Need for long-term permanent pacemaker and its association with mortality in patients undergoing transcatheter aortic valve implantation

Year 2023, Volume: 40 Issue: 2, 370 - 377, 19.07.2023

Özlem Özbek , Mehmet Can

Abstract

Despite two decades of experience and increased procedural success in TAVI, there are still matters of debate concerning need for PPI. We aimed to investigate the frequency of permanent pacemaker implantation (PPI) need and the long-term impact of PPI on all-cause mortality in patients with Transcatheter Aortic Valve Implantation (TAVI). All TAVI recipients between June 2016 and January 2021 admitted to our tertiary center were included retrospectively. In-hospital data were retrieved from the institutional digital database and later mortalities were recorded from the national E-Health application. The primary outcome was to determine the frequency of PPI requirement following TAVI. Median follow-up was 52 (12-72) months. PPI had been required in 20 (15%) of 132 TAVI recipients. PPI was necessary in 25% of Evolut R (Medtronic, CA, USA), 4% of Edwards Sapien (Edwards Lifesciences, CA, USA), 16% of Portico (Abbott Structural Heart, St Paul, MN, USA), 26% of Medtronic CoreValve (Medtronic, CA, USA), 20% of Myval THV (Meril Life Sciences, Gujarat, India), and none of ACURATE neo™ (Boston Scientific, Marlborough, MA, USA) recipients. Mortality was similar among those with and without PPI requirement. Multiple regression revealed that hyperlipidemia and preoperative valvuloplasty significantly decreased risk for all-cause mortality, while higher CRP increased the risk of mortality. New generation TAVI devices appear to decrease the frequency of PPI need compared to older generation devices, as reported in the literature. PPI was not associated with all-cause mortality at a median follow-up of 52 months in TAVI recipients.

Keywords

Transcatheter aortic valve replacement, pacemaker, mortality

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