TY - JOUR
T1 - Permanent Pacemaker Implantation Following Valve-in-Valve Transcatheter Aortic Valve Replacement
T2 - VIVID Registry
AU - Alperi, Alberto
AU - Rodés-Cabau, Josep
AU - Simonato, Matheus
AU - Tchetche, Didier
AU - Charbonnier, Gaetan
AU - Ribeiro, Henrique B.
AU - Latib, Azeem
AU - Montorfano, Matteo
AU - Barbanti, Marco
AU - Bleiziffer, Sabine
AU - Redfors, Björn
AU - Abdel-Wahab, Mohamed
AU - Allali, Abdelhakim
AU - Bruschi, Giuseppe
AU - Napodano, Massimo
AU - Agrifoglio, Marco
AU - Petronio, Anna Sonia
AU - Giannini, Cristina
AU - Chan, Albert
AU - Kornowski, Ran
AU - Pravda, Nili Schamroth
AU - Adam, Matti
AU - Iadanza, Alessandro
AU - Noble, Stephane
AU - Chatfield, Andrew
AU - Erlebach, Magdalena
AU - Kempfert, Jörg
AU - Ubben, Timm
AU - Wijeysundera, Harindra
AU - Seiffert, Moritz
AU - Pilgrim, Thomas
AU - Kim, Won Keun
AU - Testa, Luca
AU - Hildick-Smith, David
AU - Nerla, Roberto
AU - Fiorina, Claudia
AU - Brinkmann, Christina
AU - Conzelmann, Lars
AU - Champagnac, Didier
AU - Saia, Francesco
AU - Nissen, Henrik
AU - Amrane, Hafid
AU - Whisenant, Brian
AU - Shamekhi, Jasmin
AU - Søndergaard, Lars
AU - Webb, John G.
AU - Dvir, Danny
N1 - Publisher Copyright:
© 2021 American College of Cardiology Foundation
PY - 2021/5/11
Y1 - 2021/5/11
N2 - Background: Permanent pacemaker implantation (PPI) remains one of the main drawbacks of transcatheter aortic valve replacement (TAVR), but scarce data exist on PPI after valve-in-valve (ViV) TAVR, particularly with the use of newer-generation transcatheter heart valves (THVs). Objectives: The goal of this study was to determine the incidence, factors associated with, and clinical impact of PPI in a large series of ViV-TAVR procedures. Methods: Data were obtained from the multicenter VIVID Registry and included the main baseline and procedural characteristics, in-hospital and late (median follow-up: 13 months [interquartile range: 3 to 41 months]) outcomes analyzed according to the need of periprocedural PPI. All THVs except CoreValve, Cribier-Edwards, Sapien, and Sapien XT were considered to be new-generation THVs. Results: A total of 1,987 patients without prior PPI undergoing ViV-TAVR from 2007 to 2020 were included. Of these, 128 patients (6.4%) had PPI after TAVR, with a significant decrease in the incidence of PPI with the use of new-generation THVs (4.7% vs. 7.4%; p = 0.017), mainly related to a reduced PPI rate with the Evolut R/Pro versus CoreValve (3.7% vs. 9.0%; p = 0.002). There were no significant differences in PPI rates between newer-generation balloon- and self-expanding THVs (6.1% vs. 3.9%; p = 0.18). In the multivariable analysis, older age (odds ratio [OR]: 1.05 for each increase of 1 year; 95% confidence interval [CI]: 1.02 to 1.07; p = 0.001), larger THV size (OR: 1.10; 95% CI: 1.01 to 1.20; p = 0.02), and previous right bundle branch block (OR: 2.04; 95% CI: 1.00 to 4.17; p = 0.05) were associated with an increased risk of PPI. There were no differences in 30-day mortality between the PPI (4.7%) and no-PPI (2.7%) groups (p = 0.19), but PPI patients exhibited a trend toward higher mortality risk at follow-up (hazard ratio: 1.39; 95% CI: 1.02 to 1.91; p = 0.04; p = 0.08 after adjusting for age differences between groups). Conclusions: In a contemporary large series of ViV-TAVR patients, the rate of periprocedural PPI was relatively low, and its incidence decreased with the use of new-generation THV systems. PPI following ViV-TAVR was associated with a trend toward increased mortality at follow-up.
AB - Background: Permanent pacemaker implantation (PPI) remains one of the main drawbacks of transcatheter aortic valve replacement (TAVR), but scarce data exist on PPI after valve-in-valve (ViV) TAVR, particularly with the use of newer-generation transcatheter heart valves (THVs). Objectives: The goal of this study was to determine the incidence, factors associated with, and clinical impact of PPI in a large series of ViV-TAVR procedures. Methods: Data were obtained from the multicenter VIVID Registry and included the main baseline and procedural characteristics, in-hospital and late (median follow-up: 13 months [interquartile range: 3 to 41 months]) outcomes analyzed according to the need of periprocedural PPI. All THVs except CoreValve, Cribier-Edwards, Sapien, and Sapien XT were considered to be new-generation THVs. Results: A total of 1,987 patients without prior PPI undergoing ViV-TAVR from 2007 to 2020 were included. Of these, 128 patients (6.4%) had PPI after TAVR, with a significant decrease in the incidence of PPI with the use of new-generation THVs (4.7% vs. 7.4%; p = 0.017), mainly related to a reduced PPI rate with the Evolut R/Pro versus CoreValve (3.7% vs. 9.0%; p = 0.002). There were no significant differences in PPI rates between newer-generation balloon- and self-expanding THVs (6.1% vs. 3.9%; p = 0.18). In the multivariable analysis, older age (odds ratio [OR]: 1.05 for each increase of 1 year; 95% confidence interval [CI]: 1.02 to 1.07; p = 0.001), larger THV size (OR: 1.10; 95% CI: 1.01 to 1.20; p = 0.02), and previous right bundle branch block (OR: 2.04; 95% CI: 1.00 to 4.17; p = 0.05) were associated with an increased risk of PPI. There were no differences in 30-day mortality between the PPI (4.7%) and no-PPI (2.7%) groups (p = 0.19), but PPI patients exhibited a trend toward higher mortality risk at follow-up (hazard ratio: 1.39; 95% CI: 1.02 to 1.91; p = 0.04; p = 0.08 after adjusting for age differences between groups). Conclusions: In a contemporary large series of ViV-TAVR patients, the rate of periprocedural PPI was relatively low, and its incidence decreased with the use of new-generation THV systems. PPI following ViV-TAVR was associated with a trend toward increased mortality at follow-up.
KW - pacemaker
KW - transcatheter aortic valve replacement
KW - valve in valve
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U2 - 10.1016/j.jacc.2021.03.228
DO - 10.1016/j.jacc.2021.03.228
M3 - Article
C2 - 33958122
AN - SCOPUS:85104667620
SN - 0735-1097
VL - 77
SP - 2263
EP - 2273
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 18
ER -