Abstract 14177: Permanent Pacemaker Implantation after Transcatheter Aortic Valve Implantation: Is There any Impact on Survival?
Background: Severe cardiac conduction disturbances requiring permanent pacemaker implantation (PPI) are frequent complications following transcatheter aortic valve implantation (TAVI). There is only limited information available about the prognostic impact of this complication.
Objectives: In order to evaluate whether PPI after TAVI carries short and mid-term prognostic issues, we compared 30-day and one-year survival of patients with and without de novo PPI after TAVI.
Methods: From October 2006 to April 2012, 960 patients with severe symptomatic aortic stenosis underwent TAVI in three tertiary centers. Both the balloon-expandable Edwards-Sapien valve (ES) (672, 70%) and the self-expanding Medtronic CoreValve (MCV) (288, 30%) were used.
Results: 51 patients treated with the ES (7.6%) and 61 patients with the MCV (21.2%) required a PPI (p<0.0001). Patients who needed a PPI had a higher body mass index (26.8±4.8 vs. 25.7±4.4 kg/m2, p=0.011) and had a larger prosthesis diameter (26.9±2.1 vs. 26.0±2.3mm, p<0.0001). Transfemoral approach was also more frequently used (78.3 vs. 69.0%, p=0.049). The other demographic and procedural characteristics did not differ (similar age 83±6.3 years, logistic Euroscore 22.9±11.1% and ejection fraction 52±14.7%). Hospital stay was increased in patients with PPI (12.2±7.0 vs. 10.5±8.0 days, p=0.032) but 30-day survival was similar in the global cohort (91.1 vs. 89.4%, p=0.578), with the ES (90.2 vs. 88.5%, p=0.718) or the MCV (91.8 vs. 91.6%, p=0.965). The one-year survival rate was lower in patients who needed a PPI compared to those who did not, but the difference was not significant (55.3 vs. 60.9%, p=0.456). This holds true for both types of valve (ES 54.5 vs. 61%, p=0.544; MCV 56 vs. 60.4%, p=0.688).
Conclusion: In this large observational study, PPI after TAVI did not negatively impact early and mid-term survival in patients treated with either the ES or MCV prosthesis.
- © 2012 by American Heart Association, Inc.