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Brown C, Ryan MP, Chikermane SG, Kelley MA, Walker TM, Stinis CT. Incremental costs of new permanent pacemaker implantation (PPMI) after transcatheter aortic valve replacement (TAVR). CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 65:101-103. [PMID: 38429171 DOI: 10.1016/j.carrev.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/19/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024]
Affiliation(s)
| | - Michael P Ryan
- MPR Consulting, Cincinnati, OH, United States of America
| | | | | | - Tara M Walker
- Edwards Lifesciences, Irvine, CA, United States of America
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Khedr MA, Ali EA, Sanhoury MI, Hussein RM. The feasibility of motivational interviewing on adherence to care practices, emotional intelligence, and dispositional optimism among patients with permanent pacemakers. Eur J Cardiovasc Nurs 2024; 23:497-509. [PMID: 38165278 DOI: 10.1093/eurjcn/zvad113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 01/03/2024]
Abstract
AIMS Motivational interviewing (MI) has been recognized as highly effective for treating chronic diseases and various conditions, with encouraging results demonstrating its effectiveness in promoting health behaviour change. The current study was proposed to evaluate the feasibility of MI on adherence to care practices, emotional intelligence (EI), and dispositional optimism among patients with permanent pacemakers. METHODS AND RESULTS This study was a parallel arm randomized controlled trial. Seventy clients with permanent pacemakers were randomly allocated to a six-session MI intervention (n = 35) or a waiting list control group (n = 35). A statistically significant improvement in the mean scores of adherence to care practices, EI, and dispositional optimism, along with a significant reduction in pessimism, was registered among the study group compared with the control group. CONCLUSION Following the intervention for 1- and 2-month follow-up measurements, there were statistically significant improvements in self-care practice adherence. After 1 month of intervention, there were statistically significant gains in EI and dispositional optimism, but at the 2-month follow-up measurement, this improvement had somewhat lessened. The findings suggest that MI may be a feasible and practical approach for improving adherence to care practices, EI, and dispositional optimism in patients with permanent pacemakers. REGISTRATION ClinicalTrials.gov: NCT05883514.
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Affiliation(s)
- Mahmoud Abdelwahab Khedr
- Department of Psychiatric and Mental Health Nursing, Faculty of Nursing, Alexandria University, Smoha district, 21648, Alexandria, Egypt
- Department of Nursing, College of Applied Medical Sciences, Hafr Al Batin University, Hafr Al Batin, 39921, Saudi Arabia
| | - Eman Abdeen Ali
- Department of Medical-Surgical Nursing, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | | | - Rasha Mohamed Hussein
- Department of Psychiatric and Mental Health Nursing, Faculty of Nursing, Zagazig University, Zagazig, Egypt
- Department of Community, Psychiatric and Mental Health Nursing, College of Nursing, Qassim University, Buraidah, Saudi Arabia
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Batta A, Hatwal J. Risk of permanent pacemaker implantation following transcatheter aortic valve replacement: Which factors are most relevant? World J Cardiol 2024; 16:49-53. [PMID: 38456072 PMCID: PMC10915891 DOI: 10.4330/wjc.v16.i2.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/30/2023] [Accepted: 01/11/2024] [Indexed: 02/21/2024] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as a formidable treatment option for severe symptomatic aortic stenosis ahead of surgical aortic valve replacement. The encouraging results from large randomized controlled trials has resulted in an exponential rise in the use of TAVR even in the low-risk patients. However, this is not without challenges. Need for permanent pacemaker (PPM) post-TAVR remains the most frequent and clinically relevant challenge. Naturally, identifying risk factors which predispose an individual to develop high grade conduction block post-TAVR is important. Various demographic factors, electrocardiographic features, anatomic factors and procedural characteristics have all been linked to the development of advanced conduction block and need for PPM following TAVR. Amongst these electrophysiological variables, most notably a prolonged QRS > 120 ms regardless of the type of conduction block seems to be one of the strongest predictors on logistic regression models. The index study by Nwaedozie et al highlights that patients requiring PPM post-TAVR had higher odds of having a baseline QRS > 120 ms and were more likely to be having diabetes mellitus that those who did not require PPM.
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Affiliation(s)
- Akash Batta
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India.
| | - Juniali Hatwal
- Department of Internal Medicine, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
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Medranda GA, Rogers T, Case BC, Zhang C, Cellamare M, Shea C, Rappaport H, Cohen JE, Shults CC, Ben-Dor I, Satler LF, Waksman R. The impact of cusp overlap on permanent pacemaker requirement following self-expanding transcatheter aortic valve replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 59:9-13. [PMID: 37550124 DOI: 10.1016/j.carrev.2023.07.018] [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: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND/PURPOSE The cusp overlap technique has standardized implantation for self-expanding valves with the goal of achieving more consistent implantation depths and lowering permanent pacemaker (PPM) implantation rates. We retrospectively compared short-term outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) with a self-expanding valve implanted using the cusp overlap technique vs. the traditional coplanar technique in a large tertiary referral center. METHODS We conducted a retrospective study among PPM-naïve patients who underwent TAVR using the CoreValve Evolut PRO/PRO+. We compared in-hospital PPM rates in patients who underwent TAVR using the cusp overlap technique vs. the coplanar technique. Additional outcomes included in-hospital all-cause mortality, stroke, major vascular complications, annular rupture, and >mild paravalvular leak. Furthermore, we compared outcomes over time to see whether there was evidence of a learning curve. RESULTS Of the 528 patients included, 270 underwent TAVR using the coplanar technique and 258 underwent TAVR using the cusp overlap technique. The rate of new PPM implantation did not differ between cohorts (17.0 % vs. 16.7 %; p = 0.910). Additionally, rates of in-hospital all-cause mortality (0.0 % vs. 0.4 %; p = 0.328), stroke (3.7 % vs. 1.6 %; p = 0.124), major vascular complications (0.7 % vs. 1.2 %; p = 0.617), annular rupture (0.4 % vs. 0.0 %; p = 0.328) and >mild paravalvular leak (0.0 % vs. 0.4 %; p = 0.444) were similar. Our secondary analysis did not identify any evidence of a learning curve. CONCLUSIONS The cusp overlap technique may not yield a reduction in PPM rates when compared with the coplanar technique. Other confounders should be explored to further minimize in-hospital PPM rates.
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Affiliation(s)
- Giorgio A Medranda
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Cheng Zhang
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Matteo Cellamare
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Corey Shea
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Hank Rappaport
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Jeffrey E Cohen
- Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Christian C Shults
- Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
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Ullah W, Suleiman ARM, Osman H, Bodempudi S, Muhammadzai HZU, Zahid S, Zghouzi M, Sattar Y, Virani SS, Fischman DL, Alraies MC. Trends and Outcomes of Transcatheter Aortic Valve Implantation in Aortic Insufficiency: A Nationwide Readmission Database Analysis. Curr Probl Cardiol 2024; 49:102012. [PMID: 37549814 DOI: 10.1016/j.cpcardiol.2023.102012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 08/09/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) has increasingly been utilized in patients with aortic insufficiency (AI) with insufficient data on its safety. The Nationwide Readmissions Database (NRD) was queried to identify patients undergoing TAVI for AI. Net clinical events (composite of in-hospital mortality, stroke, major bleeding) and procedural complications were assessed using a propensity-score matched (PSM) analysis to calculate adjusted odds ratios (OR). A total of 185,703 (AI 3873, aortic stenosis [AS] 181,830) patients were included in the analysis. Due to a significant difference in the baseline characteristics, a matched sample of 7929 patients (AI 3873, AS 4056) was selected. At index admission, the adjusted odds of in-hospital NACE (aOR 2.0, 95% CI 1.59-2.51), mortality (aOR 3.06, 95% CI 2.38-5.47), major bleeding (aOR 1.53, 95% CI 1.13-2.06) and valvular complications (aOR 9.48, 95% CI 6.73-13.38) were significantly higher in patients undergoing TAVI for AI compared with those undergoing TAVI for AS. However, there was no significant difference in the incidence of NACE, mortality, stroke, major bleeding, and need for permanent pacemaker implantation at 30- and 180-days follow-up. TAVI in AI was associated with a higher risk of periprocedural NACE, mortality, and major bleeding. The risk of these complications attenuated at 30- and 180-day readmission.
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Affiliation(s)
- Waqas Ullah
- Thomas Jefferson University Hospital, Philadelphia, PA.
| | - Abdul-Rahman M Suleiman
- University of Tennessee Health Sceince Center, Nashville, TN and Ascenstion St. Thomas Hospital, Nashville, TN
| | - Heba Osman
- Wayne State University/Detroit Medical Center, Detroit, MI
| | | | | | - Salman Zahid
- Oregan Health and Science University, Portland, OR
| | - Mohamed Zghouzi
- University of Tennessee Health Sceince Center, Nashville, TN and Ascenstion St. Thomas Hospital, Nashville, TN
| | | | | | | | - M Chadi Alraies
- University of Tennessee Health Sceince Center, Nashville, TN and Ascenstion St. Thomas Hospital, Nashville, TN
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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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Sousonis V, Menè R, Jacob S, Zeriouh S, van Rothem J, Marijon E, Combes S, Boveda S. Temporal Trends in Pacemaker Implantations Over the Past Decade in France: Impact of Transcatheter Aortic Valve Implantations. Am J Cardiol 2023; 203:403-405. [PMID: 37523936 DOI: 10.1016/j.amjcard.2023.07.075] [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: 06/13/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 08/02/2023]
Abstract
In this study, we assessed the temporal trends of permanent pacemaker implantations in France from 2008 to 2018 using data from the Échantillon Généraliste de Bénéficiaires (EGB) administrative database, a representative sample of the French population. Additionally, we evaluated the impact of transcatheter aortic valve implantations on the overall pacemaker implantation rate. Our data suggest that the incidence of permanent pacemaker implantations in France increased significantly only in patients ≥80 years old, with post-transcatheter aortic valve implantations accounting for at least 2/3 of this increase.
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Affiliation(s)
| | - Roberto Menè
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France; Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Sophie Jacob
- Institute for Radiological Protection and Nuclear Safety (IRSN), PSE-SANTE, Laboratory of Epidemiology, Fontenay-aux-Roses, France
| | - Sarah Zeriouh
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
| | | | - Eloi Marijon
- Paris Cardiovascular Research Center, INSERM U970, Paris, France; Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | - Stéphane Combes
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France; Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-VUB, Brussels, Belgium.
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Rivera FB, Cha SW, Aparece JP, Gonzales JST, Salva WFC, Bantayan NRB, Carado GP, Sharma V, Al-Abcha A, Co ML, Collado FMS, Volgman AS. Sex differences in permanent pacemaker implantation after transcatheter aortic valve replacement: a systematic review and meta-analysis. Expert Rev Cardiovasc Ther 2023; 21:631-641. [PMID: 37608465 DOI: 10.1080/14779072.2023.2250719] [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: 06/21/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND There is limited evidence on the effect of sex on permanent pacemaker implantation (PPMI) after transcatheter aortic valve replacement (TAVR). The primary objective of this meta-analysis was to determine the role of sex among patients requiring PPMI post-TAVR. METHODS A literature search was conducted using the SCOPUS, MEDLINE, and CINAHL databases for studies published until October 2022. Eligible studies included published randomized controlled trials (RCTs) and Observational Cohort Studies (OCS) articles that reported PPMI as an outcome of pacemaker status following TAVR. This study was performed per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. Publication bias was estimated using a Funnel plot and Egger's test. Data were pooled using a random-effects model. The primary endpoint was the sex difference in PPMI after TAVR, with odds ratios and 95% confidence intervals (CIs) extracted. RESULTS Data was obtained from 63 studies, and a total of 79,655 patients were included. The cumulative PPMI rate was 15.5% (95% CI, 13.6%-17.7%). The pooled analysis revealed that while there were more females than males undergoing TAVR (51.6%, 95% CI 50.4%-52.8%), males have a 14.5% higher risk for post-TAVR PPMI than females (OR 1.145, 95% CI 1.047-1.253, P < 0.01). CONCLUSIONS Males are more likely to experience PPMI after TAVR than females. Further research needs to be done to better explain these observed differences in outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | - Vikram Sharma
- Department of Cardiology, University of Iowa Hospitals and Clinics, Lowa City, IA, USA
| | - Abdullah Al-Abcha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael Lawrenz Co
- Section of Clinical Cardiac Electrophysiology, Thomas Jefferson University, Philadelphia, PA, USA
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Invasive electrophysiological testing to predict and guide permanent pacemaker implantation after transcatheter aortic valve implantation: A meta-analysis. Heart Rhythm O2 2022; 4:24-33. [PMID: 36713040 PMCID: PMC9877393 DOI: 10.1016/j.hroo.2022.10.007] [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] [Indexed: 11/06/2022] Open
Abstract
Background Atrioventricular conduction abnormalities after transcatheter aortic valve implantation (TAVI) are common. The value of electrophysiological study (EPS) for risk stratification of high-grade atrioventricular block (HG-AVB) and guidance of permanent pacemaker (PPM) implantation is poorly defined. Objective The purpose of this study was to identify EPS parameters associated with HG-AVB and determine the value of EPS-guided PPM implantation after TAVI. Methods We performed a systematic review and meta-analysis of studies investigating the value of EPS parameters for risk stratification of TAVI-related HG-AVB and for guidance of PPM implantation among patients with equivocal PPM indications after TAVI. Results Eighteen studies (1230 patients) were eligible. In 7 studies, EPS was performed only after TAVI, whereas in 11 studies EPS was performed both before and after TAVI. Overall PPM implantation rate for HG-AVB was 16%. AV conduction intervals prolonged after TAVI, with the AH and HV intervals showing the largest magnitude of changes. Pre-TAVI HV >70 ms and the absolute value of the post-TAVI HV interval were associated with subsequent HG-AVB and PPM implantation with odds ratios of 2.53 (95% confidence interval [CI] 1.11-5.81; P = .04) and 1.10 (95% CI 1.03-1.17; P = .02; per 1-ms increase), respectively. In 10 studies, PPM was also implanted due to abnormal EPS findings in patients with equivocal PPM indications post-TAVI (typically new left bundle branch block or transient HG-AVB). Among them, the rate of long-term PPM dependency was 57%. Conclusion Selective EPS testing may assist in the risk stratification of post-TAVI HG-AVB and in the guidance of PPM implantation, especially in patients with equivocal PPM indications post-TAVI.
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Kawsara A, Berzingi C, Alkhouli M. Rates of Late Permanent Pacemaker Implantation After Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement. Am J Cardiol 2022; 182:104-105. [PMID: 36075758 DOI: 10.1016/j.amjcard.2022.08.008] [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: 07/08/2022] [Revised: 07/19/2022] [Accepted: 08/05/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Akram Kawsara
- Division of Cardiology, Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - Chalak Berzingi
- Division of Cardiology, Department of Medicine, Carilion Clinic, Roanoke, Virginia
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota
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Zahid S, Khan MZ, Ullah W, Tanveer Ud Din M, Abbas S, Ubaid A, Khan MU, Rai D, Baibhav B, Rao M, Singla A, Goldsweig AM, Depta JP, Balla S. In-hospital outcomes of TAVR patients with a bundle branch block: Insights from the National Inpatient Sample 2011-2018. Catheter Cardiovasc Interv 2022; 100:424-436. [PMID: 35842779 DOI: 10.1002/ccd.30341] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/18/2022] [Accepted: 07/05/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Data on the outcomes following transcatheter aortic valve replacement (TAVR) in patients with a bundle branch block (BBB) remains limited. METHODS We studied the outcomes of TAVR patients with a BBB from the National Inpatient Sample (NIS) database between 2011 and 2018 using ICD-9-CM and ICD-10-CM codes. RESULTS Between 2011 and 2018, 194,237 patients underwent TAVR, where 1.7% (n = 3,232) had a right BBB (RBBB) and 13.7% (n = 26,689) had a left BBB (LBBB). Patients with a RBBB and LBBB had a higher rate of new permanent pacemaker (PPM) implantation (31.5% - RBBB, 15.7% LBBB vs. 10.2% - no BBB). RBBB was associated with a significantly longer median length of stay (5 days) and total hospitalization cost ($53,669) compared with LBBB (3 days and $47,552) and no BBB (3 days and $47,171). Trend analysis revealed lower rates of PPM implantation and reduced lengths of stay and costs across all comparison groups. CONCLUSION In conclusion, patients undergoing TAVR with a BBB are associated with higher new rates of PPM implantation. RBBB is the strongest independent predictor for new PPM implantation following TAVR. Rates of new PPM implantation in TAVR patients with and without a BBB have improved over time including reductions in length of stay and hospital costs. Further study is needed to reduce the risks of PPM implantation in TAVR patients.
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Affiliation(s)
- Salman Zahid
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York, USA
| | - Muhammad Z Khan
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA
| | - Waqas Ullah
- Department of Cardiovascular Medicine, Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Mian Tanveer Ud Din
- Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Sakina Abbas
- Department of Medicine, Dow Medical College, Karachi, Pakistan
| | - Aamer Ubaid
- Department of Medicine, University of Missouri-Kansas City, Kansas city, Missouri, USA
| | - Muhammad U Khan
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA
| | - Devesh Rai
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York, USA
| | - Bipul Baibhav
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York, USA
| | - Mohan Rao
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York, USA
| | - Atul Singla
- Division of Cardiology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Andrew M Goldsweig
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jeremiah P Depta
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York, USA
| | - Sudarshan Balla
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA
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Isogai T, Shekhar S, Saad AM, Abdelfattah OM, Tarakji KG, Wazni OM, Kalra A, Yun JJ, Krishnaswamy A, Reed GW, Kapadia SR, Puri R. Conduction Disturbance, Pacemaker Rates, and Hospital Length of Stay Following Transcatheter Aortic Valve Implantation with the Sapien 3 Valve. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100019. [PMID: 37274547 PMCID: PMC10236805 DOI: 10.1016/j.shj.2022.100019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/03/2022] [Accepted: 01/14/2022] [Indexed: 06/06/2023]
Abstract
Background In the absence of randomized data, an expert panel recently proposed an algorithm for conduction disturbance management in transcatheter aortic valve implantation (TAVI) recipients. However, external validations of its recommendations are limited. Methods We retrospectively identified 808 patients without a pre-existing pacing device who underwent transfemoral TAVI with the Sapien 3 valve at our institution in 2018-2019. Patients were grouped based on pre-existing conduction disturbance and immediate post-TAVI electrocardiogram. Timing of temporary pacemaker (TPM) removal and hospital discharge were compared with those of the expert panel recommendations to evaluate the associated risk of TPM reinsertion and permanent pacemaker (PPM) implantation. Results In most group 1 patients (no electrocardiogram changes without pre-existing right bundle branch block), the timing of TPM removal and discharge were concordant with those of the expert panel recommendations, with low TPM reinsertion (0.8%) and postdischarge PPM (0.8%) rates. In the majority of group 5 patients (procedural high-degree/complete atrioventricular block), TPM was maintained, followed by PPM implantation, compatible with the expert panel recommendations. In contrast, in groups 2-4 (pre-existing/new conduction disturbances), earlier TPM removal than recommended by the expert panel (mostly, immediately after procedure) was feasible in 97.5%-100% of patients, with a low TPM reinsertion rate (0.0%-1.8%); earlier discharge was also feasible in 50.0%-65.5%, with a low 30-day postdischarge PPM rate (0.0%-2.8%) and no 30-day death. Conclusions Early TPM removal and discharge after TAVI appear safe and feasible in the majority of cases. These data may provide a framework for an early, streamlined hospital discharge plan for TAVI recipients, optimizing both cost savings and patient safety.
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Affiliation(s)
- Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shashank Shekhar
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anas M. Saad
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Omar M. Abdelfattah
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Khaldoun G. Tarakji
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Oussama M. Wazni
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - James J. Yun
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Grant W. Reed
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samir R. Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Patel KP, Vandermolen S, Herrey AS, Cheasty E, Menezes L, Moon JC, Pugliese F, Treibel TA. Cardiac Computed Tomography: Application in Valvular Heart Disease. Front Cardiovasc Med 2022; 9:849540. [PMID: 35402562 PMCID: PMC8987722 DOI: 10.3389/fcvm.2022.849540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
The incidence and prevalence of valvular heart disease (VHD) is increasing and has been described as the next cardiac epidemic. Advances in imaging and therapeutics have revolutionized how we assess and treat patients with VHD. Although echocardiography continues to be the first-line imaging modality to assess the severity and the effects of VHD, advances in cardiac computed tomography (CT) now provide novel insights into VHD. Transcatheter valvular interventions rely heavily on CT guidance for procedural planning, predicting and detecting complications, and monitoring prosthesis. This review focuses on the current role and future prospects of CT in the assessment of aortic and mitral valves for transcatheter interventions, prosthetic valve complications such as thrombosis and endocarditis, and assessment of the myocardium.
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Affiliation(s)
- Kush P. Patel
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
- Faculty of Population Health Sciences, Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Sebastian Vandermolen
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Anna S. Herrey
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
- Faculty of Population Health Sciences, Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Emma Cheasty
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
| | - Leon Menezes
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
- Institute of Nuclear Medicine, University College London, London, United Kingdom
- NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - James C. Moon
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
- Faculty of Population Health Sciences, Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Francesca Pugliese
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Thomas A. Treibel
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
- Faculty of Population Health Sciences, Institute of Cardiovascular Sciences, University College London, London, United Kingdom
- Institute of Nuclear Medicine, University College London, London, United Kingdom
- *Correspondence: Thomas A. Treibel,
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14
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Haouzi A, Tuttle M, Eyal A, Tandon K, Tung P, Zimetbaum PJ, Kramer DB. Clinical management of conduction abnormalities following transcatheter aortic valve replacement: prospective evaluation of a standardized management pathway. J Interv Card Electrophysiol 2022; 64:195-202. [PMID: 35212830 PMCID: PMC8873349 DOI: 10.1007/s10840-022-01156-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/08/2022] [Indexed: 11/26/2022]
Abstract
Purpose Limited evidence guides management of conduction abnormalities following TAVR. Standardized clinical pathways may reduce variability in care while minimizing bradyarrhythmic morbidity, length of stay (LOS), and pacemaker (PPM) implantation rates. Methods A multidisciplinary consensus pathway to standardize post-TAVR management was developed. We evaluated (1) pathway adherence; (2) LOS; (3) PPM implantation rates; (4) 1-month survival, and (5) late heart block. Exploratory analyses evaluated factors associated with PPM implantation. Results A total of 181 consecutive patients without prior PPM who underwent TAVR between February 2020 and February 2021 (mean age 77.9 ± 9.1, 38% women) were included. Average LOS was 3.0 days (± 2.7), and no deaths related to syncope/bradyarrhythmia were reported by 1 month. Overall, 93% of the 181 patients were managed by pathway; deviations were due to failure of discharge with a heart monitor when it was clinically indicated for either pre-existing RBBB or new PR prolongation/new LBBB. PPM implantation occurred in 19 patients by discharge, and 21 by 1-month (13%). In our exploratory analysis, pre-existing RBBB, transient peri-procedural heart block, and LOTUS valves were associated with pacemaker implantation: OR (CI) of 8.16 (3.06–21.78), 6.83 (1.94–24.03), and 8.32 (1.11–62.49), respectively. Conclusions This report illustrates that a standardized protocol for the management of conduction abnormalities after TAVR can be implemented with high compliance, safe management of conduction disturbance, and relatively short LOS with discharge supported by ambulatory monitoring.
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Affiliation(s)
- Alice Haouzi
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, 375 Longwood Ave, 4th floor, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | | | | | | | - Patricia Tung
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, 375 Longwood Ave, 4th floor, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Daniel B Kramer
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, 375 Longwood Ave, 4th floor, Boston, MA, 02215, USA.
- Harvard Medical School, Boston, MA, USA.
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15
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Ravaux JM, Van Kuijk SMJ, Di Mauro M, Vernooy K, Bidar E, Van’t Hof AW, Veenstra L, Kats S, Houterman S, Maessen JG, Lorusso R. Incidence and Predictors of Permanent Pacemaker Implantation after Transcatheter Aortic Valve Procedures: Data of The Netherlands Heart Registration (NHR). J Clin Med 2022; 11:jcm11030560. [PMID: 35160012 PMCID: PMC8836997 DOI: 10.3390/jcm11030560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 12/30/2022] Open
Abstract
Atrioventricular conduction disturbance leading to permanent pacemaker (PM) implantation is a frequent and relevant complication after transcatheter aortic valve implantation (TAVI). We aimed to evaluate the rate of post-TAVI permanent PM implantation over time and to identify the predictive factors for post-TAVI PM. The data were retrospectively collected by the Netherlands Heart Registration (NHR). In total, 7489 isolated TAVI patients between 2013 and 2019 were included in the final analysis. The primary endpoint was a permanent PM implantation within 30 days following TAVI. The incidence of the primary endpoint was 12%. Post-TAVI PM showed a stable rate over time. Using multivariable logistic regression analysis, age (OR 1.01, 95% CI 1.00–1.02), weight (OR 1.00, 95% CI 1.00–1.01), creatinine serum level (OR 1.15, 95% CI 1.01–1.31), transfemoral TAVI approach (OR 1.34, 95% CI 1.11–1.61), and TAVI post-dilatation (OR 1.58, 95% CI 1.33–1.89) were shown to be independent predictors of PM. Male sex (OR 0.80, 95% CI 0.68–0.93) and previous aortic valve surgery (OR 0.42, 95% CI 0.26–0.69) had a protective effect on post-TAVI PM. From a large national TAVI registry, some clinical and procedural factors have been identified as promoting or preventing post-TAVI PM. Further efforts are required to identify high-risk patients for post-TAVI PM and to reduce the incidence of this important issue.
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Affiliation(s)
- Justine M. Ravaux
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), 6202 AZ Maastricht, The Netherlands; (S.M.J.V.K.); (M.D.M.); (E.B.); (S.K.); (J.G.M.); (R.L.)
- Correspondence:
| | - Sander M. J. Van Kuijk
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), 6202 AZ Maastricht, The Netherlands; (S.M.J.V.K.); (M.D.M.); (E.B.); (S.K.); (J.G.M.); (R.L.)
| | - Michele Di Mauro
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), 6202 AZ Maastricht, The Netherlands; (S.M.J.V.K.); (M.D.M.); (E.B.); (S.K.); (J.G.M.); (R.L.)
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Centre (MUMC), 6202 AZ Maastricht, The Netherlands; (K.V.); (A.W.V.H.); (L.V.)
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands
- Department of Cardiology, Radboud University Medical Centre (Radboudumc), 6525 GA Nijmegen, The Netherlands
| | - Elham Bidar
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), 6202 AZ Maastricht, The Netherlands; (S.M.J.V.K.); (M.D.M.); (E.B.); (S.K.); (J.G.M.); (R.L.)
| | - Arnoud W. Van’t Hof
- Department of Cardiology, Maastricht University Medical Centre (MUMC), 6202 AZ Maastricht, The Netherlands; (K.V.); (A.W.V.H.); (L.V.)
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands
- Department of Cardiology, Zuyderland Medical Center, 6419 PC Heerlen, The Netherlands
| | - Leo Veenstra
- Department of Cardiology, Maastricht University Medical Centre (MUMC), 6202 AZ Maastricht, The Netherlands; (K.V.); (A.W.V.H.); (L.V.)
| | - Suzanne Kats
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), 6202 AZ Maastricht, The Netherlands; (S.M.J.V.K.); (M.D.M.); (E.B.); (S.K.); (J.G.M.); (R.L.)
| | - Saskia Houterman
- Netherlands Heart Registration (NHR), 1105 AZ Amsterdam, The Netherlands;
| | - Jos G. Maessen
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), 6202 AZ Maastricht, The Netherlands; (S.M.J.V.K.); (M.D.M.); (E.B.); (S.K.); (J.G.M.); (R.L.)
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), 6202 AZ Maastricht, The Netherlands; (S.M.J.V.K.); (M.D.M.); (E.B.); (S.K.); (J.G.M.); (R.L.)
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands
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16
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Guo Y, Zhou D, Dang M, He Y, Zhang S, Fang J, Wu S, Huang Q, Chen L, Yuan Y, Fan J, Jilaihawi H, Liu X, Wang J. The Predictors of Conduction Disturbances Following Transcatheter Aortic Valve Replacement in Patients With Bicuspid Aortic Valve: A Multicenter Study. Front Cardiovasc Med 2021; 8:757190. [PMID: 34912864 PMCID: PMC8667767 DOI: 10.3389/fcvm.2021.757190] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/15/2021] [Indexed: 12/29/2022] Open
Abstract
Objective: To evaluate the predictors of new-onset conduction disturbances in bicuspid aortic valve patients using self-expanding valve and identify modifiable technical factors. Background: New-onset conduction disturbances (NOCDs), including complete left bundle branch block and high-grade atrioventricular block, remain the most common complication after transcatheter aortic valve replacement (TAVR). Methods: A total of 209 consecutive bicuspid patients who underwent self-expanding TAVR in 5 centers in China were enrolled from February 2016 to September 2020. The optimal cut-offs in this study were generated from receiver operator characteristic curve analyses. The infra-annular and coronal membranous septum (MS) length was measured in preoperative computed tomography. MSID was calculated by subtracting implantation depth measure on postoperative computed tomography from infra-annular MS or coronal MS length. Results: Forty-two (20.1%) patients developed complete left bundle branch block and 21 (10.0%) patients developed high-grade atrioventricular block after TAVR, while 61 (29.2%) patients developed NOCDs. Coronal MS <4.9 mm (OR: 3.08, 95% CI: 1.63-5.82, p = 0.001) or infra-annular MS <3.7 mm (OR: 2.18, 95% CI: 1.04-4.56, p = 0.038) and left ventricular outflow tract perimeter <66.8 mm (OR: 4.95 95% CI: 1.59-15.45, p = 0.006) were powerful predictors of NOCDs. The multivariate model including age >73 years (OR: 2.26, 95% CI: 1.17-4.36, p = 0.015), Δcoronal MSID <1.8 mm (OR: 7.87, 95% CI: 2.84-21.77, p < 0.001) and prosthesis oversizing ratio on left ventricular outflow tract >3.2% (OR: 3.42, 95% CI: 1.74-6.72, p < 0.001) showed best predictive value of NOCDs, with c-statistic = 0.768 (95% CI: 0.699-0.837, p < 0.001). The incidence of NOCDs was much lower (7.5 vs. 55.2%, p < 0.001) in patients without Δcoronal MSID <1.8 mm and prosthesis oversizing ratio on left ventricular outflow tract >3.2% compared with patients who had these two risk factors. Conclusion: The risk of NOCDs in bicuspid aortic stenosis patients could be evaluated based on MS length and prosthesis oversizing ratio. Implantation depth guided by MS length and reducing the oversizing ratio might be a feasible strategy for heavily calcified bicuspid patients with short MS.
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Affiliation(s)
- Yuchao Guo
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dao Zhou
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengqiu Dang
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuxing He
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shenwei Zhang
- Department of Cardiology, Zhengzhou Cardiovascular Hospital (The Seventh People' Hospital of Zheng Zhou), Zhengzhou, China
| | - Jun Fang
- Department of Cardiology, Fujian Heart Medical Center, Fujian Institute of Coronary Heart Disease, Fujian Medical University Union Hospital, Fuzhou, China
| | - Shili Wu
- Department of Cardiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Qiong Huang
- Department of Cardiology, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Lianglong Chen
- Department of Cardiology, Fujian Heart Medical Center, Fujian Institute of Coronary Heart Disease, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yiqiang Yuan
- Department of Cardiology, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Jiaqi Fan
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hasan Jilaihawi
- Heart Valve Center, NYU Langone Health, New York City, NY, United States
| | - Xianbao Liu
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian'an Wang
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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17
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Incidence and Outcomes of Pericardial Effusion and Cardiac Tamponade Following Permanent Pacemaker Implantation After Transcatheter Aortic Valve Implantation. Am J Cardiol 2021; 157:135-139. [PMID: 34366112 DOI: 10.1016/j.amjcard.2021.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/27/2021] [Accepted: 07/01/2021] [Indexed: 11/20/2022]
Abstract
Permanent pacemaker (PPM) implantation is required in 5% to 10% of patients following transcatheter aortic valve implantation (TAVI). However, there are limited data on the impact of PPM implantation on the incidence of pericardial effusion, cardiac tamponade, and outcomes after TAVI. We identified all hospitalizations in patients ≥18 years of age who underwent TAVI in the years 2016 to 2017 in the Nationwide Readmission Database. The endpoints of the study were pericardial effusion, cardiac tamponade, and percutaneous or surgical drainage of the pericardial cavity in patients that required PPM implantation after TAVI. Multivariable logistic regression determined associations of PPM implantation, pericardial effusion, and tamponade with patient outcomes. A total of 54,317 unweighted hospitalizations for TAVI were identified, of which 5,639 (10.4%) required PPM. The risk of pericardial effusion was significantly greater in patients who required PPM (2.4% vs 1.6%, adjusted odds ratio (aOR) 1.39 (1.15 to 1.70), p <0.001)), and risk of cardiac tamponade nearly doubled (1.6% vs 0.8%, p <0.001; aOR: 1.90 (1.48 to 2.40), p <0.001). Female gender was independently associated with increased risk of pericardial effusion and cardiac tamponade whereas history of previous CABG was associated with decreased risk of both. Pericardial complications following PPM implantation were associated with increased in-hospital mortality, length of stay (LOS), hospital costs, and risk of 30-day readmission following TAVI (p <0.01 for all comparisons). In conclusion, although common, PPM implantation post-TAVI carries increased risks of pericardial effusion and associated cardiac tamponade. Patients developing these pericardial complications are at particularly high-risk for in-hospital mortality, greater LOS, and 30-day readmission.
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18
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Impact of Cusp-Overlap View for TAVR with Self-Expandable Valves on 30-Day Conduction Disturbances. J Interv Cardiol 2021; 2021:9991528. [PMID: 34007249 PMCID: PMC8099519 DOI: 10.1155/2021/9991528] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 01/12/2023] Open
Abstract
Methods and Results We retrospectively compared 257 consecutive patients undergoing TAVR with self-expandable valves using either CON (n = 101) or COVL (n = 156) in four intermediate/low volume centers. There were no significant differences in baseline characteristics between the groups. The 30-day incidence of new-onset LBBB (12.9% vs. 5.8%; p=0.05) and PPMI rate (17.8% vs. 6.4%; p=0.004) was significantly lower when using the COVL implantation view. There was no difference between the CON and COVL groups in 30-day incidence of death (4.9% vs. 2.6%), any stroke (0% vs. 0.6%), and the need for surgical aortic valve replacement (0% for both groups). Conclusion Using the COVL view for implantation, we achieved a significant reduction of the LBBB and PPMI rate after TAVR in comparison with the traditional CON view, without compromising the TAVR outcomes when using self-expandable prostheses.
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Kawsara A, Sulaiman S, Alqahtani F, Eleid MF, Deshmukh AJ, Cha YM, Rihal CS, Alkhouli M. Temporal Trends in the Incidence and Outcomes of Pacemaker Implantation After Transcatheter Aortic Valve Replacement in the United States (2012-2017). J Am Heart Assoc 2020; 9:e016685. [PMID: 32862774 PMCID: PMC7726966 DOI: 10.1161/jaha.120.016685] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Nationwide studies documenting temporal trends in permanent pacemaker implantation (PPMI) following transcatheter aortic valve replacement (TAVR) are limited. Methods and Results We selected patients who underwent TAVR between 2012 and 2017 in the National Readmission Database. The primary end point was the 6‐year trend in post‐TAVR PPMI at index hospitalization and at 30, 90, and 180 days after discharge. The secondary end point was the association between PPMI and in‐hospital mortality, stroke, cost, length of stay, and disposition. Among the 89 202 patients who underwent TAVR, 77 405 (86.8%) with no prior pacemaker or defibrillator were included. Patients who required PPMI had a higher prevalence of atrial fibrillation (43.6% versus 38.7%, P<0.001) and conduction abnormalities (28.4% versus 15.3%, P<0.001). The incidence of PPMI during index admission increased from 8.7% in 2012 to 13.2% in 2015, and then decreased to 9.6% in 2017. The incidence of inpatient PPMI within 30 days after discharge increased from 0.5% in 2012 to 1.25% in 2017 (Ptrend<0.001). Inpatient PPMI beyond 30 days remained rare (<0.5%) during the study period. After risk adjustment, PPMI was not associated with in‐hospital mortality or stroke but was associated with increased nonhome discharge, longer hospitalization, and higher cost. The incremental expenditure associated with post‐TAVR PPMI during index admission increased from $9.6 million to $72.2 million between 2012 and 2017. Conclusions After an upward trend, rates of PPMI after TAVR in the United States stabilized at ~10% in 2016 to 2017, but there was a notable increase in PPMI within 30 days after the index admission. PPMI was not associated with increased in‐hospital morbidity or mortality but led to longer hospitalization, higher cost, and more nonhome discharges.
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Affiliation(s)
- Akram Kawsara
- Division of Cardiology Department of Medicine West Virginia University Morgantown WV
| | - Samian Sulaiman
- Division of Cardiology Department of Medicine West Virginia University Morgantown WV
| | - Fahad Alqahtani
- Division of Cardiology Department of Medicine University of Kentucky Lexington KY
| | - Mackram F Eleid
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| | - Abhishek J Deshmukh
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| | - Yong-Mei Cha
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
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