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Predictors of Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement
Matthew J Hoyt1, Jessica Hathaway1, Roseanne Palmer1
1Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Journal of Cardiothoracic and Vascular Anesthesia
|September 20, 2015
Summary
Valve-in-valve (VIV) placement after transcatheter aortic valve replacement (TAVR) significantly increases the need for permanent pacemakers (PPM). Paravalvular leak also emerged as a predictor for PPM implantation following TAVR.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Transcatheter aortic valve replacement (TAVR) is a common procedure for aortic stenosis.
- Permanent pacemaker (PPM) implantation is a known complication after TAVR.
- Predictors for PPM implantation require further elucidation to optimize patient care.
Purpose of the Study:
- To identify key predictors of permanent pacemaker (PPM) implantation following transcatheter aortic valve replacement (TAVR).
- To evaluate the impact of valve-in-valve (VIV) procedures and paravalvular leak on PPM rates.
Main Methods:
- Retrospective chart review of patients who underwent TAVR at a single academic institution.
- Analysis of patient demographics, electrocardiogram, procedural, and echocardiographic data.
- Multivariate regression analysis to determine associations with PPM implantation.
Main Results:
- Valve-in-valve (VIV) placement was a significant predictor of PPM implantation (OR 6.0, p = 0.02).
- Patients undergoing VIV had a 50% PPM rate compared to 14% for single valve recipients.
- Degree of paravalvular leak trended towards significance, with higher leak severity associated with lower PPM rates, but VIV in patients with no or trace leak significantly increased PPM likelihood.
Conclusions:
- Valve-in-valve (VIV) placement and the degree of paravalvular leak are significant predictors of permanent pacemaker (PPM) placement after TAVR.
- These findings may guide prophylactic pacemaker placement decisions in select TAVR patients, particularly those undergoing VIV or with specific leak characteristics.
