Implantation depth of balloon-expandable transcatheter heart valves and risks for permanent pacemaker implantation and midterm adverse events.

Pellegrini, Costanza; Freißmuth, Markus; Rheude, Tobias; Graas, David; Mayr, N Patrick; Syryca, Finn; Alvarez-Covarrubias, Hector A; Fetcu, Andrei; Hübner, Judith; Lennerz, Carsten; Schunkert, Heribert; Kastrati, Adnan; Xhepa, Erion; Joner, Michael

doi:10.1002/ccd.30870

2023

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Document type:: Journal Article
Author(s):: Pellegrini, Costanza; Freißmuth, Markus; Rheude, Tobias; Graas, David; Mayr, N Patrick; Syryca, Finn; Alvarez-Covarrubias, Hector A; Fetcu, Andrei; Hübner, Judith; Lennerz, Carsten; Schunkert, Heribert; Kastrati, Adnan; Xhepa, Erion; Joner, Michael
Title:: Implantation depth of balloon-expandable transcatheter heart valves and risks for permanent pacemaker implantation and midterm adverse events.
Abstract:: BACKGROUND: Permanent pacemaker implantation (PPI) remains a relevant complication after transcatheter aortic valve implantation (TAVI) and its impact on outcome remains controversial. AIMS: This study aimed to analyze the effects of implantation depth on PPI at 30 days and assess its impact on outcome with the balloon-expandable Sapien 3 (S3) prosthesis. METHODS: Between 2014 and 2018, 849 patients without previous pacemaker undergoing transfemoral TAVI with the S3 were included. Prosthesis implantation depth was measured and divided into Quintiles. An ordinal logistic regression was used to assess its association with PPI, while a multivariate logistic regression was performed to identify predictors of PPI. Survival analyses were performed with the Kaplan-Meier method and a multivariable Cox regression was performed to ascertain the impact of PPI on mortality. RESULTS: Overall, incidence of PPI at 30 days was 9.7%. Implantation depth decreased consistently from a median of 6.7 mm [5.55-8.00] in 2014 to 2.7 mm [2.30-3.50] in 2018 (p < 0.001). When considering Quintiles of implantation depth, incidence of PPI was significantly higher in upper Quintiles and risk for PPI was significantly lower for the 1. Quintile compared to the 5. Quintile (OR: 0.34, 95% CI: [0.16-0.73]; p = 0.003). In the adjusted multivariable logistic regression implantation depth persisted ad independent predictor of PPI at 30 days. Patients requiring PPI at 30 days displayed significantly higher mortality at 4 years compared to patients without PPI (49.5% vs. 40.0%; log-rank = 0.022). In a multivariate analysis, increased logistic EuroScore, diabetes mellitus, and history of atrial fibrillation, were independent predictors of all-cause mortality at 2 years. CONCLUSIONS: Higher prosthesis implantation relative to the virtual aortic annulus was significantly associated with reduced risk for PPI at 30 days. Patients with PPI at 30 days exhibited higher mortality during follow-up, however, only logistic EuroScore, diabetes mellitus, and history of atrial fibrillation were identified as independent predictors of mortality at 2 years.
Journal title abbreviation:: Catheter Cardiovasc Interv
Year:: 2023
Journal volume:: 102
Journal issue:: 7
Pages contribution:: 1301-1310
Fulltext / DOI:: doi:10.1002/ccd.30870
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/37877190
Print-ISSN:: 1522-1946
TUM Institution:: Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (DHM) (Prof. Schunkert)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (DHM) (Prof. Schunkert)2023