successfully decreases ventricular strut length, reducing the permanent pacemaker implantation rate after transcatheter aortic valve implantation.
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Affiliation(s)
- Takayuki Onishi
- Department of Cardiology, Kawasaki Heart Centre, Kawasaki Saiwai Hospital, Saiwai-ku, Kawasaki-shi, 212-0014 Kanagawa, Japan.
| | - Osamu Komori
- Department of Computer and Information Science, Faculty of Science and Technology, Seikei University, Musashino-shi, 180-8633 Tokyo, Japan; School of Statistical Thinking, The Institute of Statistical Mathematics, Tachikawa, 190-8562 Tokyo, Japan
| | - Tomo Ando
- Department of Cardiology, Kawasaki Heart Centre, Kawasaki Saiwai Hospital, Saiwai-ku, Kawasaki-shi, 212-0014 Kanagawa, Japan
| | - Motoki Fukutomi
- Department of Cardiology, Kawasaki Heart Centre, Kawasaki Saiwai Hospital, Saiwai-ku, Kawasaki-shi, 212-0014 Kanagawa, Japan
| | - Tetsuya Tobaru
- Department of Cardiology, Kawasaki Heart Centre, Kawasaki Saiwai Hospital, Saiwai-ku, Kawasaki-shi, 212-0014 Kanagawa, Japan
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11
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(Permanent pacemaker implantation in patients undergoing TAVR - single center study between years 2009 and 2021). COR ET VASA 2022. [DOI: 10.33678/cor.2022.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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12
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Temporal Trends in Internal vs. External Referrals for TAVR in a Large Academic Center: Patients Characteristics and Outcomes. J Interv Cardiol 2022; 2022:6074368. [PMID: 36051379 PMCID: PMC9410986 DOI: 10.1155/2022/6074368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 05/09/2022] [Accepted: 07/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background Since transcatheter aortic valve replacement (TAVR) first became approved for inoperable patients followed by high, intermediate-, and low-risk patients, referrals to TAVR centers have rapidly increased. The purpose of this study was to investigate referral patterns to a large academic TAVR center in the state of North Carolina and evaluate differences between externally and internally referred patients. Methods Data for all patients who underwent TAVR at our institution between November 2014 and March 2020 were pulled from the Transcatheter Valve Therapy Registry. The electronic medical record was used to determine the referral source. The descriptive statistical analysis was performed using Excel (Microsoft, Redmond, Washington). Results 491 patients underwent TAVR at our institution between November 2014 and March 2020. Half of the patients were referred by a cardiologist within the same health system (N = 250, 50.9%). Other referral sources included a cardiologist external to the health system (N = 210, N = 42.8%) and a surgeon or proceduralist (such as urologist, surgeon, or gastroenterologist) during the workup for another procedure (N = 26, 5.3%). Over time, there was a trend toward an increasing proportion of patients referred by a cardiologist external to our system, but this trend did not reach statistical significance (20.0% in 2014, 29.2% in 2015, 30.7% in 2016, 53.0% in 2017, 36% in 2018, 48.4% in 2019, and 56.8% in 2020, p=0.06 using the Mann–Kendall trend test). Externally referred patients were less likely to have private insurance and were more likely to have a reduced ejection fraction and had a higher mean gradient across the valve. Postprocedure, externally referred patients were more likely to have the procedure under moderate sedation and less likely to be discharged home. Conclusions This study presents the referral pattern to a large TAVR center in North Carolina. Over time, there was an increase in external referrals suggesting that TAVR is increasingly adopted as an important component of the management of aortic valve stenosis. Internally and externally referred patients have differences in baseline demographic and clinical characteristics which may have an impact on clinical outcomes.
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13
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Gerdisch M, Lehr E, Dunnington G, Johnkoski J, Barksdale A, Parikshak M, Ryan P, Youssef S, Fletcher R, Barnhart G. Mid‐term outcomes of concomitant Cox‐Maze IV: Results from a multicenter prospective registry. J Card Surg 2022; 37:3006-3013. [PMID: 35870185 PMCID: PMC9543802 DOI: 10.1111/jocs.16777] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/26/2022] [Accepted: 05/12/2022] [Indexed: 11/29/2022]
Abstract
Background Benefits of concomitant atrial fibrillation (AF) surgical treatment are well established. Cardiac societies support treating AF during cardiac surgery with a class I recommendation. Despite these guidelines, adoption has been inconsistent. We report results of routine performance of concomitant Cox‐Maze IV (CMIV) from participating centers using a standardized, prospective registry. Methods Nine surgeons at four cardiac surgery programs enrolled 807 patients undergoing concomitant CMIV surgery over 12 years. Lesions were created using bipolar radiofrequency clamps and cryoablation probes. Follow‐up occurred at 3‐ and 6‐months, then annually for 3 years. Freedom from AF was defined as no episode >30 s of atrial arrhythmia. Results Sixty‐four percent of patients were male, mean age 69 years, mean left atrial size 4.6 cm, mean preoperative AF duration 4.0 years, mean EuroSCORE 6.4, and mean CHADS2 score 3.1. Thirty‐day postoperative mortality and neurologic event rates were 3.3% and 1.3%, respectively. New pacemaker implant rate was 6.3%. Freedom from AF rates at 1‐ and 3‐years stratified by preoperative AF type were: paroxysmal 94.6% and 87.5%, persistent 82.1% and 81.9%, and longstanding persistent 84.1% and 78.1%. At 3‐year follow up, 84% of patients were off antiarrhythmic drugs and 74% of sinus rhythm patients were off oral anticoagulants. Conclusions Routine CMIV is safe and effective. Acceptable outcomes can be achieved across multiple centers and multiple operators even in a moderate risk patient population undergoing more complex procedures. Surgeons and institutions should be encouraged by all cardiac societies to adopt the CMIV procedure to maximize patient benefit.
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Affiliation(s)
- Marc Gerdisch
- Franciscan Health Indianapolis Indianapolis Indiana USA
| | - Eric Lehr
- Swedish Medical Center Seattle Washington USA
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Vilalta V, Cediel G, Mohammadi S, López H, Kalavrouziotis D, Resta H, Dumont E, Voisine P, Philippon F, Escabia C, Borrellas A, Alperi A, Bayes-Genis A, Rodes-Cabau J. Incidence, Predictors and Prognostic Value of Permanent Pacemaker Implantation Following Sutureless Valve Implantation in Low-Risk Aortic Stenosis Patients. Eur J Cardiothorac Surg 2022; 62:6593489. [PMID: 35639725 DOI: 10.1093/ejcts/ezac307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/11/2022] [Accepted: 05/20/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES SU-SAVR has been associated with higher rates of permanent pacemaker (PPM) compared with conventionally implanted aortic bioprostheses. The purpose of this study was to determine the incidence, predictors and mid-term prognostic impact of PPM after Perceval (Livanova, London, UK) SU-SAVR in low-risk patients. METHODS A total of 400 consecutive low-risk (EuroSCORE II < 4%) patients without prior pacemaker who underwent SAVR with the Perceval prosthesis from 2013 to 2019 in two centres were included. Baseline, clinical and electrocardiographic parameters, procedural characteristics, and follow-up data were collected. RESULTS PPM was required in 36 (9%) patients after SU-SAVR, with a median time between the procedure and PPM implantation of 7.5 (4.5-10.5) days. Older age and prior right bundle branch block (RBBB) were associated with an increased risk of PPM (p < 0.05 for all), but only baseline RBBB was found to be an independent predictor of new PPM requirement (Odds ratio: 2.60, 95% confidence interval: 1.15-5.81; p = 0.022). At a median follow-up of 3.4 (2.3-4.5) years, there were no differences between groups in mortality (PPM: 36%, no PPM: 22%, p = 0.105) or heart failure rehospitalization (PPM: 25%, no PPM: 21%, p = 0.839). CONCLUSIONS About 1 out of 10 low-risk patients with aortic stenosis undergoing SU-SAVR with the Perceval prosthesis required PPM implantation. Prior RBBB determined an increased risk (close to 3 times) of PPM following the procedure. PPM was not associated with a higher risk of clinical events at 3-year follow-up.
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Affiliation(s)
- Victoria Vilalta
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Germán Cediel
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Siamak Mohammadi
- Department of Cardiac Surgery, Quebec Heart & Lung Institute, Quebec City, Canada
| | - Helena López
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | - Helena Resta
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Eric Dumont
- Department of Cardiac Surgery, Quebec Heart & Lung Institute, Quebec City, Canada
| | - Pierre Voisine
- Department of Cardiac Surgery, Quebec Heart & Lung Institute, Quebec City, Canada
| | - François Philippon
- Department of Cardiology, Quebec Heart & Lung Institute, Quebec City, Canada
| | - Claudia Escabia
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Andrea Borrellas
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Alberto Alperi
- Department of Cardiology, Quebec Heart & Lung Institute, Quebec City, Canada
| | - Antoni Bayes-Genis
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep Rodes-Cabau
- Department of Cardiology, Quebec Heart & Lung Institute, Quebec City, Canada
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15
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Thuraisingam A, Newcomb AE. Rhythm disturbances following rapid-deployment aortic valve replacement. JTCVS Tech 2021; 10:219-226. [PMID: 34984381 PMCID: PMC8691943 DOI: 10.1016/j.xjtc.2021.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/03/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives There have been reports of postoperative conduction disturbances after rapid-deployment aortic valve replacement. Our objective was to assess electrocardiogram changes in patients undergoing this procedure and review the literature on this topic. Methods In this retrospective case series, clinical data were extracted from patient records at St Vincent's Hospital Melbourne and the Australia New Zealand Society of Cardiac and Thoracic Surgeons database. Electrocardiogram data were obtained at baseline and postoperatively on day 5 and at week 6 and reviewed for rhythm disturbances and intracardiac conduction problems. Pacemaker status was also recorded. Results From 2013 to 2017, 100 consecutive patients underwent rapid-deployment aortic valve replacement with 1 valve type at our institution. Three patients were excluded because of paced rhythm preoperatively, leaving 97 patients (mean age 74.7 ± 8.12 years; 56.7% male) for analysis. Some 18.6% of patients developed new left bundle branch block at 5 days postoperatively and only 4.1% of patients found with persistent left bundle branch block at 6-week follow-up compared with preoperatively. No significant changes were observed in the frequencies of atrial fibrillation, first-degree heart block, and right bundle branch block. However, there was evidence of increases in paced rhythm and subsequent need for a permanent pacemaker. A total of 14 patients (14.4%) had a permanent pacemaker implanted at an average of 11.1 ± 2.9 days postoperatively. Conclusions Rhythm disturbances and conduction abnormalities are noted with the rapid-deployment aortic valves used at our institution, but appear comparable to other rapid-deployment aortic valve replacement bioprostheses. These abnormalities may be related to the effect of the sub-annular stent frame of the valve system and implantation technique.
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16
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Dalén M, Persson M, Glaser N, Sartipy U. Permanent pacemaker implantation after On-X surgical aortic valve replacement: SWEDEHEART observational study. BMJ Open 2021; 11:e047962. [PMID: 34794986 PMCID: PMC8603281 DOI: 10.1136/bmjopen-2020-047962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Bioprosthetic aortic valves with an extended subannular component, such as transcatheter valves, exert increased compression on the cardiac conduction system and increase the risk for permanent pacemaker implantation. It is unknown if the On-X mechanical prosthetic valve, which has an elongated subannular valve housing, increases the risk of permanent pacemaker implantation following aortic valve replacement. DESIGN Observational nationwide cohort study. SETTING Swedish population-based study. PARTICIPANTS All patients aged 18-65 years who underwent primary mechanical aortic valve replacement in Sweden between 2005 and 2018. We used the Swedish Web system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies register and other Swedish national health-data registers. EXPOSURE Patients implanted with an On-X valve versus patients implanted with other bileaflet mechanical valves. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome measure was permanent pacemaker implantation within 30 days of surgery. RESULTS A total of 2602 patients were included, and 581 patients received an On-X valve and 2021 patients received a St Jude Masters/Regent (n=945) or Carbomedics Reduced valve (n=1076). In the total study population, 115 (4.4%) permanent pacemaker implantations were performed within 30 days after aortic valve replacement. In the propensity score matched population, there was no significant difference in the rate of permanent pacemaker implantation in the On-X group compared with the control group: 3.6% (95% CI: 2.4% to 5.5%) vs 4.0% (95% CI: 2.7% to 5.9%), p=0.877. CONCLUSIONS The On-X prosthetic heart valve was associated with a similarly low risk for permanent pacemaker implantation after aortic valve replacement compared with other conventional bileaflet mechanical valves. The On-X elongated subannular valve housing does not interfere with the cardiac conduction system.
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Affiliation(s)
- Magnus Dalén
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Michael Persson
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Natalie Glaser
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden
| | - Ulrik Sartipy
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Tarakji KG, Patel D, Krishnaswamy A, Hussein A, Saliba W, Wilkoff BL, Wolski K, Svensson L, Wazni OM, Kapadia SR. Bradyarrhythmias detected by extended rhythm recording in patients undergoing transcatheter aortic valve replacement (Brady-TAVR Study). Heart Rhythm 2021; 19:381-388. [PMID: 34801735 DOI: 10.1016/j.hrthm.2021.11.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/31/2021] [Accepted: 11/14/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Bradyarrhythmias leading to permanent pacemaker (PPM) implantation continue to be a complication after transcatheter aortic valve replacement (TAVR). OBJECTIVE The purpose of this study was to assess the prevalence of bradyarrhythmias using an electrocardiographic (ECG) extended rhythm recording in patients pre- and post-TAVR and whether they can predict the need for PPM. METHODS This was a prospective single-center study in patients undergoing TAVR. Patients received an ECG patch for 2 weeks pre-, immediately post-, and 2-3 months post-TAVR. Caring physicians were blinded to the results of the patch except when predefined urgent arrhythmias were detected. The main outcome was the need for PPM implantation after TAVR. RESULTS We enrolled 110 patients, of whom 96 underwent TAVR and were included in the final analysis. Bradyarrhythmias, defined as a pause of 3 seconds or more, occurred in 5.2%, 12.7%, and 7% of patients pre-, immediately post-, and 2-3 months post-TAVR, respectively. PPM implantation occurred in 12 patients (12.5%), of whom 9 (9.4%) underwent implantation during their index hospitalization while 3 (3.1%) required implantation postdischarge for indications other than heart block. No patients required PPM after receiving an ECG patch 2-3 months post-TAVR. Significant baseline predictors for the need for PPM included the presence of right bundle branch block and increased QRS duration. Bradyarrhythmias detected by the ECG patch did not predict the need for PPM at either the index hospitalization or the follow-up period. CONCLUSION Bradyarrhythmias are common and can be detected with extended ECG monitoring before and after TAVR; however, in our study they did not predict the need for PPM after TAVR (ClinicalTrials.gov identifier: NCT03180073).
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Affiliation(s)
- Khaldoun G Tarakji
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Divyang Patel
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amar Krishnaswamy
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ayman Hussein
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Walid Saliba
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Bruce L Wilkoff
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kathy Wolski
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lars Svensson
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Oussama M Wazni
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samir R Kapadia
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
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18
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Rück A, Saleh N, Glaser N. Outcomes Following Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: SWEDEHEART Observational Study. JACC Cardiovasc Interv 2021; 14:2173-2181. [PMID: 34620397 DOI: 10.1016/j.jcin.2021.07.043] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/22/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study was performed to investigate long-term, clinically important outcomes in patients who underwent permanent pacemaker implantation after transcatheter aortic valve replacement (TAVR). BACKGROUND The impact of permanent pacemaker implantation after TAVR is unknown, and prior studies have produced conflicting results. METHODS In this nationwide, population-based cohort study, the study included all patients who underwent transfemoral TAVR in Sweden from 2008 to 2018 from the SWEDEHEART (Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) register. Additional baseline characteristics and information about outcomes were obtained by individual crosslinking with other national health data registers. Unadjusted and multivariable-adjusted analyses were performed using Cox proportional hazards regression. RESULTS Of 3,420 patients, 481 (14.1%) underwent permanent pacemaker implantation within 30 days after TAVR. The survival rate at 1, 5, and 10 years was 90.0%, 52.7%, and 10.9% in the pacemaker group and 92.7%, 53.8%, and 15.3% in the nonpacemaker group, respectively (HR: 1.03; 95% CI: 0.88-1.22; P = 0.692). The median follow-up was 2.7 years (interquartile range: 2.5, and maximum 11.8 years). There was no difference in the risk of cardiovascular death (HR: 0.91; 95% CI: 0.71-1.18; P = 0.611), heart failure (HR: 1.23; 95% CI: 0.92-1.63; P = 0.157), or endocarditis (HR: 0.90; 95% CI: 0.47-1.69; P = 0.734) between the groups. CONCLUSIONS The study found no difference in long-term survival between patients who did and did not undergo permanent pacemaker implantation after TAVR. As the use of TAVR expands to include younger and low-risk patients with a long life expectancy, it will become increasingly important to understand the impact of permanent pacemaker implantation after TAVR.
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Affiliation(s)
- Andreas Rück
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Nawzad Saleh
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Natalie Glaser
- Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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Dalén M, Persson M, Glaser N, Sartipy U. Sex and permanent pacemaker implantation after surgical aortic valve replacement. Ann Thorac Surg 2021; 114:1621-1627. [PMID: 34648811 DOI: 10.1016/j.athoracsur.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 08/23/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND We performed a nationwide population-based cohort study to investigate sex differences in rate of permanent pacemaker implantation after surgical aortic valve replacement (AVR). METHODS This study included all adult patients who underwent primary AVR in Sweden between 2005 and 2018. Study data were obtained from the SWEDEHEART register and other Swedish national health-data registers. The rate of permanent pacemaker implantation within 30 days of surgery was compared between men and women. We estimated propensity scores that was used for inverse probability of treatment weighting to account for sex differences in patient characteristics. RESULTS A total of 18131 patients were included, 11657(64%) men and 6474(36%) women. The rate of permanent pacemaker implantation did not differ between women and men (3.8% (95% CI, 3.2%-4.3%) vs. 3.7% (95%CI, 3.3%-4.1%);p=0.831). In patients <60 years of age, the rate of permanent pacemaker implantation was significantly higher in women (6.2% (95%CI, 4.3%-8.0%) vs. 3.6% (95%CI, 2.8%-4.4%);p=0.006). The odds of pacemaker implantation in patients <60 years of age was significantly higher in women (odds ratio, 1.76; 95%CI, 1.17-2.63;p=0.006). In patients aged 60-79 years and ≥80 years, the rate of pacemaker implantation did not differ between men and women. CONCLUSIONS The rate of permanent pacemaker implantation after surgical AVR in patients <60 years of age was higher in women than men. The susceptibility to conduction disturbances requiring permanent pacemaker implantation in women below 60 years warrants further investigation and should be recognized as transcatheter aortic valve replacement expands into younger patients.
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Affiliation(s)
- Magnus Dalén
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
| | - Michael Persson
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Natalie Glaser
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden
| | - Ulrik Sartipy
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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20
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Nakashima M, Jilaihawi H. Conduction Disturbances and Pacing in Transcatheter Aortic Valve Replacement. Interv Cardiol Clin 2021; 10:455-463. [PMID: 34593109 DOI: 10.1016/j.iccl.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Conduction disturbances (CDs) after transcatheter artic replacement remain a clinical concern and relatively common complication. A recent meta-analysis showed both new-onset persistent left bundle branch block and new permanent pacemaker implantation were related to all-cause death with risk ratio 1.32 (95% confidence interval [CI] 1.17 to 1.49; P<.001) and 1.17 (95% CI 1.11-1.25; P<.001) at 1 year, respectively. Preprocedural computed tomography imaging can highlight potential risk factors for CDs, such as membranous septum length, device landing zone calcium, and the annulus size/degree of device oversizing.
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Affiliation(s)
- Makoto Nakashima
- Heart Valve Center, NYU Langone Health, 530 1st Avenue, Suite 9V, New York, NY 10016, USA
| | - Hasan Jilaihawi
- Heart Valve Center, NYU Langone Health, 530 1st Avenue, Suite 9V, New York, NY 10016, USA.
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21
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Cioffi GM, Gasperetti A, Tersalvi G, Schiavone M, Compagnucci P, Sozzi FB, Casella M, Guerra F, Dello Russo A, Forleo GB. Etiology and device therapy in complete atrioventricular block in pediatric and young adult population: Contemporary review and new perspectives. J Cardiovasc Electrophysiol 2021; 32:3082-3094. [PMID: 34570400 DOI: 10.1111/jce.15255] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 08/24/2021] [Accepted: 09/11/2021] [Indexed: 11/30/2022]
Abstract
Complete atrioventricular block (CAVB) is a total dissociation between the atrial and ventricular activity, in the absence of atrioventricular conduction. Several diseases may result in CAVB in the pediatric and young-adult population. Permanent right ventricular (RV) pacing is required in permanent CAVB, when the cause is neither transient nor reversible. Continuous RV apical pacing has been associated with unfavorable outcomes in several studies due to the associated ventricular dyssynchrony. This study aims to summarize the current literature regarding CAVB in the pediatric and young adult population and to explore future treatment perspectives.
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Affiliation(s)
- Giacomo M Cioffi
- Division of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Alessio Gasperetti
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy.,Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi", Marche Polytechnic University, Ancona, Italy.,Department of Cardiology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Gregorio Tersalvi
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.,Department of Internal Medicine, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - Marco Schiavone
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi", Marche Polytechnic University, Ancona, Italy
| | - Fabiola B Sozzi
- Department of Cardiology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, Department of Clinical, Special and Dental Sciences, University Hospital "Umberto I-Lancisi-Salesi", Marche Polytechnic University, Ancona, Italy
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi", Marche Polytechnic University, Ancona, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi", Marche Polytechnic University, Ancona, Italy
| | - Giovanni Battista Forleo
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
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22
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Aymond JD, Benn F, Williams CM, Bernard ML, Hiltbold AE, Khatib S, Polin GM, Rogers PA, Tafur Soto JD, Ramee SR, Parrino PE, Falterman JB, Al-Khatib SM, Morin DP. Epidemiology, evaluation, and management of conduction disturbances after transcatheter aortic valve replacement. Prog Cardiovasc Dis 2021; 66:37-45. [PMID: 34332660 DOI: 10.1016/j.pcad.2021.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aortic stenosis is the most common valvulopathy requiring replacement by means of the surgical or transcatheter approach. Transcatheter aortic valve replacement (TAVR) has quickly become a viable and often preferred treatment strategy compared to surgical aortic valve replacement. However, transcatheter heart valve system deployment not infrequently injures the specialized electrical system of the heart, leading to new conduction disorders including high-grade atrioventricular block and complete heart block (CHB) necessitating permanent pacemaker implantation (PPI), which may lead to deleterious effects on cardiac function and patient outcomes. Additional conduction disturbances (e.g., new-onset persistent left bundle branch block, PR/QRS prolongation, and transient CHB) currently lack clearly defined management algorithms leading to variable strategies among institutions. This article outlines the current understanding of the pathophysiology, patient and procedural risk factors, means for further risk stratification and monitoring of patients without a clear indication for PPI, our institutional approach, and future directions in the management and evaluation of post-TAVR conduction disturbances.
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Affiliation(s)
- Joshua D Aymond
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - Francis Benn
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - Cody M Williams
- Ochsner Medical Center, New Orleans, LA, United States of America
| | | | - A Elise Hiltbold
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - Sammy Khatib
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - Glenn M Polin
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - Paul A Rogers
- Ochsner Medical Center, New Orleans, LA, United States of America
| | | | - Stephen R Ramee
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - P Eugene Parrino
- Ochsner Medical Center, New Orleans, LA, United States of America
| | | | - Sana M Al-Khatib
- Ochsner Medical Center, New Orleans, LA, United States of America
| | - Daniel P Morin
- Ochsner Medical Center, New Orleans, LA, United States of America.
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23
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Marie B, David CH, Guimbretière G, Foucher Y, Buschiazzo A, Letocart V, Manigold T, Plessis J, Jaafar P, Morin H, Rozec B, Roussel JC, Sénage T. Carotid versus femoral access for transcatheter aortic valve replacement: comparable results in the current era. Eur J Cardiothorac Surg 2021; 60:874-879. [PMID: 33724380 DOI: 10.1093/ejcts/ezab109] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/16/2020] [Accepted: 12/29/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The carotid approach for transcatheter aortic valve replacement (TAVR) has been shown to be feasible and safe. The goal of this study was to compare the 30-day outcomes of trans-carotid (TC) and transfemoral (TF) TAVR. METHODS This retrospective study enrolled 500 consecutive patients treated by TC-TAVR (n = 100) or TF-TAVR (n = 400) with percutaneous closure between January 2018 and January 2020 at the Nantes University Hospital. The primary end-point was the occurrence of cardiovascular death and cerebrovascular events at 30 days. RESULTS The mean age was 79.9 ± 8.1 in the TC group and 81.3 ± 6.9 (P = 0.069) in the TF group. The TC group had more men (69% vs 50.5%; P = 0.001) and more patients with peripheral vascular disease (86% vs 14.8%; P < 0.0001). Cardiac characteristics were similar between the groups, and the EuroSCORE II was 3.8 ± 2.6% vs 4.6 ± 6.0%, respectively (P = 0.443). The 30-day mortality was 2% in the TC group versus 1% in the TF group (P = 0.345). TC-TAVR was not associated with an increased risk of stroke (2% vs 2.5%; P = 0.999) or major vascular complications (2% vs 4%; P = 0.548). More permanent pacemakers were implanted in the TF group (14.9% vs 5.6%; P = 0.015), and no moderate or severe aortic regurgitation was observed in the TC group (0 vs 3.3%; P = 0.08). TC-TAVR was not associated with an increased risk of mortality or stroke at 30 days (odds ratio 1.32; 95% confidence interval 0.42-4.21; P = 0.63) in the multivariable analysis. CONCLUSIONS No statistically significant differences between TC-TAVR and TF-TAVR were observed; therefore, TC-TAVR should be the first alternative in patients with anatomical contraindications to the femoral route.
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Affiliation(s)
- Basile Marie
- Department of Thoracic and Cardio-Vascular Surgery, Thorax Institute, Nantes Hospital University, Nantes, France
| | - Charles Henri David
- Department of Thoracic and Cardio-Vascular Surgery, Thorax Institute, Nantes Hospital University, Nantes, France
| | - Guillaume Guimbretière
- Department of Thoracic and Cardio-Vascular Surgery, Thorax Institute, Nantes Hospital University, Nantes, France
| | - Yohann Foucher
- INSERM UMR 1246 - SPHERE, Nantes University, Tours University, Nantes, France
| | - Antoine Buschiazzo
- Department of Thoracic and Cardio-Vascular Surgery, Thorax Institute, Nantes Hospital University, Nantes, France
| | - Vincent Letocart
- Department of Cardiology, Thorax Institute, Nantes Hospital University, Nantes, France
| | - Thibaut Manigold
- Department of Cardiology, Thorax Institute, Nantes Hospital University, Nantes, France
| | - Julien Plessis
- Department of Cardiology, Thorax Institute, Nantes Hospital University, Nantes, France
| | - Philippe Jaafar
- Department of Cardiology, Thorax Institute, Nantes Hospital University, Nantes, France
| | - Hélène Morin
- Department of Anesthesiology, Nantes Hospital University, Nantes, France
| | - Bertrand Rozec
- Department of Anesthesiology, Nantes Hospital University, Nantes, France
| | - Jean Christian Roussel
- Department of Thoracic and Cardio-Vascular Surgery, Thorax Institute, Nantes Hospital University, Nantes, France
| | - Thomas Sénage
- Department of Thoracic and Cardio-Vascular Surgery, Thorax Institute, Nantes Hospital University, Nantes, France.,INSERM UMR 1246 - SPHERE, Nantes University, Tours University, Nantes, France
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24
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Stankowski T, Mangner N, Linke A, Aboul-Hassan SS, Gąsior T, Muehle A, Herwig V, Harnath A, Salem M, Szłapka M, Grimmig O, Just S, Fritzsche D, Perek B. Cardiac conduction abnormalities in patients with degenerated bioprostheses undergoing transcatheter aortic valve-in-valve implantations and their impact on long-term outcomes. Int J Cardiol 2021; 330:16-22. [PMID: 33592238 DOI: 10.1016/j.ijcard.2021.02.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The relationship between preoperative cardiac conduction abnormalities (CCA) and long-term outcomes after transcatheter aortic valve-in-valve implantation (TAVI-VIV) remains unclear. The aim of the study was to evaluate the effects of preoperative CCA on mortality and morbidity after TAVI-VIV and to estimate the impact of new-onset CCA on postoperative outcomes. METHODS Between 2011 and 2020, 201 patients with degenerated aortic bioprostheses were qualified for TAVI-VIV procedures in two German heart centers. Cases with previously implanted permanent rhythm-controlling devices were excluded (n = 53). A total of 148 subjects met the eligibility criteria and were divided into 2 study groups according to the presence of preexisting CCA (CCA (n = 84) and non-CCA (n = 64), respectively). Early and late mortality and morbidity were evaluated. Follow-up functional status was assessed according to New York Heart Association (NYHA) classification. RESULTS There were no procedural deaths. TAVI-VIV related new-onset CCAs were observed in 35.8% patients. The 30-day permanent pacemaker implantation rate was 1.6% in non-CCA vs 9.5% in CCA group (p = 0.045). Preexisting right bundle-branch block (OR:5.01; 95%CI, 1.05-23.84) and first-degree atrioventricular block (OR:4.55; 95%CI, 1.10-18.73) were independent predictors of new pacemaker implantation. One-year and five-year probability of survival were comparable in CCA and non-CCA groups: 90.3% vs 91.8% and 68.2% vs 74.3%, respectively. Surviving patients with preexisting and new-onset CCA had a worse functional status according to NYHA classification at follow-up. CONCLUSION Preexisting and new-onset postoperative CCAs did not affect early and late mortality after TAVI-VIV procedures, however, they may have a negative impact on late functional status.
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Affiliation(s)
- Tomasz Stankowski
- Sana Heart Center Cottbus, Department of Cardiac Surgery, Cottbus, Germany.
| | - Norman Mangner
- Herzzentrum Dresden, Technische Universität Dresden, Department of Internal Medicine and Cardiology, Dresden, Germany
| | - Axel Linke
- Herzzentrum Dresden, Technische Universität Dresden, Department of Internal Medicine and Cardiology, Dresden, Germany
| | | | - Tomasz Gąsior
- Herzzentrum Dresden, Technische Universität Dresden, Department of Internal Medicine and Cardiology, Dresden, Germany
| | - Anja Muehle
- Sana Heart Center Cottbus, Department of Cardiac Surgery, Cottbus, Germany
| | - Volker Herwig
- Sana Heart Center Cottbus, Department of Cardiac Surgery, Cottbus, Germany
| | - Axel Harnath
- Sana Heart Center Cottbus, Department of Cardiac Surgery, Cottbus, Germany
| | - Mohammed Salem
- Department of Cardiology, Carl-Thiem-Klinikum, Cottbus, Germany
| | - Michał Szłapka
- Department of Cardiac Surgery, Asklepios Klinik Harburg, Hamburg, Germany
| | - Oliver Grimmig
- Sana Heart Center Cottbus, Department of Cardiac Surgery, Cottbus, Germany
| | - Soeren Just
- Sana Heart Center Cottbus, Department of Cardiac Surgery, Cottbus, Germany
| | - Dirk Fritzsche
- Sana Heart Center Cottbus, Department of Cardiac Surgery, Cottbus, Germany
| | - Bartłomiej Perek
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
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25
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Fischlein T, Folliguet T, Meuris B, Shrestha ML, Roselli EE, McGlothlin A, Kappert U, Pfeiffer S, Corbi P, Lorusso R. Sutureless versus conventional bioprostheses for aortic valve replacement in severe symptomatic aortic valve stenosis. J Thorac Cardiovasc Surg 2020; 161:920-932. [PMID: 33478837 DOI: 10.1016/j.jtcvs.2020.11.162] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Sutureless aortic valves are a novel option for aortic valve replacement. We sought to demonstrate noninferiority of sutureless versus standard bioprostheses in severe symptomatic aortic stenosis. METHODS The Perceval Sutureless Implant Versus Standard-Aortic Valve Replacement is a prospective, randomized, adaptive, open-label trial. Patients were randomized (March 2016 to September 2018) to aortic valve replacement with a sutureless or stented valve using conventional or minimally invasive approach. Primary outcome was freedom from major adverse cerebral and cardiovascular events (composite of all-cause death, myocardial infarction, stroke, or valve reintervention) at 1 year. RESULTS At 47 centers (12 countries), 910 patients were randomized to sutureless (n = 453) or conventional stented (n = 457) valves; mean ages were 75.4 ± 5.6 and 75.0 ± 6.1 years, and 50.1% and 44.9% were female, respectively. Mean ± standard deviation Society of Thoracic Surgeons scores were 2.4 ± 1.7 and 2.1 ± 1.3, and a ministernotomy approach was used in 50.4% and 47.3%, respectively. Concomitant procedures were performed with similar rates in both groups. Noninferiority was demonstrated for major adverse cerebral and cardiovascular events at 1 year, whereas aortic valve hemodynamics improved equally in both groups. Use of sutureless valves significantly reduced surgical times (mean extracorporeal circulation times: 71.0 ± 34.1 minutes vs 87.8 ± 33.9 minutes; mean crossclamp times: 48.5 ± 24.7 vs 65.2 ± 23.6; both P < .0001), but resulted in a higher rate of pacemaker implantation (11.1% vs 3.6% at 1 year). Incidences of perivalvular and central leak were similar. CONCLUSIONS Sutureless valves were noninferior to stented valves with respect to major adverse cerebral and cardiovascular events at 1 year in patients undergoing aortic valve replacement (alone or with coronary artery bypass grafting). This suggests that sutureless valves should be considered as part of a comprehensive valve program.
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Affiliation(s)
- Theodor Fischlein
- Klinikum Nürnberg, Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany.
| | - Thierry Folliguet
- Department of Cardiac Surgery, Hôpital Henri Mondor, Université Paris 12, Créteil, Paris, France
| | - Bart Meuris
- UZ Gasthuisberg Leuven, University Hospital, Leuven, Belgium
| | | | - Eric E Roselli
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Utz Kappert
- Herzzentrum Dresden GmbH Universitätsklinik, Dresden, Germany
| | - Steffen Pfeiffer
- Klinikum Nürnberg, Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany; Schön Klinik Vogtareuth, Vogtareuth, Germany
| | | | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart and Vascular Center, Maastricht University Medical Center (MUMC+), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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26
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Bruno F, D'Ascenzo F, Vaira MP, Elia E, Omedè P, Kodali S, Barbanti M, Rodès-Cabau J, Husser O, Sossalla S, Van Mieghem NM, Bax J, Hildick-Smith D, Munoz-Garcia A, Pollari F, Fischlein T, Budano C, Montefusco A, Gallone G, De Filippo O, Rinaldi M, la Torre M, Salizzoni S, Atzeni F, Pocar M, Conrotto F, De Ferrari GM. Predictors of pacemaker implantation after transcatheter aortic valve implantation according to kind of prosthesis and risk profile: a systematic review and contemporary meta-analysis. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 7:143-153. [PMID: 33289527 DOI: 10.1093/ehjqcco/qcaa089] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/14/2020] [Accepted: 11/19/2020] [Indexed: 12/12/2022]
Abstract
AIMS Permanent pacemaker implantation (PPI) may be required after transcatheter aortic valve implantation (TAVI). Evidence on PPI prediction has largely been gathered from high-risk patients receiving first-generation valve implants. We undertook a meta-analysis of the existing literature to examine the incidence and predictors of PPI after TAVI according to generation of valve, valve type, and surgical risk. METHODS AND RESULTS We made a systematic literature search for studies with ≥100 patients reporting the incidence and adjusted predictors of PPI after TAVI. Subgroup analyses examined these features according to generation of valve, specific valve type, and surgical risk. We obtained data from 43 studies, encompassing 29 113 patients. Permanent pacemaker implantation rates ranged from 6.7% to 39.2% in individual studies with a pooled incidence of 19% (95% CI 16-21). Independent predictors for PPI were age [odds ratio (OR) 1.05, 95% confidence interval (CI) 1.01-1.09], left bundle branch block (LBBB) (OR 1.45, 95% CI 1.12-1.77), right bundle branch block (RBBB) (OR 4.15, 95% CI 3.23-4.88), implantation depth (OR 1.18, 95% CI 1.11-1.26), and self-expanding valve prosthesis (OR 2.99, 95% CI 1.39-4.59). Among subgroups analysed according to valve type, valve generation and surgical risk, independent predictors were RBBB, self-expanding valve type, first-degree atrioventricular block, and implantation depth. CONCLUSIONS The principle independent predictors for PPI following TAVI are age, RBBB, LBBB, self-expanding valve type, and valve implantation depth. These characteristics should be taken into account in pre-procedural assessment to reduce PPI rates. PROSPERO ID CRD42020164043.
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Affiliation(s)
- Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Matteo Pio Vaira
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Edoardo Elia
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Pierluigi Omedè
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Susheel Kodali
- Department of Cardiology, Division of Cardiology, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Marco Barbanti
- Department of Cardiology, C.A.S.T. Policlinic G. Rodolico Hospital, University of Catania, Catania, Italy
| | - Josep Rodès-Cabau
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Oliver Husser
- Klinik für Innere Medizin I St.-Johannes-Hospital, Dortmund, Germany
| | - Samuel Sossalla
- Department for Internal Medicine II, Cardiology, Pneumology, Intensive Care, University Hospital Regensburg, Regensburg, Germany
| | - Nicolas M Van Mieghem
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jeroen Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
| | - David Hildick-Smith
- Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | | | - Francesco Pollari
- Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg - Paracelsus Medical University, Breslauer Str. 201, Nuremberg, Germany
| | - Theodor Fischlein
- Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg - Paracelsus Medical University, Breslauer Str. 201, Nuremberg, Germany
| | - Carlo Budano
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Antonio Montefusco
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Guglielmo Gallone
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Mauro Rinaldi
- Division of Cardiosurgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Michele la Torre
- Division of Cardiosurgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Stefano Salizzoni
- Division of Cardiosurgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Francesco Atzeni
- Division of Cardiosurgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Marco Pocar
- Division of Cardiosurgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Federico Conrotto
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
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von Aspern K, Bianchi E, Haunschild J, Dahlenburg C, Misfeld M, Borger MA, Etz CD. Propensity score matched comparison of isolated, elective aortic valve replacement with and without concomitant septal myectomy: is it worth it? THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 62:258-267. [PMID: 32885927 DOI: 10.23736/s0021-9509.20.11443-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Septal myectomy during open aortic valve replacement (AVR) is an effective surgical treatment for asymmetric secondary basal septal hypertrophy. Concerns regarding higher rates of complications associated with this procedure have been raised - such as permanent pacemaker implantation. The aim of this study was to compare outcomes and complications of patients with and without concomitant septal myectomy using propensity score matching applied to a large, consecutive single center cohort. METHODS A total of 2199 consecutive patients undergoing either AVR with concomitant myectomy (AVR-M, N.=212) or AVR alone (N.=1987) were analyzed (2009-2015). Patients with previous cardiac or emergency surgery, concomitant cardiac procedures and endocarditis were excluded. As reference to previously published data, patient characteristics and outcomes of the overall cohort were examined and for comparison between groups propensity score matching utilized. RESULTS In the unmatched cohort, AVR-M patients were older (71.2±8 vs. 67.6±10 years, P<0.001) and more often female (68% vs. 37%, P<0.001) in comparison to patients receiving only AVR. After matching (N.=374) no significant difference in baseline features was evident. No significant difference in hospital mortality (2.1% vs. 1.6%, P=1.000) and pacemaker-implantation rate (5.3% vs. 3.7%, P=0.621) was observed. Mid-term survival was comparable between the two groups (86.1±5% vs. 84.4±5% after 6 years, P=0.957). The overall patient cohort showed a survival comparable to that of an adjusted regional normal population (P=0.178). CONCLUSIONS This study demonstrates that concomitant myectomy in patients undergoing AVR is a safe surgical technique resulting in comparable hospital mortality and mid-term survival. Concomitant septal myectomy seems not to be associated with an increased pacemaker implantation rate.
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Affiliation(s)
| | - Edoardo Bianchi
- Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | | | | | - Martin Misfeld
- Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany.,Department of Cardiothoracic Surgery, The Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael A Borger
- Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Christian D Etz
- Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany -
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Biancari F, Pykäri J, Savontaus M, Laine M, Husso A, Virtanen M, Maaranen P, Niemelä M, Mäkikallio T, Tauriainen T, Eskola M, Raivio P, Valtola A, Juvonen T, Airaksinen J. Early and late pace-maker implantation after transcatheter and surgical aortic valve replacement. Catheter Cardiovasc Interv 2020; 97:E560-E568. [PMID: 32767643 DOI: 10.1002/ccd.29177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/06/2020] [Accepted: 07/19/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Conduction defects requiring permanent pacemaker (PPM) implantation are frequent complications occurring after surgical (SAVR) and transcatheter aortic valve replacement (TAVR). METHODS Patients who underwent TAVR or SAVR with a bioprosthesis from the nationwide FinnValve registry were the subjects of this study. Patients with prior PPM, who received a sutureless prosthesis, or required cardiac resynchronization therapy or implantable cardioverter defibrillator were excluded from this analysis. RESULTS Four thousand and ten patients underwent SAVR and 1,897 underwent TAVR. TAVR had an increased risk of PPM implantation at 30-day (10.1% vs. 3.5%, unadjusted OR 3.11, 95%CI 2.56-3.87) and 5-year (15.7% vs. 8.6%, unadjusted SHR, 2.12, 95%CI 1.81-2.48) compared to SAVR. PPM implantation within 30 days from the index procedure did not increase the risk of 5-year mortality after either SAVR or TAVR. Among 1,042 propensity score matched pairs, TAVR had an increased risk of PPM implantation at 30-day (9.9% vs. 4.7%, p < .0001) and 5-year (14.7% vs. 11.4%, p = .001), but late (>30 days) PPM implantation at 5-year (4.7% vs. 6.9% SHR 0.72, 95%CI 0.47-1.10) was comparable to SAVR. The types of prosthesis had an impact on 30-day PPM implantation after TAVR, but not on late (>30 days) PPM implantation. CONCLUSIONS Although the risk of 30-day PPM implantation is higher after TAVR compared to SAVR, late (>30 days) PPM implantation was comparable with these treatment methods. PPM implantation within 30 days did not affect late survival.
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Affiliation(s)
- Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.,Heart Center, Turku University Hospital, and University of Turku, Turku, Finland.,Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, Oulu, Finland
| | - Jouni Pykäri
- Heart Center, Turku University Hospital, and University of Turku, Turku, Finland
| | - Mikko Savontaus
- Heart Center, Turku University Hospital, and University of Turku, Turku, Finland
| | - Mika Laine
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | | | - Marko Virtanen
- Heart Hospital, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Pasi Maaranen
- Heart Hospital, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Matti Niemelä
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Timo Mäkikallio
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Tuomas Tauriainen
- Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, Oulu, Finland
| | - Markku Eskola
- Heart Hospital, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Peter Raivio
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Antti Valtola
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Tatu Juvonen
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.,Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, Oulu, Finland
| | - Juhani Airaksinen
- Heart Center, Turku University Hospital, and University of Turku, Turku, Finland
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Amirjamshidi H, Vidovich C, Knight PA. Routine Placement of Temporary Epicardial Pacing Leads Is Not Required After Minimally Invasive Aortic Valve Replacement. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:355-360. [PMID: 32703047 DOI: 10.1177/1556984520938027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Our objective is to identify the incidence of urgent transvenous (TV) pacing wire placement following minimally invasive aortic valve replacement (mini-AVR). METHODS This is a single-center, retrospective, observational study including 359 individuals who underwent isolated mini-AVR through right anterior mini-thoracotomy between January 2015 and September 2019. Patients were grouped according to avoidance or insertion of epicardial pacing wires, and further subdivided based on the requirement for postoperative emergent temporary TV pacing or permanent pacemaker (PPM) placement during the index admission. RESULTS Two hundred forty-two (67.4%) had acceptable rate and no high-degree atrioventricular (AV) block prior to chest closure and did not have insertion of epicardial pacing wires. Of those patients, only 3 (1.2%) required emergent TV pacing and 6 (2.5%) required nonemergent TV pacing with or without PPM placement during the index admission. Sixty-two (17.3%) patients received only atrial epicardial pacing leads secondary to sinus bradycardia or junctional rhythm and 3 (4.8%) of those patients required PPM placement due to sick sinus syndrome and 1 (1.6%) patient required nonemergent TV pacing and PPM due to high-grade AV heart block. Fifty-five (15.3%) patients received ventricular leads due to high-grade AV heart block and 7 (12.7%) of those patients required PPM placement during the index admission. CONCLUSIONS Temporary epicardial lead insertion is not routinely required in mini-AVR in patients with normal rate and acceptable AV conduction prior to chest closure. In the absence of epicardial ventricular lead insertion, the chance of requiring urgent TV pacing wire placement during the index admission is 0.99%.
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Affiliation(s)
- Hossein Amirjamshidi
- 6923 Division of Cardiac Surgery, University of Rochester Medical Center, NY, USA
| | - Courtney Vidovich
- 6923 Division of Cardiac Surgery, University of Rochester Medical Center, NY, USA
| | - Peter A Knight
- 6923 Division of Cardiac Surgery, University of Rochester Medical Center, NY, USA
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30
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Guo J, Li L, Xiao G, Huang X, Li Q, Wang Y, Cai B. Feasibility and stability of left bundle branch pacing in patients after prosthetic valve implantation. Clin Cardiol 2020; 43:1110-1118. [PMID: 32609400 PMCID: PMC7533988 DOI: 10.1002/clc.23413] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/07/2020] [Accepted: 06/10/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Left bundle branch pacing (LBBP) has emerged as a promising pacing modality for preventing pacing induced cardiomyopathy in patients complicated with conduction abnormalities (CAs) after prosthetic valve (PV) implantation. OBJECTIVE The present study aimed to evaluate the safety and feasibility of LBBP in this patient population. METHODS LBBP was attempted in 20 patients complicated with atrioventricular block after PV implantation. Surface, intracardiac electrical measurements, and echocardiographic data were documented. Lead parameters and complications were routinely tracked at implantation and each follow-up visit. RESULTS LBBP was successful in 90% (18/20) participants. The paced QRS duration and the stimulus to left ventricular activation time were 106.8 ± 6.8 ms and 65.5 ± 5.4 ms, respectively. Left bundle branch (LBB) potential was recorded in 61.1% (11/18) patients who succeeded in LBBP. During the procedure, the mean unipolar myocardium capture threshold was 0.51 ± 0.15 V@0.4 ms while the unipolar bundle capture threshold was 0.84 ± 0.51 V@0.4 ms. The mean fluoroscopic exposure time and the radiation dose were 13.0 ± 9.2 min and 81.7 ± 8.3 mGy, respectively. The average follow-up period was 10.4 ± 5.9 months (range 3-23 months). Pacing parameters remained stable and no significant lead-related complications occurred during the whole observation period. CONCLUSIONS LBBP was safe and feasible in patients with PVs. Acceptable and stable pacing parameters could be expected during the procedure and the follow-ups.
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Affiliation(s)
- Jincun Guo
- Division of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Linlin Li
- Division of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Guosheng Xiao
- Division of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Xinyi Huang
- Division of Echocardiography, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Qiang Li
- Division of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Yan Wang
- Division of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Binni Cai
- Division of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
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31
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Haunschild J, Misfeld M, Schroeter T, Lindemann F, Davierwala P, von Aspern K, Spampinato RA, Weiss S, Borger MA, Etz CD. Prevalence of permanent pacemaker implantation after conventional aortic valve replacement—a propensity-matched analysis in patients with a bicuspid or tricuspid aortic valve: a benchmark for transcatheter aortic valve replacement. Eur J Cardiothorac Surg 2020; 58:130-137. [DOI: 10.1093/ejcts/ezaa053] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 01/24/2020] [Accepted: 01/29/2020] [Indexed: 12/13/2022] Open
Abstract
Abstract
OBJECTIVES
Elective treatment of aortic valve disease by transcatheter aortic valve replacement (TAVR) is becoming increasingly popular, even in patients with low risk and intermediate risk. Even patients with a bicuspid aortic valve (BAV) are increasingly considered eligible for TAVR. Permanent pacemaker implantation (PMI) is a known—frequently understated—complication of TAVR affecting 9–15% of TAVR patients with a potentially significant impact on longevity and quality of life. BAV patients are affected by the highest PMI rates, although they are frequently younger compared to their tricuspid peers. The aim of the study is to report benchmark data—from a high-volume centre (with a competitive TAVR programme) on PMI after isolated surgical aortic valve replacement (SAVR) in patients with BAV and tricuspid aortic valve (TAV).
METHODS
We performed a retrospective single-centre analysis on 4154 patients receiving isolated SAVRs (w/o concomitant procedures), between 2000 and 2019, of whom 1108 had BAV (27%). PMI rate and early- and long-term outcomes were analysed. For better comparability of these demographically unequal cohorts, 1:1 nearest neighbour matching was performed.
RESULTS
At the time of SAVR, BAV patients were on average 10 years younger than their TAV peers (59.7 ± 12 vs 69.3 ± 9; P < 0.001) and had less comorbidities; all relevant characteristics were equally balanced after statistical matching. Overall PMI rate was significantly higher in BAV patients (5.4% vs 3.8%; P = 0.03). BAV required PMI exclusively (100%) and TAV required predominately (96%) for persistent postoperative high-degree atrioventricular block. After matching, the PMI rate was similar (5.1% vs 4.4%, P = 0.5). In-hospital mortality in the matched cohort was 1% in both groups. Long-term survival was more favourable in BAV patients (94% vs 90% in TAV at 5 years; 89% vs 82% in TAV at 9 years; P = 0.013).
CONCLUSIONS
With SAVR, the overall incidence of PMI among BAV patients seems significantly higher; however, after propensity matching, no difference in PMI rates between BAV and TAV is evident. The PMI rate was remarkably lower among BAV patients after SAVR compared to the reported incidence after TAVR.
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Affiliation(s)
- Josephina Haunschild
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Martin Misfeld
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Thomas Schroeter
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Frank Lindemann
- Department of Electrophysiology, Leipzig Heart Center, Leipzig, Germany
| | - Piroze Davierwala
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | | | - Ricardo A Spampinato
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Stefan Weiss
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Michael A Borger
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Christian D Etz
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
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32
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Yazdchi F, Hirji S, Kaneko T. Quality Control for Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement. Ann Thorac Surg 2019; 110:347-348. [PMID: 31846637 DOI: 10.1016/j.athoracsur.2019.10.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 10/15/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Farhang Yazdchi
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, 15 Francis St, Boston, MA 02115
| | - Sameer Hirji
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, 15 Francis St, Boston, MA 02115
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, 15 Francis St, Boston, MA 02115.
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33
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Viktorsson SA, Orrason AW, Vidisson KO, Gunnarsdottir AG, Johnsen A, Helgason D, Arnar DO, Geirsson A, Gudbjartsson T. Immediate and long-term need for permanent cardiac pacing following aortic valve replacement. SCAND CARDIOVASC J 2019; 54:186-191. [PMID: 31809597 DOI: 10.1080/14017431.2019.1698761] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction: Atrioventricular (AV) node conduction disturbances are common following surgical aortic valve replacement (SAVR), and in some cases the patient needs a permanent pacemaker (PPM) implantation before discharge from hospital. Little is known about the long-term need for PPM and the PPM dependency of these individuals. We determined the incidence of PPM implantation before and after discharge in SAVR patients. Methods: We studied 557 consecutive patients who underwent SAVR for aortic stenosis in Iceland between 2002 and 2016. Timing and indication for PPM were registered, with a new concept, ventricular pacing proportion (VPP), defined as ventricular pacing ≥90% of the time, being used to approximate pacemaker dependency. The median follow-up time was 73 months. We plotted the cumulative incidence of pacemaker implantation, treating death as a competing risk. Results: Of the 557 patients, 22 (3.9%) received PPM in the first 30 days after surgery, most commonly for complete AV block (n = 14) or symptomatic bradycardia (n = 8); Thirty-eight other patients (6.8%) had a PPM implanted >30 days postoperatively, at a median of 43 months after surgery (range 0‒181), most often for AV block (n = 13) or sick-sinus syndrome (n = 10). The cumulative incidence of PPM implantation at 1, 5, and 10 years postoperatively was 5.0%, 9.2%, and 12.3%, respectively. During follow-up, 45.0% of the 60 patients had VPP ≥90%. Conclusion: The cumulative incidence of permanent pacemaker implantation following SAVR was about 12% at 10 years, with every other patient having VPP ≥90% during follow-up. This suggests that AV node conduction disturbances extend significantly beyond the perioperative period.
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Affiliation(s)
- Sindri A Viktorsson
- Division of Cardiothoracic Surgery, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - Andri W Orrason
- Division of Cardiothoracic Surgery, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - Kristjan O Vidisson
- Division of Cardiothoracic Surgery, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - Anna G Gunnarsdottir
- Division of Cardiothoracic Surgery, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - Arni Johnsen
- Division of Cardiothoracic Surgery, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - Dadi Helgason
- Internal Medicine Services, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - David O Arnar
- Division of Cardiology, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Tomas Gudbjartsson
- Division of Cardiothoracic Surgery, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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Avoiding Pacemakers and Parallax. J Am Coll Cardiol 2019; 74:2621-2622. [PMID: 31753205 DOI: 10.1016/j.jacc.2019.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/16/2019] [Indexed: 11/23/2022]
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35
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Pollari F, Fischlein T, Pfeiffer S. Need for Pacemaker After Aortic Valve Replacement: Is Removal of Calcifications the Key? Ann Thorac Surg 2019; 109:619. [PMID: 31356794 DOI: 10.1016/j.athoracsur.2019.05.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 05/26/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Francesco Pollari
- Department of Cardiac Surgery, Cardiovascular Center, Nürnberg Clinic, Paracelsus Medical University, Breslauer Str 201, 90471 Nuremberg, Germany.
| | - Theodor Fischlein
- Department of Cardiac Surgery, Cardiovascular Center, Nürnberg Clinic, Paracelsus Medical University, Breslauer Str 201, 90471 Nuremberg, Germany
| | - Steffen Pfeiffer
- Department of Cardiac Surgery, Cardiovascular Center, Nürnberg Clinic, Paracelsus Medical University, Breslauer Str 201, 90471 Nuremberg, Germany
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