Pagnesi, Matteo; Kim, Won-Keun; Baggio, Sara; Scotti, Andrea; Barbanti, Marco; De Marco, Federico; Adamo, Marianna; Eitan, Amnon; Estévez-Loureiro, Rodrigo; Conradi, Lenard; Toggweiler, Stefan; Mylotte, Darren; Veulemans, Verena; Sondergaard, Lars; Wolf, Alexander; Giannini, Francesco; Maffeo, Diego; Pilgrim, Thomas; Montorfano, Matteo; Zweiker, David; ... (2023). Incidence, Predictors, and Prognostic Impact of New Permanent Pacemaker Implantation After TAVR With Self-Expanding Valves. JACC. Cardiovascular Interventions, 16(16), pp. 2004-2017. Elsevier 10.1016/j.jcin.2023.05.020
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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.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology |
UniBE Contributor: |
Pilgrim, Thomas, Windecker, Stephan |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
1876-7605 |
Publisher: |
Elsevier |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
25 Jul 2023 11:14 |
Last Modified: |
01 Sep 2023 00:16 |
Publisher DOI: |
10.1016/j.jcin.2023.05.020 |
PubMed ID: |
37480891 |
Uncontrolled Keywords: |
Acurate neo Evolut PRO mortality pacemaker self-expanding transcatheter aortic valve replacement |
BORIS DOI: |
10.48350/185007 |
URI: |
https://boris.unibe.ch/id/eprint/185007 |
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