Pacemaker Implantation Rates With the Self-Expandable Navitor Valve

Area of Science:

• Cardiology
• Interventional Cardiology
• Biomedical Engineering

Background:

• Self-expandable valves in transcatheter aortic valve replacement (TAVR) are associated with higher permanent pacemaker implantation (PPI) rates than balloon-expandable systems.
• The Navitor prosthesis is a novel, tubular-shaped self-expandable valve with increasing clinical use.

Purpose of the Study:

• To compare 30-day PPI rates between the Navitor and Evolut self-expandable TAVR systems.
• To investigate factors influencing PPI rates with the Navitor prosthesis.

Main Methods:

• A comparative study of 148 patients receiving the Navitor system and 165 patients receiving the Evolut system.
• Exclusion of patients with pre-existing PPI, high-risk ECG, or specific prosthesis sizes.
• Multivariable logistic regression analysis to adjust for baseline differences.

Main Results:

• The Navitor group was older and had a higher predicted mortality risk.
• Overall PPI rates were significantly higher with Navitor (17.6%) versus Evolut (6.7%), persisting after adjustment.
• In patients with small annuli, PPI rates were similar between the two systems.
• Higher PPI rates were observed with larger Navitor prostheses (27/29mm).
• Deeper implantation depth was associated with lower PPI rates in the Navitor cohort.

Conclusions:

• Navitor TAVR may have PPI rates comparable to other self-expandable valves, depending on prosthesis size.
• Optimizing implantation depth for the Navitor prosthesis could potentially reduce PPI rates.