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Pacemaker Implantation After Balloon- or Self-Expandable Transcatheter Aortic Valve Replacement in Patients With

Arnaud Bisson1, Alexandre Bodin1, Julien Herbert1,2

  • 1Service de Cardiologie Centre Hospitalier Universitaire Trousseau et Faculté de Médecine EA7505 Université de Tours France.

Journal of the American Heart Association
|May 5, 2020
PubMed

Insights

Permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR) is more common than previously thought. Balloon-expandable TAVR valves are associated with lower PPI rates compared to self-expanding valves.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Biomaterials and Medical Devices

Background:

  • The incidence of conduction abnormalities requiring permanent pacemaker implantation (PPI) following transcatheter aortic valve replacement (TAVR) is a subject of ongoing debate, particularly concerning early versus later generation prostheses.
  • Understanding the factors influencing PPI rates is crucial for optimizing TAVR procedures and patient outcomes.

Purpose of the Study:

  • To compare the incidence of PPI after TAVR based on the type (balloon-expandable vs. self-expanding) and generation of the implanted valve.
  • To analyze PPI rates in a large, nationwide cohort of patients undergoing TAVR for aortic stenosis.

Main Methods:

  • A retrospective analysis of administrative hospital-discharge data from France (2010-2019) was conducted.
  • Data included 49,201 patients with aortic stenosis treated with TAVR using either balloon-expandable (BE) Edwards SAPIEN valves or self-expanding (SE) Medtronic CoreValve prostheses.
  • Multivariable analysis was used to compare PPI rates between different valve types and generations, adjusting for potential confounders.

Main Results:

  • The overall incidence of PPI was higher than previously reported, with 22.4% of patients requiring implantation within 30 days.
  • Compared to early balloon-expandable (BE) TAVR, latest BE TAVR showed a lower adjusted odds ratio for early PPI (0.88).
  • Self-expanding (SE) TAVR, both early (1.40) and latest (1.17), demonstrated higher adjusted odds ratios for early PPI compared to early BE TAVR.
  • During the entire follow-up, latest BE TAVR showed similar PPI rates to early BE TAVR (HR 1.01), while early SE TAVR (1.30) and latest SE TAVR (1.25) had higher rates.

Conclusions:

  • Balloon-expandable TAVR technology is independently associated with lower rates of permanent pacemaker implantation in both acute and chronic phases compared to self-expanding technology.
  • Recent generations of TAVR devices did not show independent associations with significantly different PPI rates compared to early generations over the entire follow-up period.
  • The findings highlight the importance of valve type selection in mitigating the risk of conduction abnormalities after TAVR.

Keywords:
aortic stenosispacemakertranscatheter aortic valve implantation

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