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Survival relative to pacemaker status after transcatheter aortic valve implantation

Lookup NU author(s): Dr Mark De Belder, Professor Azfar Zaman

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Abstract

© 2021 Wiley Periodicals LLC.Objectives: To determine whether a permanent pacemaker (PPM) in situ can enhance survival after transcatheter aortic valve implantation (TAVI), in a predominantly inoperable or high risk cohort. Background: New conduction disturbances are the most frequent complication of TAVI, often necessitating PPM implantation before hospital discharge. Methods: We performed an observational cohort analysis of the UK TAVI registry (2007–2015). Primary and secondary endpoints were 30-day post-discharge all-cause mortality and long-term survival, respectively. Results: Of 8,651 procedures, 6,815 complete datasets were analyzed. A PPM at hospital discharge, irrespective of when implantation occurred (PPM 1.68% [22/1309] vs. no PPM 1.47% [81/5506], odds ratio [OR] 1.14, 95% confidence interval [CI] 0.71–1.84; p =.58), or a PPM implanted peri- or post-TAVI only (PPM 1.44% [11/763] vs. no PPM 1.47% [81/5506], OR 0.98 [0.51–1.85]; p =.95) did not significantly reduce the primary endpoint. Patients with a PPM at discharge were older, male, had right bundle branch block at baseline, were more likely to have received a first-generation self-expandable prosthesis and had experienced more peri- and post-procedural complications including bailout valve-in-valve rescue, bleeding and acute kidney injury. A Cox proportional hazards model demonstrated significantly reduced long-term survival in all those with a PPM, irrespective of implantation timing (hazard ratio [HR] 1.14 [1.02–1.26]; p =.019) and those receiving a PPM only at the time of TAVI (HR 1.15 [1.02–1.31]; p =.032). The reasons underlying this observation warrant further investigation. Conclusions: A PPM did not confer a survival advantage in the first 30 days after hospital discharge following TAVI.

Publication metadata

Author(s): Myat A, Mouy F, Buckner L, Cockburn J, Baumbach A, MacCarthy P, Banning AP, Curzen N, Hilling-Smith R, Blackman DJ, Mullen M, de Belder M, Cox I, Kovac J, Manoharan G, Zaman A, Muir D, Smith D, Brecker S, Turner M, Khogali S, Malik IS, Alsanjari O, D'Auria F, Redwood S, Prendergast B, Trivedi U, Robinson D, Ludman P, de Belder A, Hildick-Smith D

Publication type: Article

Publication status: Published

Journal: Catheterization and Cardiovascular Interventions

Year: 2021

Volume: 98

Issue: 3

Pages: E444-E452

Print publication date: 01/09/2021

Online publication date: 27/01/2021

Acceptance date: 08/01/2021

ISSN (print): 1522-1946

ISSN (electronic): 1522-726X

Publisher: John Wiley and Sons Inc

URL: https://doi.org/10.1002/ccd.29498

DOI: 10.1002/ccd.29498

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