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Narayan P. From NOTIONs to nuances: TAVR and SAVR in low-risk patients. Indian J Thorac Cardiovasc Surg 2024; 40:388-390. [PMID: 38681717 PMCID: PMC11045686 DOI: 10.1007/s12055-024-01716-7] [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: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 05/01/2024] Open
Abstract
The NOTION trial, in this 10-year follow-up report, comprehensively compares transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in low-risk patients. The study reveals similar outcomes in terms of mortality, stroke, and myocardial infarction. TAVR demonstrates advantages such as improved effective orifice area and transprosthetic gradients, along with reduced rates of new-onset atrial fibrillation. However, it is associated with higher rates of permanent pacemaker implantation and paravalvular leaks. Concerns exist regarding the generalizability of findings and unblinding during outcome assessments.
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Affiliation(s)
- Pradeep Narayan
- Department of Cardiac Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, 124, EM Bypass, Mukundapur, Kolkata, 700099 India
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Tiago C, Dias Vaz M, Marques A, Barata M, Braga JP, Boa A, Carvalho AF. Intraoperative Corticosteroids and Pacemaker Implantation After Transcatheter Aortic Valve Replacement. Cureus 2024; 16:e56824. [PMID: 38654777 PMCID: PMC11037441 DOI: 10.7759/cureus.56824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic stenosis. However, conduction disturbances leading to pacemaker implantation remain a common complication, increasing morbidity and mortality in these patients. Hence, measures to lower its incidence should be taken, and corticosteroid therapy could be effective by reducing inflammation caused by direct mechanical trauma to the conduction system. METHODS A retrospective cohort study was conducted at the Centro Hospitalar de Vila Nova de Gaia/Espinho, analyzing the medical records of patients with native severe aortic stenosis who underwent transfemoral TAVR in 2022. The Chi-square test was used to compare the rate of pacemaker implantation in patients who received corticosteroids with patients who didn't. The statistical significance was considered for a p-value <0.05. RESULTS A total of 341 patients were included in this study. Monitored anesthesia care was the preferred anesthetic technique (99.1%). Sixty-three point three percent (63.3%) of patients received corticosteroids at the beginning of the procedure. Corticosteroid administration did not significantly affect the incidence of permanent pacemaker implantation (p=0.277), vascular complications on the access site (p=0.765), or in-hospital mortality (p=0.909). Male gender, 1st-degree atrioventricular block, and right branch block were the only identified predictors of permanent pacemaker implantation after transfemoral TAVR (p=0.041 <0.001 and <0.001, respectively). CONCLUSION Corticosteroid administration at the beginning of TAVR doesn't seem to influence the incidence of permanent pacemaker implantation, which can suggest that other factors play a more important role in the development of conduction disturbances leading to pacemaker implantation.
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Affiliation(s)
- Catarina Tiago
- Anesthesiology, Centro Hospitalar de Vila Nova de Gaia - Espinho, Porto, PRT
| | - Marta Dias Vaz
- Anesthesiology, Centro Hospitalar de Vila Nova de Gaia - Espinho, Porto, PRT
| | - Ana Marques
- Anesthesiology, Centro Hospitalar de Vila Nova de Gaia - Espinho, Porto, PRT
| | - Melanie Barata
- Anesthesiology, Centro Hospitalar de Vila Nova de Gaia - Espinho, Porto, PRT
| | - José Pedro Braga
- Cardiology, Centro Hospitalar de Vila Nova de Gaia - Espinho, Porto, PRT
| | - Ana Boa
- Anesthesiology, Centro Hospitalar de Vila Nova de Gaia - Espinho, Porto, PRT
| | - Ana Filipa Carvalho
- Anesthesiology, Centro Hospitalar de Vila Nova de Gaia - Espinho, Porto, PRT
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3
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De Felice F, Paolucci L, Cesario V, Musto C, Nazzaro MS, Chin D, Stio R, Pennacchi M, Gabrielli D, Fiorina C, Massussi M, Angelillis M, Costa G, Bruschi G, Fineschi M, Maffeo D, Barletta M, Regazzoli D, Montorfano M. Impact of Pacemaker Implantation After Transcatheter Aortic Valve Replacement on Long-Term Survival in Patients With Bicuspid Aortic Valve. Am J Cardiol 2024; 210:146-152. [PMID: 37838072 DOI: 10.1016/j.amjcard.2023.10.018] [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: 08/17/2023] [Revised: 09/29/2023] [Accepted: 10/05/2023] [Indexed: 10/16/2023]
Abstract
Limited data are available about the impact of permanent pacemaker (PPM) implantation on long-term survival in patients with a bicuspid aortic valve (BAV) and severe aortic stenosis (AS) treated with transcatheter aortic valve replacement (TAVR). We aimed to evaluate the long-term clinical outcomes of patients with BAV with AS who underwent periprocedural PPM implantation after TAVR with a self-expandable prosthesis. Data from patients with BAV and severe AS who underwent TAVR between April 2009 and January 2022 and followed in the framework of the One Hospital ClinicalService-CoreValve Project were collected. Patients were categorized in 2 groups according to PPM implantation after TAVR ("PPM" group) or not ("no PPM" group). The coprimary end points were all-cause death and a composite of cardiac mortality, rehospitalization because of cardiac causes, stroke, and myocardial infarction. Overall, 106 patients were considered (74 in the "no PPM" group and 32 in the "PPM" group). No statistically significant difference was found between the groups in terms of follow-up and baseline characteristics. Patients in the PPM group were more likely to show baseline conduction abnormalities (p = 0.023). Patients in the PPM group were more often treated with older generation prosthesis than those in the no PPM group (28.1% vs 5.4%, respectively, p = 0.013). At 2 years of follow-up, all-cause death in the no PPM and PPM groups occurred in 20.0% and 10.0% of patients, respectively (hazard ratio 0.37, 95% confidence interval 0.08 to 1.67). Similarly, no difference was evident for the composite end point between the 2 groups (no PPM vs PPM: 8 [14.6%] vs 6 [19.3%], hazard ratio 1.67, 95% CI 0.58 to 4.81). In conclusion, patients with severe AS and BAV treated with TAVR complicated by PPM implantation are not exposed to an increased risk of major adverse events at 2 years of follow-up.
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Affiliation(s)
- Francesco De Felice
- Interventional Cardiology Unit, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
| | - Luca Paolucci
- Interventional Cardiology Unit, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Vincenzo Cesario
- Interventional Cardiology Unit, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Carmine Musto
- Interventional Cardiology Unit, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Marco Stefano Nazzaro
- Interventional Cardiology Unit, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Diana Chin
- Interventional Cardiology Unit, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Rocco Stio
- Interventional Cardiology Unit, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Mauro Pennacchi
- Interventional Cardiology Unit, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Domenico Gabrielli
- Interventional Cardiology Unit, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Claudia Fiorina
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Mauro Massussi
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Angelillis
- Catheterization Laboratory, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Giulia Costa
- Catheterization Laboratory, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - Massimo Fineschi
- Interventional Cardiology UOSA, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Diego Maffeo
- Interventional Cardiology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Marta Barletta
- Clinical and Interventional Cardiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Damiano Regazzoli
- Humanitas Research Hospital Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rozzano, Italy
| | - Matteo Montorfano
- School of Medicine, Vita-salute San Raffaele University, Milan, Italy; Interventional Cardiology Unit IRCCS San Raffaele Scientific Institute, Milan, Italy
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4
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Nasso G, Vignaroli W, Contegiacomo G, Marchese A, Fattouch K, D’Alessandro P, Brigiani MS, Vitobello V, Triggiani V, Demola MA, Tonioni S, Paparella D, Sechi S, Bonifazi R, Santarpino G, Resta F, Bartolomucci F, Lorusso R, Larosa C, Valenti G, Tito A, Moscarelli M, Margari V, Fiore F, Condello I, Speziale G. Emergent Conversion to Open Heart Surgery during Transcatheter Aortic Valve Implantation: The Presence of a Rescue Team Improves Outcomes. J Clin Med 2023; 12:7705. [PMID: 38137774 PMCID: PMC10743555 DOI: 10.3390/jcm12247705] [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: 10/29/2023] [Revised: 12/03/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE Transcatheter aortic valve implant (TAVI) is the gold standard for the high-surgical-risk group of patients with aortic valve disease and it is an alternative to surgery in patients at intermediate risk. Lethal complications can occur, and many of these are manageable only with emergent conversion to open heart surgery. We retrospectively evaluate the outcome of all patients undergoing TAVI in our departments and the impact of a complete cardiac rescue team to reduce 30-day mortality. METHODS Data from all patients undergoing TAVI between January 2020 and August 2023 in our center were analyzed. An expert complete rescue was present in catheter laboratory. Primary outcomes were in-hospital and at 30-day mortality and evaluation of all cases needed for emergent conversion to open heart surgery. RESULTS 825 patients were enrolled. The total mortality was 19/825 (2.3%). Eleven of the total patients (1.3%) required emergent conversion to open heart surgery. Among them, eight were alive (73%), with a theoretical decrease of 0.98% in overall mortality. CONCLUSIONS surgical treatment is rare during TAVI. The presence of an expert complete rescue team as support means an increase in survival. Surgery must be used only to restore circulatory and to treat complication while percutaneous approaches should complete the procedure.
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Affiliation(s)
- Giuseppe Nasso
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Walter Vignaroli
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
- Department of Cardiac Surgery, San Carlo di Nancy, GVM Care & Research, 00165 Roma, Italy; (K.F.); (S.T.); (S.S.)
| | - Gaetano Contegiacomo
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Alfredo Marchese
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, 70124 Bari, Italy; (A.M.); (F.R.); (A.T.); (V.M.)
| | - Khalil Fattouch
- Department of Cardiac Surgery, San Carlo di Nancy, GVM Care & Research, 00165 Roma, Italy; (K.F.); (S.T.); (S.S.)
| | - Pasquale D’Alessandro
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Mario Siro Brigiani
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Vincenza Vitobello
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Vera Triggiani
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Maria Antonietta Demola
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Stefano Tonioni
- Department of Cardiac Surgery, San Carlo di Nancy, GVM Care & Research, 00165 Roma, Italy; (K.F.); (S.T.); (S.S.)
| | - Domenico Paparella
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, 70124 Bari, Italy; (A.M.); (F.R.); (A.T.); (V.M.)
| | - Stefano Sechi
- Department of Cardiac Surgery, San Carlo di Nancy, GVM Care & Research, 00165 Roma, Italy; (K.F.); (S.T.); (S.S.)
| | - Raffaele Bonifazi
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Giuseppe Santarpino
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Fabrizio Resta
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, 70124 Bari, Italy; (A.M.); (F.R.); (A.T.); (V.M.)
| | - Francesco Bartolomucci
- Department of Cardiology, Hospital of Andria, 76123 Andria, Italy; (F.B.); (C.L.); (G.V.)
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), 6229 HX Maastricht, The Netherlands;
| | - Claudio Larosa
- Department of Cardiology, Hospital of Andria, 76123 Andria, Italy; (F.B.); (C.L.); (G.V.)
| | - Giovanni Valenti
- Department of Cardiology, Hospital of Andria, 76123 Andria, Italy; (F.B.); (C.L.); (G.V.)
| | - Antonio Tito
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, 70124 Bari, Italy; (A.M.); (F.R.); (A.T.); (V.M.)
| | - Marco Moscarelli
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Vito Margari
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, 70124 Bari, Italy; (A.M.); (F.R.); (A.T.); (V.M.)
| | - Flavio Fiore
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Ignazio Condello
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Giuseppe Speziale
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
- Department of Cardiac Surgery, San Carlo di Nancy, GVM Care & Research, 00165 Roma, Italy; (K.F.); (S.T.); (S.S.)
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5
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Pagnesi M, Kim WK, Baggio S, Scotti A, Barbanti M, De Marco F, Adamo M, Eitan A, Estévez-Loureiro R, Conradi L, Toggweiler S, Mylotte D, Veulemans V, Søndergaard L, Wolf A, Giannini F, Maffeo D, Pilgrim T, Montorfano M, Zweiker D, Ferlini M, Kornowski R, Hildick-Smith D, Taramasso M, Abizaid A, Schofer J, Sinning JM, Van Mieghem NM, Wöhrle J, Khogali S, Van der Heyden JAS, Wood DA, Ielasi A, MacCarthy P, Brugaletta S, Hamm CW, Costa G, Testa L, Massussi M, Alarcón R, Schäfer U, Brunner S, Reimers B, Lunardi M, Zeus T, Vanhaverbeke M, Naber CK, Di Ienno L, Buono A, Windecker S, Schmidt A, Lanzillo G, Vaknin-Assa H, Arunothayaraj S, Saccocci M, Siqueira D, Brinkmann C, Sedaghat A, Ziviello F, Seeger J, Rottbauer W, Brouwer J, Buysschaert I, Jelisejevas J, Bharucha A, Regueiro A, Metra M, Colombo A, Latib A, Mangieri A. Incidence, Predictors, and Prognostic Impact of New Permanent Pacemaker Implantation After TAVR With Self-Expanding Valves. JACC Cardiovasc Interv 2023; 16:2004-2017. [PMID: 37480891 DOI: 10.1016/j.jcin.2023.05.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/23/2023] [Accepted: 05/08/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVES The authors sought to evaluate the incidence, predictors, and outcomes of new permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR) with contemporary self-expanding valves (SEV). BACKGROUND Need for PPI is frequent post-TAVR, but conflicting data exist on new-generation SEV and on the prognostic impact of PPI. METHODS This study included 3,211 patients enrolled in the multicenter NEOPRO (A Multicenter Comparison of Acurate NEO Versus Evolut PRO Transcatheter Heart Valves) and NEOPRO-2 (A Multicenter Comparison of ACURATE NEO2 Versus Evolut PRO/PRO+ Transcatheter Heart Valves 2) registries (January 2012 to December 2021) who underwent transfemoral TAVR with SEV. Implanted transcatheter heart valves (THV) were Acurate neo (n = 1,090), Acurate neo2 (n = 665), Evolut PRO (n = 1,312), and Evolut PRO+ (n = 144). Incidence and predictors of new PPI and 1-year outcomes were evaluated. RESULTS New PPI was needed in 362 patients (11.3%) within 30 days after TAVR (8.8%, 7.7%, 15.2%, and 10.4%, respectively, after Acurate neo, Acurate neo2, Evolut PRO, and Evolut PRO+). Independent predictors of new PPI were Society of Thoracic Surgeons Predicted Risk of Mortality score, baseline right bundle branch block and depth of THV implantation, both in patients treated with Acurate neo/neo2 and in those treated with Evolut PRO/PRO+. Predischarge reduction in ejection fraction (EF) was more frequent in patients requiring PPI (P = 0.014). New PPI was associated with higher 1-year mortality (16.9% vs 10.8%; adjusted HR: 1.66; 95% CI: 1.13-2.43; P = 0.010), particularly in patients with baseline EF <40% (P for interaction = 0.049). CONCLUSIONS New PPI was frequently needed after TAVR with SEV (11.3%) and was associated with higher 1-year mortality, particularly in patients with EF <40%. Baseline right bundle branch block and depth of THV implantation independently predicted the need of PPI.
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Affiliation(s)
- Matteo Pagnesi
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Won-Keun Kim
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Sara Baggio
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | | | - Marianna Adamo
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Amnon Eitan
- Department of Cardiology, Carmel Medical Center, Haifa, Israel
| | - Rodrigo Estévez-Loureiro
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute, Vigo, Spain
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center, Hamburg, Germany
| | - Stefan Toggweiler
- Heart Center Lucerne, Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Darren Mylotte
- Department of Cardiology, Galway University Hospitals, Galway, Ireland
| | - Verena Veulemans
- Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Lars Søndergaard
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Alexander Wolf
- Contilia Heart and Vascular Centre, Elisabeth-Krankenhaus Essen, Essen, Germany
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Diego Maffeo
- Interventional Cardiology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - David Zweiker
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
| | - David Hildick-Smith
- Department of Cardiology, Royal Sussex County Hospital, Brighton, United Kingdom
| | | | | | - Joachim Schofer
- Department for Percutaneous Treatment of Structural Heart Disease, Albertinen Heart Center, Hamburg, Germany; MVZ Department Structural Heart Disease, Asklepios St. Georg Clinic, Hamburg, Germany
| | - Jan-Malte Sinning
- Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jochen Wöhrle
- Department of Cardiology and Intensive Care, Medical Campus Lake Constance, Friedrichshafen, Germany
| | - Saib Khogali
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
| | - Jan A S Van der Heyden
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands; Interventional Cardiology Unit, AZ Sint-Jan Hospital, Bruges, Belgium
| | - David A Wood
- Centre for Heart Valve and Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Philip MacCarthy
- Department of Cardiology, King's College Hospital, London, United Kingdom
| | - Salvatore Brugaletta
- Clinic Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Christian W Hamm
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Giuliano Costa
- Department of Cardiology, C.A.S.T. Policlinico G. Rodolico, Catania, Italy
| | - Luca Testa
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Mauro Massussi
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Robert Alarcón
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute, Vigo, Spain
| | - Ulrich Schäfer
- Department of Internal Medicine, Marienkrankenhaus, Hamburg, Germany
| | - Stephanie Brunner
- Heart Center Lucerne, Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Bernhard Reimers
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Mattia Lunardi
- Department of Cardiology, Galway University Hospitals, Galway, Ireland
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Maarten Vanhaverbeke
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christoph K Naber
- Contilia Heart and Vascular Centre, Elisabeth-Krankenhaus Essen, Essen, Germany
| | - Luca Di Ienno
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Andrea Buono
- Interventional Cardiology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Albrecht Schmidt
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Giuseppe Lanzillo
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Hana Vaknin-Assa
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
| | | | - Matteo Saccocci
- Cardiac Surgery Unit, Fondazione Poliambulanza, Brescia, Italy
| | | | - Christina Brinkmann
- MVZ Department Structural Heart Disease, Asklepios St. Georg Clinic, Hamburg, Germany
| | - Alexander Sedaghat
- Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Francesca Ziviello
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Julia Seeger
- Department of Cardiology and Intensive Care, Medical Campus Lake Constance, Friedrichshafen, Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II, University Hospital Ulm, Ulm, Germany
| | - Jorn Brouwer
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Ian Buysschaert
- Interventional Cardiology Unit, AZ Sint-Jan Hospital, Bruges, Belgium
| | - Julius Jelisejevas
- Centre for Heart Valve and Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Apurva Bharucha
- Department of Cardiology, King's College Hospital, London, United Kingdom
| | - Ander Regueiro
- Clinic Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy.
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6
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Alabdaljabar MS, Eleid MF. Risk Factors, Management, and Avoidance of Conduction System Disease after Transcatheter Aortic Valve Replacement. J Clin Med 2023; 12:4405. [PMID: 37445439 DOI: 10.3390/jcm12134405] [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: 05/05/2023] [Revised: 06/14/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Transcatheter valve replacement (TAVR) is a rapidly developing modality to treat patients with aortic stenosis (AS). Conduction disease post TAVR is one of the most frequent and serious complications experienced by patients. Multiple factors contribute to the risk of conduction disease, including AS and the severity of valve calcification, patients' pre-existing conditions (i.e., conduction disease, anatomical variations, and short septum) in addition to procedure-related factors (e.g., self-expanding valves, implantation depth, valve-to-annulus ratio, and procedure technique). Detailed evaluation of risk profiles could allow us to better prevent, recognize, and treat this entity. Available evidence on management of conduction disease post TAVR is based on expert opinion and varies widely. Currently, conduction disease in TAVR patients is managed depending on patient risk, with minimal-to-no inpatient/outpatient observation, inpatient monitoring (24-48 h) followed by ambulatory monitoring, or either prolonged inpatient and outpatient monitoring or permanent pacemaker implantation. Herein, we review the incidence and risk factors of TAVR-associated conduction disease and discuss its management.
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Affiliation(s)
| | - Mackram F Eleid
- Division of Interventional Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
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7
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Sammour YM, Lak H, Gajulapalli RD, Chawla S, Abushouk A, Parikh P, Alkhalaileh F, Kumar S, Svensson L, Yun J, Popovic Z, Harb S, Tarakji K, Wazni O, Reed GW, Puri R, Krishnaswamy A, Kapadia SR. Pacing-Related Differences After SAPIEN-3 TAVI: Clinical and Echocardiographic Correlates. Am J Cardiol 2023; 197:24-33. [PMID: 37137251 DOI: 10.1016/j.amjcard.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/15/2023] [Accepted: 04/02/2023] [Indexed: 05/05/2023]
Abstract
Data regarding the impact of pacing on outcomes after transcatheter aortic valve implantation (TAVI) is evolving especially with regards to pre-existing permanent pacemaker (PPM). We examined the impact of new and previous PPM on the clinical and hemodynamic outcomes after SAPIEN-3 TAVI. We included all consecutive patients who underwent transfemoral TAVI using SAPIEN-3 valve from 2015 to 2018 at our institution. Among 1,028 patients, 10.2% required a new PPM within 30 days, whereas 14% had a pre-existing PPM. The presence of either previous or new PPM had no impact on the 3-year mortality (log-rank p = 0.6) or 1-year major adverse cardiac and cerebrovascular events (log-rank p = 0.65). New PPM was associated with lower left ventricular (LV) ejection fraction (LVEF) at both 30 days (54.4 ± 11.3% vs 58.4 ± 10.1%, p = 0.001) and 1 year (54.2 ± 12% vs 59.1 ± 9.9%, p = 0.009) than no PPM. Similarly, previous PPM was associated with worse LVEF at 30 days (53.6 ± 12.3%, p <0.001) and 1 year (55.5 ± 12.1%, p = 0.006) than no PPM. Interestingly, new PPM was associated with lower 1-year mean gradient (11.4 ± 3.8 vs 12.6 ± 5.6 mm Hg, p = 0.04) and peak gradient (21.3 ± 6.5 vs 24.1 ± 10.4 mm Hg, p = 0.01), despite no baseline differences. Previous PPM was also associated with lower 1-year mean gradient (10.3 ± 4.4 mm Hg, p = 0.001) and peak gradient (19.4 ± 8 mm Hg, p <0.001) and higher Doppler velocity index (0.51 ± 0.12 vs 0.47 ± 0.13, p = 0.039). Moreover, 1-year LV end-systolic volume index was higher with new (23.2 ± 16.1 vs 20 ± 10.8 ml/m2, p = 0.038) and previous PPM (24.5 ± 19.7, p = 0.038) than no PPM. Previous PPM was associated with higher moderate-to-severe tricuspid regurgitation (35.3% vs 17.7%, p <0.001). There were no differences regarding the rest of the studied echocardiographic outcomes at 1 year. In conclusion, new and previous PPM did not affect 3-year mortality or 1-year major adverse cardiac and cerebrovascular events; however, they were associated with worse LVEF, higher 1-year LV end-systolic volume index, and lower mean and peak gradients on follow-up than no PPM.
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Affiliation(s)
- Yasser M Sammour
- Aortic Valve Center, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hassan Lak
- Section of Clinical Cardiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Sanchit Chawla
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Abdelrahman Abushouk
- Aortic Valve Center, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Parth Parikh
- Aortic Valve Center, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Sachin Kumar
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Lars Svensson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - James Yun
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Zoran Popovic
- Aortic Valve Center, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Serge Harb
- Aortic Valve Center, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Khaldoun Tarakji
- Aortic Valve Center, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Oussama Wazni
- Aortic Valve Center, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Grant W Reed
- Aortic Valve Center, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rishi Puri
- Aortic Valve Center, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amar Krishnaswamy
- Aortic Valve Center, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samir R Kapadia
- Aortic Valve Center, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
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8
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Gada H, Vora AN, Tang GHL, Mumtaz M, Forrest JK, Laham RJ, Yakubov SJ, Deeb GM, Rammohan C, Huang J, Reardon MJ. Site-Level Variation and Predictors of Permanent Pacemaker Implantation Following TAVR in the Evolut Low-Risk Trial. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 47:48-54. [PMID: 36266154 DOI: 10.1016/j.carrev.2022.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 01/28/2023]
Abstract
We evaluated predictors of permanent pacemaker implantation (PPI) following self-expanding transcatheter aortic valve replacement (TAVR), examined site-to-site variability of PPI rates, and explored the relationship of implantation methods on the need for PPI. Despite the benefits of TAVR compared to surgical aortic valve replacement, increased PPI remains a limitation. A total of 699 patients without baseline PPI were included in the study. Clinical, echocardiographic, and procedural characteristics were compared in patient with and without new PPI. Clinical outcomes were assessed at 30 days and 1 year. Funnel plots were constructed to display site-to- site variability and identify outliers in PPI. Clinical outcomes were similar in patients with and without PPI. Predictors of a new PPI within 7 days included a baseline right bundle branch block (p < 0.001) and not using general anesthesia (p = 0.003). There was substantial site to site variability in the rate of PPI. Patients at sites with a lower PPI rate had shallower implantation depth at the non-coronary (p < 0.001) and the left coronary sinus (p < 0.001), and fewer patients with an implantation depth > 5 mm below the annulus (p = 0.004). In low-risk patients undergoing TAVR with Evolut valves, baseline conduction disorders and implant depth were important predictors of PPI. Implantation method may have contributed to this variability in PPI rates across clinical sites.
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Affiliation(s)
- Hemal Gada
- Department of Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle, Wormleysburg, PA, United States of America.
| | - Amit N Vora
- Department of Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle, Wormleysburg, PA, United States of America
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, NY, New York, United States of America
| | - Mubashir Mumtaz
- Department of Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle, Wormleysburg, PA, United States of America
| | - John K Forrest
- Department of Internal Medicine (Cardiology), Yale University School of Medicine, New Haven, CT, United States of America
| | - Roger J Laham
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Steven J Yakubov
- Department of Interventional Cardiology, Riverside Methodist-Ohio Health, Columbus, OH, United States of America
| | - G Michael Deeb
- Department of Cardiac Surgery, University of Michigan Hospitals, Ann Arbor, MI, United States of America
| | - Chad Rammohan
- El Camino Hospital, Department of Interventional Cardiology, Mountain View, CA, United States of America
| | - Jian Huang
- Department of Statistics, Medtronic, Minneapolis, MN, United States of America
| | - Michael J Reardon
- Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Institute, Houston, TX, United States of America
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9
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Serna-Gallegos D, Brown JA, Ridgley J, Aranda-Michel E, Navid F, Wang Y, Thoma FW, Sultan I. Long-term outcomes of patients undergoing mechanical versus bioprosthetic aortic root replacement. J Card Surg 2022; 37:1861-1867. [PMID: 35488772 DOI: 10.1111/jocs.16544] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 03/02/2022] [Accepted: 03/23/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND We evaluated the impact of valve type (mechanical vs. bioprosthetic) on survival after aortic root replacement (ARR). METHODS In a propensity-matched analysis, we evaluated consecutive operations from 2010 to 2018. Patients were identified using a prospectively maintained institutional database. Patients with infective endocarditis were excluded. Kaplan-Meier survival estimation and multivariable Cox regression analysis were performed. Cox regression adjusted for age, sex, baseline comorbidities, and operative variables. Propensity score matching yielded 153 pairs of patients. RESULTS A total of 893 patients were identified. We excluded 192 patients with endocarditis and evaluated 701 patients. Of these patients, 455 (64.9%) received a bioprosthetic valve, 246 (35.1%) received a mechanical valve. Median follow-up was 4.06 years. The proportion of aortic dissections and circulatory arrest as well as cardiopulmonary bypass and ischemic times were similar across groups (p = .207, p = .086, p = .668, p = .454, respectively). Operative mortality was significantly higher in the bioprosthetic valve group (7.9% vs. 2.4%, p = .004). Total length of hospital stay was longer (11.4 ± 11.0 vs. 9.5 ± 10.1, p < .001) and there was a higher proportion of prolonged postoperative ventilation >24 h (21.3% vs. 13.0%, p = .007) in the bioprosthetic group. Postoperative outcomes were similar, regarding stroke (p = .077), re-exploration for bleeding (p = .211), new dialysis requirement (p = .077), long-term bleeding complications (p = .561), and reoperations (p = .755). Mechanical valve replacement was associated with improved long-term survival (adjusted HR 0.42, 95% CI: 0.23-0.77, p = .005). CONCLUSIONS These findings suggest that mechanical valves for ARRs may confer a survival benefit over bioprosthetic valves. Surgeon bias was likely to account for this survival advantage.
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Affiliation(s)
- Derek Serna-Gallegos
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - James A Brown
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jacqueline Ridgley
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Edgar Aranda-Michel
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Forozan Navid
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yisi Wang
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Floyd W Thoma
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ibrahim Sultan
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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10
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Zito A, Princi G, Lombardi M, D'Amario D, Vergallo R, Aurigemma C, Romagnoli E, Pelargonio G, Bruno P, Trani C, Burzotta F, Crea F. Long-term clinical impact of permanent pacemaker implantation in patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis. Europace 2022; 24:1127-1136. [PMID: 35138367 PMCID: PMC9460982 DOI: 10.1093/europace/euac008] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/27/2022] [Indexed: 11/12/2022] Open
Abstract
Aims The aims of this study is to assess by an updated meta-analysis the clinical outcomes related to permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) at long-term (≥12 months) follow-up (LTF). Methods and results A comprehensive literature research was performed on PubMed and EMBASE. The primary endpoint was all-cause death. Secondary endpoints were rehospitalization for heart failure, stroke, and myocardial infarction. A subgroup analysis was performed according to the Society of Thoracic Surgeon—Predicted Risk of Mortality (STS-PROM) score. This study is registered with PROSPERO (CRD42021243301). A total of 51 069 patients undergoing TAVI from 31 observational studies were included. The mean duration of follow-up was 22 months. At LTF, PPI post-TAVI was associated with a higher risk of all-cause death [risk ratio (RR) 1.18, 95% confidence interval (CI) 1.10–1.25; P < 0.001] and rehospitalization for heart failure (RR 1.32, 95% CI 1.13–1.52; P < 0.001). In contrast, the risks of stroke and myocardial infarction were not affected. Among the 20 studies that reported procedural risk, the association between PPI and all-cause death risk at LTF was statistically significant only in studies enrolling patients with high STS-PROM score (RR 1.25, 95% CI 1.12–1.40), although there was a similar tendency of the results in those at medium and low risk. Conclusion Patients necessitating PPI after TAVI have a higher long-term risk of all-cause death and rehospitalization for heart failure as compared to those who do not receive PPI.
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Affiliation(s)
- Andrea Zito
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy
| | - Giuseppe Princi
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy
| | - Marco Lombardi
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy
| | - Domenico D'Amario
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rocco Vergallo
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gemma Pelargonio
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piergiorgio Bruno
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168 Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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11
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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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12
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Sammour Y, Krishnaswamy A, Kumar A, Puri R, Tarakji KG, Bazarbashi N, Harb S, Griffin B, Svensson L, Wazni O, Kapadia SR. Incidence, Predictors, and Implications of Permanent Pacemaker Requirement After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2021; 14:115-134. [PMID: 33478630 DOI: 10.1016/j.jcin.2020.09.063] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/04/2020] [Accepted: 09/29/2020] [Indexed: 12/29/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is a safe and feasible alternative to surgery in patients with symptomatic severe aortic stenosis regardless of the surgical risk. Conduction abnormalities requiring permanent pacemaker (PPM) implantation remain a common finding after TAVR due to the close proximity of the atrioventricular conduction system to the aortic root. High-grade atrioventricular block and new onset left bundle branch block (LBBB) are the most commonly reported conduction abnormalities after TAVR. The overall rate of PPM implantation after TAVR varies and is related to pre-procedural and intraprocedural factors. The available literature regarding the impact of conduction abnormalities and PPM requirement on morbidity and mortality is still conflicting. Pre-procedural conduction abnormalities such as right bundle branch block and LBBB have been linked with increased PPM implantation and mortality after TAVR. When screening patients for TAVR, heart teams should be aware of various anatomical and pathophysiological conditions that make patients more susceptible to increased risk of conduction abnormalities and PPM requirement after the procedure. This is particularly important as TAVR has been recently approved for patients with low surgical risk. The purpose of this review is to discuss the incidence, predictors, impact, and management of the various conduction abnormalities requiring PPM implantation in patients undergoing TAVR.
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Affiliation(s)
- Yasser Sammour
- Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA; Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Amar Krishnaswamy
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Arnav Kumar
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rishi Puri
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Khaldoun G Tarakji
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Najdat Bazarbashi
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Serge Harb
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Brian Griffin
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Lars Svensson
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Oussama Wazni
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Samir R Kapadia
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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Ullah W, Zahid S, Zaidi SR, Sarvepalli D, Haq S, Roomi S, Mukhtar M, Khan MA, Gowda SN, Ruggiero N, Vishnevsky A, Fischman DL. Predictors of Permanent Pacemaker Implantation in Patients Undergoing Transcatheter Aortic Valve Replacement - A Systematic Review and Meta-Analysis. J Am Heart Assoc 2021; 10:e020906. [PMID: 34259045 PMCID: PMC8483489 DOI: 10.1161/jaha.121.020906] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background As transcatheter aortic valve replacement (TAVR) technology expands to healthy and lower‐risk populations, the burden and predictors of procedure‐related complications including the need for permanent pacemaker (PPM) implantation needs to be identified. Methods and Results Digital databases were systematically searched to identify studies reporting the incidence of PPM implantation after TAVR. A random‐ and fixed‐effects model was used to calculate unadjusted odds ratios (OR) for all predictors. A total of 78 studies, recruiting 31 261 patients were included in the final analysis. Overall, 6212 patients required a PPM, with a mean of 18.9% PPM per study and net rate ranging from 0.16% to 51%. The pooled estimates on a random‐effects model indicated significantly higher odds of post‐TAVR PPM implantation for men (OR, 1.16; 95% CI, 1.04–1.28); for patients with baseline mobitz type‐1 second‐degree atrioventricular block (OR, 3.13; 95% CI, 1.64–5.93), left anterior hemiblock (OR, 1.43; 95% CI, 1.09–1.86), bifascicular block (OR, 2.59; 95% CI, 1.52–4.42), right bundle‐branch block (OR, 2.48; 95% CI, 2.17–2.83), and for periprocedural atriorventricular block (OR, 4.17; 95% CI, 2.69–6.46). The mechanically expandable valves had 1.44 (95% CI, 1.18–1.76), while self‐expandable valves had 1.93 (95% CI, 1.42–2.63) fold higher odds of PPM requirement compared with self‐expandable and balloon‐expandable valves, respectively. Conclusions Male sex, baseline atrioventricular conduction delays, intraprocedural atrioventricular block, and use of mechanically expandable and self‐expanding prosthesis served as positive predictors of PPM implantation in patients undergoing TAVR.
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Affiliation(s)
- Waqas Ullah
- Thomas Jefferson University Hospitals Philadelphia PA
| | | | | | | | | | | | - Maryam Mukhtar
- University Hospitals of Leicester NHS Trust Leicester UK
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14
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Bernhard B, Okuno T, Cicovic A, Stortecky S, Reichlin T, Lanz J, Praz F, Windecker S, Pilgrim T. Systemic corticosteroid exposure and atrioventricular conductance delays after transcatheter aortic valve implantation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 37:1-6. [PMID: 34238680 DOI: 10.1016/j.carrev.2021.06.127] [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: 05/31/2021] [Accepted: 06/28/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Atrioventricular conduction delays (AVCD) are common after transcatheter aortic valve implantation (TAVI) and frequently require implantation of a permanent pacemaker (PPM). Autopsy studies demonstrated the role of ischemia, inflammation, and oedema in the pathogenesis of AVCD. Corticosteroids (CS) reduce inflammation and oedema and hence might lead to a lower rate of AVCD. METHODS Based on a prospective single-center registry, we performed a propensity score (PS) matched analysis of subjects treated with or without systemic CS (>2.5 mg prednisolone-equivalent per day) at the time of TAVI. The primary endpoint was a composite of PPM-implantation and new-onset left bundle branch block (LBBB) within 30 days after TAVI. RESULTS Among 2213 consecutive patients undergoing TAVI (51.5% female, mean age 82.1 ± 6.1 years) 89 patients were treated with systemic CS, of which 87 were included in the PS matched analysis. At 30 days, rates of the composite of PPM and LBBB were comparable between patients with versus without CS both in the overall cohort (33.7% versus 33.0%, p = 0.89) and the PS matched cohort (34.5% versus 40.2%, p = 0.443). There were no differences in a composite of major or minor vascular complications and major or life-threatening bleeding events between patients with versus without CS in the overall cohort (34.8% versus 26.6%, p = 0.088) or the PS matched cohort (33.3% versus 33.3%, p ≥ 0.999). CONCLUSION In this exploratory study, intake of systemic CS among patients undergoing TAVI was not associated with differences in rates of AVCD, vascular complications, or bleeding events after TAVI.
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Affiliation(s)
- Benedikt Bernhard
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Taishi Okuno
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Aleksandar Cicovic
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
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15
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Conduction Disturbances and Permanent Pacemaker Implantation after Transcatheter Aortic Valve Replacement: Predictors and Prevention. Cardiol Rev 2021; 30:179-187. [PMID: 34132653 DOI: 10.1097/crd.0000000000000398] [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] [Indexed: 11/25/2022]
Abstract
Conduction disturbances and permanent pacemaker implantation (PPMI) remain a frequent and important consequence of transcatheter aortic valve replacement (TAVR). Understanding risk factors for TAVR-related conduction disturbances could improve patient selection, procedural techniques, and peri-procedural efforts for monitoring and treatment of heart block. Several studies have identified patient-related and procedural factors associated with new-onset left bundle branch block, high-degree atrioventricular block, and the need for PPMI after TAVR. Notable patient-related predictors include pre-existing right bundle branch block, membranous septal length, and calcification of the left ventricular outflow tract. Modifiable procedural predictors include device implantation depth, prosthesis oversizing, and valve type. This review aims to summarize the current literature examining predictors of conduction disturbances and PPMI after TAVR, particularly with regard to the newer-generation valve types. We also propose a management algorithm for the management of conduction disturbances post-procedure.
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16
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Ravaux JM, Di Mauro M, Vernooy K, Van't Hof AW, Veenstra L, Kats S, Maessen JG, Lorusso R. One-year pacing dependency after pacemaker implantation in patients undergoing transcatheter aortic valve implantation: Systematic review and meta-analysis. JTCVS OPEN 2021; 6:41-55.e15. [PMID: 36003550 PMCID: PMC9390410 DOI: 10.1016/j.xjon.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/09/2021] [Indexed: 12/04/2022]
Abstract
Objectives Atrioventricular conductions disturbances, requiring permanent pacemaker implantation (PPI), represent a potential complication after transcatheter aortic valve implantation (TAVI), However, little is known about the pacemaker dependency after PPI in this patient setting. This systematic review analyses the incidence of PPI, the short-term (1-year) pacing dependency, and predictors for such a state after TAVI. Methods We performed a systematic search in PUBMED, EMBASE, and MEDLINE to identify potentially relevant literature investigating PPI requirement and dependency after TAVI. Study data, patients, and procedural characteristics were extracted. Odds ratio (OR) with 95% confidence intervals were extracted. Results Data from 23 studies were obtained that included 18,610 patients. The crude incidence of PPI after TAVI was 17% (range, 8.8%-32%). PPI occurred at a median time of 3.2 days (range, 0-30 days). Pacing dependency at 1-year was 47.5% (range, 7%-89%). Self-expandable prosthesis (pooled OR was 2.14 [1.15-3.96]) and baseline right bundle branch block (pooled OR was 2.01 [1.06-3.83]) showed 2-fold greater risk to maintain PPI dependency at 1 year after TAVI. Conclusions Although PPI represents a rather frequent event after TAVI, conduction disorders have a temporary nature in almost 50% of the cases with recovery and stabilization after discharge. Preoperative conduction abnormality and type of TAVI are associated with higher PPI dependency at short term.
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Affiliation(s)
- Justine M. Ravaux
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Address for reprints: Justine M. Ravaux, MD, Department of Cardio-Thoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC+), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, P. Debyelaan, 25, 6202 AZ Maastricht, The Netherlands.
| | - Michele Di Mauro
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Department of Cardiology, Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands
| | - Arnoud W. Van't Hof
- Department of Cardiology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Leo Veenstra
- Department of Cardiology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Suzanne Kats
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Jos G. Maessen
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
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17
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Schäfers HJ. Commentary: Pacemaker dependency after transcatheter aortic valve implantation: Only half as bad? JTCVS OPEN 2021; 6:58-59. [PMID: 36003580 PMCID: PMC9390162 DOI: 10.1016/j.xjon.2021.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Hans-Joachim Schäfers
- Address for reprints: Hans-Joachim Schäfers, MD, Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Kirrbergerstr. 100, Homburg/Saar, Germany.
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18
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Ramanathan PK, Nazir S, Elzanaty AM, Nesheiwat Z, Mahmood M, Rachwal W, Riordan C, Letcher J, Yenrick K, Boonie E, Moront MG, Redfern RE, Crescenzo D. Novel Method for Implantation of Balloon Expandable Transcatheter Aortic Valve Replacement to Reduce Pacemaker Rate—Line of Lucency Method. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2020. [DOI: 10.1080/24748706.2020.1813355] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
| | - Salik Nazir
- ProMedica Heart Institute, ProMedica Toledo Hospital, Toledo, Ohio, USA
- Department of Cardiovascular Medicine, University of Toledo, Toledo, Ohio, USA
| | - Ahmed M. Elzanaty
- ProMedica Heart Institute, ProMedica Toledo Hospital, Toledo, Ohio, USA
- Department of Internal Medicine, University of Toledo, Toledo, Ohio, USA
| | - Zeid Nesheiwat
- ProMedica Heart Institute, ProMedica Toledo Hospital, Toledo, Ohio, USA
- Department of Internal Medicine, University of Toledo, Toledo, Ohio, USA
| | - Muhammad Mahmood
- ProMedica Heart Institute, ProMedica Toledo Hospital, Toledo, Ohio, USA
- Department of Internal Medicine, University of Toledo, Toledo, Ohio, USA
| | - William Rachwal
- ProMedica Heart Institute, ProMedica Toledo Hospital, Toledo, Ohio, USA
| | | | - John Letcher
- ProMedica Heart Institute, ProMedica Toledo Hospital, Toledo, Ohio, USA
| | - Kellie Yenrick
- ProMedica Heart Institute, ProMedica Toledo Hospital, Toledo, Ohio, USA
| | - Erica Boonie
- ProMedica Heart Institute, ProMedica Toledo Hospital, Toledo, Ohio, USA
| | - Michael G. Moront
- ProMedica Heart Institute, ProMedica Toledo Hospital, Toledo, Ohio, USA
| | | | - Donald Crescenzo
- ProMedica Heart Institute, ProMedica Toledo Hospital, Toledo, Ohio, USA
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