Abstract 15832: Complete Heart Block After Transcatheter Aortic Valve Implantation: A Meta-Analysis
Introduction: Both transcatheter aortic valve implantation (TAVI) surgical aortic valve replacement (SAVR) are associated with risk of complete heart block requiring a pacemaker. Pooled meta-analysis was performed to evaluate the relative risk of developing complete heart block with the above procedures.
Methods: All electronic databases were queried and studies reporting outcomes of heart block in patients undergoing TAVI and SAVR were included. Exclusion criteria applied was: studies lacking SAVR as controls, studies comparing trans-apical versus trans-femoral TAVI procedures and studies not reporting on the outcome of heart block or pacemaker implantation. Meta-analysis was done using Mantel-Haenszel random effects model.
Results: A total of 21 studies with a total of 5061 patients were included in the study. TAVI was done in 2692 patients. The risk of AV heart block necessitating pacemaker implantation was very high in the patients undergoing TAVI compared to SAVR (OR 3.5, 95% CI 2.4 - 5.1). Majority of the pacemaker implantations were done immediately after the TAVI procedure. Trans-femoral TAVI’s were associated with higher risk (OR 8.6, 95% CI 3.1 - 28.3) of developing permanent heart block compared to transapical route (OR 2.4, 95% CI, 1.3 - 4.3). CoreValve use was associated with a higher risk of developing permanent heart block (OR 2.4, 95% CI 1.6 - 3.6) than Edward Sapiens Valve (OR 1.9, 95% CI 1.2 - 2.8) compared to SAVR.
Conclusion: TAVI increases the risk of permanent heart block by 3.5 times and this risk is higher when CoreValve is used and when performed by the transfemoral route. The predictors of development of heart block with TAVI procedure needs further investigation.
Author Disclosures: A. Kanmanthareddy: None. A. Buddam: None. S. Sharma: None. R. Afzal: None. V.S. Koripalli: None. N. Adabala: None. M. Martin: None. G. Ries: None. S. Bommana: None. D. Atkins: None. M. Reddy: None. D. Lakkireddy: None.
- © 2014 by American Heart Association, Inc.