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Right bundle branch block and prosthesis depth predict permanent pacemaker implantation after TAVR. The Evolut R system, enabling higher valve placement, halved PPI rates compared to CoreValve, warranting further study.

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Area of Science:

  • Cardiology
  • Medical Devices
  • Interventional Cardiology

Background:

  • Transcatheter aortic valve replacement (TAVR) is a common procedure for aortic stenosis.
  • Permanent pacemaker implantation (PPI) is a known complication following TAVR.
  • Pre-existing right bundle branch block and prosthesis depth are identified predictors of PPI.

Discussion:

  • The Evolut R system's recapturable design facilitates higher and more precise valve deployment.
  • This improved implantation technique was associated with a significant reduction in PPI incidence.
  • A halved PPI rate was observed when comparing the Evolut R system to the CoreValve system.

Key Insights:

  • Higher and more precise prosthesis implantation using the Evolut R system reduces permanent pacemaker implantation (PPI) risk.
  • The Evolut R system demonstrated a halved incidence of PPI compared to the CoreValve system.
  • Systematic very high implantation (depth ≤3 mm in the left ventricle outflow tract) with Evolut R warrants further investigation.

Outlook:

  • Further large-scale studies are required to evaluate the systematic very high implantation strategy.
  • Assessing the feasibility and associated PPI rates of this technique is crucial for optimizing TAVR outcomes.
  • Investigating optimal implantation depths for TAVR devices can minimize complications like PPI.