Author + information
- Jeffrey J. Popma1,
- Stan Chetcuti2,
- Michael Reardon3,
- David Adams4,
- Susheel K. Kodali5,
- Paul Sorajja6,
- James Hermiller Jr.7 and
- Wilson Y. Szeto8
- 1Beth Israel Deaconess Medical Center, Boston, MA
- 2University of Michigan Medical Center, Ann Arbor, MI
- 3Houston-Methodist-Debakey Heart and Vascular Center, Houston, TX
- 4Mount Sinai Medical Center, New York, NY
- 5Columbia University Medical Center, New York, NY
- 6Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN
- 7St Vincent’s Heart Center of Indiana, Indianapolis, IN
- 8University of Pennsylvania School of Medicine, Philadelphia, PA
Transcatheter aortic valve replacement (TAVR) may lead to conduction abnormalities and the need for permanent pacemaker implantation (PPI) in some patients. The impact of PPI on mortality and other clinical outcomes remains unclear.
This analysis compares the clinical outcomes following commercial TAVR with the CoreValve self-expanding bioprosthesis in patients who received PPI and patients who did not require PPI in the STS/ACC Transcatheter Valve Therapies (TVT) RegistryTM. Patients with a pre-existing pacemaker or ICD in place at the time of TAVR were excluded. Site-reported adverse events for 30-day and 1 year outcomes were examined.
A total of 6167 patients were included in this analysis; 1689 (27.4%) received a PPI and 4478 (72.6%) did not require a PPI. Compared with the no PPI group, those who received a PPI were older (81.5±7.7 yrs vs. 80.8±8.4 yrs; p=0.003) and more likely to be male (58.7% vs 49.6%; p<0.0001); significantly more had a conduction defect at baseline (45.0% vs 28.2%; p<0.0001) and a history of atrial fibrillation (41.3% vs 36.3%; p=0003). Baseline STS score was similar (8.5±5.1 vs 8.3±5.2; p=0.162). At 1 year follow-up the cumulative incidence of all-cause mortality was not significantly different in patients with and without new PPI (figure).
Permanent pacemaker implantation after TAVR with the self-expanding CoreValve bioprosthesis was not associated with an increased risk for mortality at 1 year. This observation is consistent with published reports for the self-expanding valve in large scale investigational studies.