Related Experiment Video

Updated: Jul 19, 2025

Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
07:41

Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure

Published on: February 8, 2022

3.7K

Mortality Outcomes in Patients With Cardiac Implantable Electronic Devices Before and After Transcatheter Aortic

Luai Madanat1, Elizabeth Seeley2, Ramy Mando3

  • 1Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan.

The American Journal of Cardiology
|August 13, 2023
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) patients with existing cardiac implantable electronic devices (CIEDs) face higher mortality and heart failure readmissions. Adjusted survival rates showed no difference, suggesting pre-existing conditions influence outcomes.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Electrophysiology

Background:

  • Transcatheter aortic valve replacement (TAVR) is a common procedure for aortic stenosis.
  • High-grade atrioventricular block is a known complication of TAVR, often necessitating cardiac implantable electronic device (CIED) implantation.
  • The impact of pre-existing CIEDs on TAVR outcomes remains incompletely understood.

Purpose of the Study:

  • To evaluate the outcomes of TAVR in patients with pre-existing CIEDs compared to those who received a CIED post-TAVR or had no CIED.
  • To identify predictors of all-cause mortality and readmission rates following TAVR.

Main Methods:

  • Retrospective analysis of 366 patients undergoing TAVR between December 2014 and December 2019.
  • Patients were stratified into three groups: pre-existing CIED (Group 1), CIED implanted within 30 days post-TAVR (Group 2), and no CIED (Group 3).
  • Cox proportional hazard models were used to assess all-cause mortality; logistic regression for readmissions.

Main Results:

  • Patients with pre-existing CIEDs (Group 1) showed higher unadjusted all-cause mortality rates compared to Group 2 and Group 3.
  • Multivariate analysis revealed no statistically significant difference in adjusted long-term mortality among the three groups.
  • Group 1 had significantly higher 1-year readmission rates for congestive heart failure compared to Groups 2 and 3.
  • Preoperative hemoglobin levels ≤12 g/dL were identified as an independent predictor of all-cause mortality.

Conclusions:

  • While adjusted long-term survival is similar across groups, patients with pre-existing CIEDs undergoing TAVR experience higher mortality and heart failure readmission rates.
  • This increased risk appears linked to a higher burden of comorbidities rather than the CIED itself.
  • Preoperative assessment of comorbidities, including hemoglobin levels, is crucial for risk stratification in TAVR patients with existing CIEDs.

Keywords:
CIEDTAVRall-cause mortalitypacemakerrisk stratification

More Related Videos

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement14:14

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement

Published on: December 11, 2017

14.1K
Implantation of the Syncardia Total Artificial Heart16:11

Implantation of the Syncardia Total Artificial Heart

Published on: July 18, 2014

35.3K

Related Concept Videos

Aortic Regurgitation III: Medical Management01:25

Aortic Regurgitation III: Medical Management

Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
25
Cardiomyopathy V: Interprofessional Care01:29

Cardiomyopathy V: Interprofessional Care

Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
16
Aortic Regurgitation II: Clinical Features and Diagnostic Tests01:22

Aortic Regurgitation II: Clinical Features and Diagnostic Tests

Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
23
Endocarditis III: Medical Management01:18

Endocarditis III: Medical Management

Infective endocarditis management involves a multifaceted approach encompassing infection prevention, lifestyle modifications, pharmacological therapy, and surgical management.Infection Prevention:Hand Hygiene: Thorough handwashing is crucial to prevent the spread of infection. Hand hygiene should be performed regularly, especially before and after using the restroom.Oral Hygiene: Good oral hygiene is essential. It includes brushing teeth immediately after waking up and before bed, flossing...
8
Aneurysm IV: Nursing Management01:22

Aneurysm IV: Nursing Management

Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
8
Mitral Stenosis IV: Nursing Management01:27

Mitral Stenosis IV: Nursing Management

A comprehensive nursing assessment is essential for patients with valvular heart disease, which involves any dysfunction of the heart valves that could impact blood flow and overall heart function.Subjective Data Collection:Chief Complaint and Present Illness: Start with the patient's primary concerns, focusing on the onset, duration, and progression of cardiac symptoms such as dyspnea, fatigue, chest pain, and palpitations.Past Medical History: Collect detailed information on any previous...
14