Related Experiment Video
Updated: Jan 30, 2026
Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Association of Clinical and Economic Outcomes With Permanent Pacemaker Implantation After Transcatheter Aortic Valve
Talal Aljabbary1,2, Feng Qiu1, Shannon Masih1
1Institute for Clinical Evaluation Sciences, Toronto, Ontario, Canada.
Insights
Permanent pacemaker implantation after transcatheter aortic valve replacement is linked to increased mortality and hospital readmissions. However, it did not significantly affect long-term healthcare costs.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- The impact of permanent pacemaker (PPM) implantation following transcatheter aortic valve replacement (TAVR) is not well-established in existing literature.
- Understanding these outcomes is crucial for optimizing patient care pathways after TAVR.
Purpose of the Study:
- To investigate the clinical and economic consequences for patients requiring PPM implantation during the same hospitalization as their TAVR procedure.
- To provide evidence-based insights into the long-term implications of PPM post-TAVR.
Main Methods:
- A retrospective, population-based cohort study was conducted using data from a multicenter registry in Ontario, Canada (2010-2015).
- Patients undergoing TAVR were included, with exclusions for those with prior pacemakers or in-hospital mortality.
- Inverse probability of treatment weighting (IPTW) using propensity scores was applied to adjust for baseline differences between PPM and non-PPM groups.
Main Results:
- The study included 1263 patients, with 14.7% requiring PPM implantation post-TAVR.
- After IPTW, PPM implantation was associated with significantly higher all-cause mortality (HR, 1.40), all-cause readmission (HR, 1.28), and emergency department visits (HR, 1.28).
- Readmission for heart failure was also significantly higher in the PPM group (HR, 1.90), while no significant difference in 1-year cumulative healthcare costs was observed.
Conclusions:
- New PPM implantation after TAVR is associated with increased long-term morbidity and mortality.
- Despite increased adverse events, PPM implantation did not lead to higher cumulative healthcare costs within one year post-discharge.
- These findings highlight the need for careful consideration of PPM necessity in TAVR patients.
Importance:
The literature is inconsistent regarding the impact of permanent pacemaker implantation after transcatheter aortic valve replacement.
Objective:
To evaluate clinical and economic outcomes in patients who required permanent pacemaker implantation during the index hospitalization after transcatheter aortic valve replacement.
Design, Setting, And Participants:
This retrospective, population-based cohort study using data from a multicenter registry included patients who underwent a transcatheter aortic valve replacement procedure from April 1, 2010, to March 31, 2015, in Ontario, Canada, with follow-up to March 31, 2017. Patients who had a previously implanted permanent pacemaker or who died during the index hospitalization were excluded. Inverse probability of treatment weighting using the propensity score was used to adjust for baseline differences between the pacemaker and nonpacemaker groups.
Exposures:
Patients received a permanent pacemaker during the index hospitalization after transcatheter aortic valve replacement.
Main Outcomes And Measures:
All-cause mortality, readmission, readmission for heart failure, emergency department visits, and cumulative 1-year health care costs.
Results:
The study cohort consisted of 1263 patients (mean [SD] age, 82.3 [7.2] years; 595 [47.1%] female; 137 [10.8%] rural), of whom 186 (14.7%) required permanent pacemaker insertion during the index hospitalization after transcatheter aortic valve replacement. Mean follow-up was 990 days. After propensity score weighting, over the entire follow-up period, pacemaker implantation was associated with significantly higher all-cause mortality (43.9% vs 31.7%; hazard ratio [HR], 1.40; 95% CI, 1.01-1.94; P = .04), all-cause readmission (80.9% vs 70.6%; HR, 1.28; 95% CI, 1.15-1.43; P < .001), and emergency department visits (95.5% vs 87.3%; HR, 1.28; 95% CI, 1.08-1.52; P = .004). Pacemaker implantation was also associated with significantly greater readmission for heart failure (33.9% vs 19.1%; HR, 1.90; 95% CI, 1.53-2.36; P < .001). There were no statistically significant differences between groups in adjusted cumulative health care costs 1 year after discharge.
Conclusions And Relevance:
New permanent pacemaker implantation after transcatheter aortic valve replacement was associated with significantly greater morbidity and mortality at long-term follow-up. However, this did not translate to a difference in cumulative health care costs after hospital discharge.
Related Concept Videos
01:22Aortic Regurgitation II: Clinical Features and Diagnostic Tests
02:24Predicting Reaction Outcomes
01:16Heart Valves
The AV valves prevent the backflow of blood from the ventricles to the atria during ventricular contraction. These valves function with the assistance of the chordae tendineae and papillary muscles. When the ventricles are relaxed, the chordae tendineae are slack, allowing blood to flow from the atria into the...
01:13Outcomes of Glycolysis
Cellular respiration can occur aerobically (with oxygen) or anaerobically (without oxygen). In the presence of oxygen, cellular respiration starts with glycolysis and continues with pyruvate...
01:21Association Areas of the Cortex
Prefrontal Association Area: This area is located in the frontal lobe and is involved in planning, decision-making, and moderating social behavior. It connects with primary motor areas,...
01:27Associative Learning
Classical conditioning, also known...