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Integrated Impact of Post-TAVR Cardiac Damage and Pacemaker Implantation on Long-Term Outcomes

Xinyue Yang1,2, Ruisi Tang1,2, Yijun Yao1,2

  • 1Department of Cardiology, West China Hospital, Sichuan University, No. 37 Guoxue Street, Chengdu 610041, China.

Biomedicines
|July 28, 2026
PubMed

Insights

Permanent pacemaker implantation (PPMI) after transcatheter aortic valve replacement (TAVR) combined with cardiac damage significantly increases mortality risk. Integrated assessment of these factors is crucial for identifying high-risk patients and guiding lifelong management after TAVR.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Post-procedural permanent pacemaker implantation (PPMI) and cardiac damage are known risk factors after transcatheter aortic valve replacement (TAVR).
  • The combined impact of PPMI and cardiac damage on long-term outcomes following TAVR has not been thoroughly investigated.

Purpose of the Study:

  • To evaluate the joint impact of post-TAVR permanent pacemaker implantation (PPMI) and cardiac damage on long-term patient prognosis.
  • To determine if cardiac damage can identify a subgroup of patients with PPMI who face particularly adverse outcomes.
  • To assess the predictive performance of a combined risk model for identifying high-risk TAVR patients.

Main Methods:

  • Retrospective analysis of 1274 patients undergoing TAVR between 2013 and 2024.
  • Patients were categorized into four groups based on PPMI and cardiac damage status.
  • Univariate and multivariable Cox regression, ROC curves, DCA, NRI, and IDI were employed to analyze outcomes and predictive performance.

Main Results:

  • Patients with both PPMI and advanced cardiac damage exhibited significantly higher all-cause mortality (HR: 2.98) and cardiac death rates (HR: 3.85) compared to those without PPMI and early cardiac damage.
  • PPMI and cardiac damage stage were confirmed as independent prognostic factors in multivariable analysis.
  • A predictive model incorporating both PPMI and cardiac damage demonstrated superior performance (AUC = 0.703) with significant reclassification improvements.

Conclusions:

  • This study identifies a high-risk subgroup of TAVR patients experiencing adverse long-term prognosis when both PPMI and cardiac damage are present.
  • Integrated risk assessment combining PPMI and cardiac damage status is essential for effective lifelong management of TAVR patients.
  • The findings underscore the need for careful monitoring and tailored strategies for patients with combined post-TAVR complications.

Keywords:
aortic stenosiscardiac damage staging classificationpermanent pacemakertranscatheter aortic valve replacement

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