Outcomes of Permanent Pacemaker Implantation in Patients with Pure Aortic Regurgitation after TAVI.

Background: Transcatheter aortic valve implantation (TAVI) is increasingly utilized for patients with pure aortic regurgitation (PAR). A significant clinical challenge in this patient population is the need for permanent pacemaker implantation (PPI), which occurs frequently post-TAVI and can impact cardiac conduction and rhythm management. This study aimed to explore the effects of PPI on short-term mortality, rates of adverse events, and cardiac function in PAR patients following TAVI.

Methods: This retrospective study, conducted in a single center, included 69 PAR patients who underwent TAVI from January 2021 to December 2023. Patients were categorized into two groups: those who received a permanent pacemaker (PM) and those who did not (NPM). The outcomes measured included complications such as pacemaker pocket hematoma and infection, changes in postoperative left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) at 6 months, as well as rates of rehospitalization and mortality.

Results: No significant differences were noted in baseline characteristics or complications between the PM and NPM groups (p > 0.05). The types of PPI and associated complications were also comparable. There was no significant disparity in the incidence of all-cause mortality (PM: 12%, NPM: 11.36%, p = 0.755), major bleeding (PM: 4%, NPM: 4.55%, p = 0.612), or cerebral embolism (PM: 12%, NPM: 4.55%, p = 0.506) between the two groups at 6 months post-TAVI. Additionally, readmission rates were similar at 1, 3, and 6 months following the procedure. Multinomial logistic regression analysis revealed that age (p = 0.020), history of cerebral infarction (p = 0.015), and hypertension (p = 0.019) were significant predictors of mortality. The survival curve indicated that fatalities in the NPM group predominantly occurred during the perioperative period. At the 6-month follow-up, there was no significant difference in survival rates between the two groups (p = 0.971). Regarding cardiac function, irrespective of PPI, a decreasing trend in LVEDD (PM: -4.19 mm, NPM: -6.16 mm, p = 0.000) and an increasing trend in LVEF (PM: +2.19%, NPM: +2.74%, p = 0.053) were observed.

Conclusions: This study was the first to investigate the effects of PPI on the short-term mortality, adverse events, and cardiac function of PAR after TAVI. The results indicated that for PAR, advanced age and previous cerebral embolism increase the mortality after TAVI; however, PPI was not associated with mortality and adverse events after 6 months.