Survival relative to pacemaker status after transcatheter aortic valve implantation

• Published in: Catheterization and cardiovascular interventions Vol. 98; no. 3; pp. E444 - E452
• Main Authors: Myat, Aung, Mouy, Florence, Buckner, Luke, Cockburn, James, Baumbach, Andreas, MacCarthy, Philip, Banning, Adrian P., Curzen, Nick, Hilling‐Smith, Roland, Blackman, Daniel J., Mullen, Michael, Belder, Mark, Cox, Ian, Kovac, Jan, Manoharan, Ganesh, Zaman, Azfar, Muir, Douglas, Smith, David, Brecker, Stephen, Turner, Mark, Khogali, Saib, Malik, Iqbal S., Alsanjari, Osama, D'Auria, Francesca, Redwood, Simon, Prendergast, Bernard, Trivedi, Uday, Robinson, Derek, Ludman, Peter, Belder, Adam, Hildick‐Smith, David
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.09.2021; Wiley Subscription Services, Inc
• Subjects: aortic stenosis; Aortic valve; atrioventricular block; balloon expandable heart valve; left bundle branch block; Pacemakers; right bundle branch block; self‐expandable heart valve; Survival; aortic stenosis; left bundle branch block; self-expandable heart valve; right bundle branch block; atrioventricular block; balloon expandable heart valve
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.29498

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.