Pacemaker implantation after surgical aortic valve replacement and balloon-expandable transcatheter aortic valve implantation: Incidence, predictors, and prognosis

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2 Pub Date : 2025-03-01 DOI:10.1016/j.hroo.2025.01.001

Davide Gabbieri MD, PhD , Italo Ghidoni MD , Greta Mascheroni MD , Matteo Chiarabelli RN, MSN , Giuseppe D’Anniballe MD , Paolo Pisi MD , Marco Meli MD , Clorinda Labia MD , Alice Barbieri CP , Francesca Spina CP , Federico Giorgi MD

{"title":"Pacemaker implantation after surgical aortic valve replacement and balloon-expandable transcatheter aortic valve implantation: Incidence, predictors, and prognosis","authors":"Davide Gabbieri MD, PhD , Italo Ghidoni MD , Greta Mascheroni MD , Matteo Chiarabelli RN, MSN , Giuseppe D’Anniballe MD , Paolo Pisi MD , Marco Meli MD , Clorinda Labia MD , Alice Barbieri CP , Francesca Spina CP , Federico Giorgi MD","doi":"10.1016/j.hroo.2025.01.001","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) remains a significant challenge despite new-generation devices.</div></div><div><h3>Objectives</h3><div>This study aimed to identify predictors of PPI during preoperative evaluation and assess its mid-term impact in a single-center, real-world setting.</div></div><div><h3>Methods</h3><div>From 2010 to 2020, 1486 patients with aortic stenosis underwent surgical aortic valve replacement or TAVI using balloon-expandable transcatheter heart valves. The PPI rate was estimated using the hospital discharge record for each patient in the Emilia-Romagna region.</div></div><div><h3>Results</h3><div>The 30-day incidence of PPI in the TAVI group was 3.4%. While 30-day PPI did not affect overall survival (log-rank, P = .494 NS), it predicted rehospitalization due to cardiac causes (hazard ratio 10.28; 95% confidence interval [CI] 95% 3.41–31.00; P <.001). Calcifications in the leaflet (odds ratio [OR] 4.66; 95% CI 1.41–15.47; P = .012), left ventricular outflow tract (OR 4.51; 95% CI 1.48–13.76; P = .008), and device landing zone (OR 2.52; 9% CI 0.86–7.40; P = .093) were associated with a higher risk of PPI.</div></div><div><h3>Conclusion</h3><div>A low 30-day PPI incidence was observed, primarily because of the exclusive use of balloon-expandable SAPIEN transcatheter heart valves and high implantation techniques. Baseline factors such as leaflet, left ventricular outflow tract, and device landing zone calcifications, as well as right bundle branch block, highlight the need for comprehensive preoperative analysis to reduce PPI incidence and mitigate its associated longer hospital stays and rehospitalizations due to cardiac causes.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 3","pages":"Pages 259-272"},"PeriodicalIF":2.5000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Heart Rhythm O2","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666501825000017","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) remains a significant challenge despite new-generation devices.

Objectives

This study aimed to identify predictors of PPI during preoperative evaluation and assess its mid-term impact in a single-center, real-world setting.

Methods

From 2010 to 2020, 1486 patients with aortic stenosis underwent surgical aortic valve replacement or TAVI using balloon-expandable transcatheter heart valves. The PPI rate was estimated using the hospital discharge record for each patient in the Emilia-Romagna region.

Results

The 30-day incidence of PPI in the TAVI group was 3.4%. While 30-day PPI did not affect overall survival (log-rank, P = .494 NS), it predicted rehospitalization due to cardiac causes (hazard ratio 10.28; 95% confidence interval [CI] 95% 3.41–31.00; P <.001). Calcifications in the leaflet (odds ratio [OR] 4.66; 95% CI 1.41–15.47; P = .012), left ventricular outflow tract (OR 4.51; 95% CI 1.48–13.76; P = .008), and device landing zone (OR 2.52; 9% CI 0.86–7.40; P = .093) were associated with a higher risk of PPI.

Conclusion

A low 30-day PPI incidence was observed, primarily because of the exclusive use of balloon-expandable SAPIEN transcatheter heart valves and high implantation techniques. Baseline factors such as leaflet, left ventricular outflow tract, and device landing zone calcifications, as well as right bundle branch block, highlight the need for comprehensive preoperative analysis to reduce PPI incidence and mitigate its associated longer hospital stays and rehospitalizations due to cardiac causes.

Abstract Image