scholarly journals B-PO04-029 PERMANENT PACEMAKER IMPLANTATION RATE AND LONG TERM VENTRICULAR PACING PERCENTAGE AFTER TRANSCATHETER AORTIC VS. SURGICAL AORTIC VALVE REPLACEMENT

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S291
Author(s):  
Jennifer Riggs ◽  
Qiuqing Wang ◽  
Kathy Wolski ◽  
Wael A. Jaber ◽  
Amar Krishnaswamy ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Pacemaker Implantation ◽  
Implantation Rate ◽  
Permanent Pacemaker ◽  
Ventricular Pacing ◽  
Surgical Aortic Valve Replacement ◽  
Permanent Pacemaker Implantation

scholarly journals Prevalence of permanent pacemaker implantation after conventional aortic valve replacement—a propensity-matched analysis in patients with a bicuspid or tricuspid aortic valve: a benchmark for transcatheter aortic valve replacement

2020 ◽  
Vol 58 (1) ◽  
pp. 130-137 ◽  
Author(s):  
Josephina Haunschild ◽  
Martin Misfeld ◽  
Thomas Schroeter ◽  
Frank Lindemann ◽  
Piroze Davierwala ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Tricuspid Aortic Valve ◽  
Permanent Pacemaker Implantation ◽  
Transcatheter Aortic Valve

Abstract OBJECTIVES Elective treatment of aortic valve disease by transcatheter aortic valve replacement (TAVR) is becoming increasingly popular, even in patients with low risk and intermediate risk. Even patients with a bicuspid aortic valve (BAV) are increasingly considered eligible for TAVR. Permanent pacemaker implantation (PMI) is a known—frequently understated—complication of TAVR affecting 9–15% of TAVR patients with a potentially significant impact on longevity and quality of life. BAV patients are affected by the highest PMI rates, although they are frequently younger compared to their tricuspid peers. The aim of the study is to report benchmark data—from a high-volume centre (with a competitive TAVR programme) on PMI after isolated surgical aortic valve replacement (SAVR) in patients with BAV and tricuspid aortic valve (TAV). METHODS We performed a retrospective single-centre analysis on 4154 patients receiving isolated SAVRs (w/o concomitant procedures), between 2000 and 2019, of whom 1108 had BAV (27%). PMI rate and early- and long-term outcomes were analysed. For better comparability of these demographically unequal cohorts, 1:1 nearest neighbour matching was performed. RESULTS At the time of SAVR, BAV patients were on average 10 years younger than their TAV peers (59.7 ± 12 vs 69.3 ± 9; P < 0.001) and had less comorbidities; all relevant characteristics were equally balanced after statistical matching. Overall PMI rate was significantly higher in BAV patients (5.4% vs 3.8%; P = 0.03). BAV required PMI exclusively (100%) and TAV required predominately (96%) for persistent postoperative high-degree atrioventricular block. After matching, the PMI rate was similar (5.1% vs 4.4%, P = 0.5). In-hospital mortality in the matched cohort was 1% in both groups. Long-term survival was more favourable in BAV patients (94% vs 90% in TAV at 5 years; 89% vs 82% in TAV at 9 years; P = 0.013). CONCLUSIONS With SAVR, the overall incidence of PMI among BAV patients seems significantly higher; however, after propensity matching, no difference in PMI rates between BAV and TAV is evident. The PMI rate was remarkably lower among BAV patients after SAVR compared to the reported incidence after TAVR.

Oversizing Increases Pacemaker Implantation Rate After Sutureless Minimally Invasive Aortic Valve Replacement

2020 ◽  
Vol 15 (5) ◽  
pp. 449-455
Author(s):  
Borut Geršak ◽  
Mattia Glauber ◽  
Denis Bouchard ◽  
Jure Jug ◽  
Marco Solinas
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Pacemaker Implantation ◽  
Implantation Rate ◽  
Permanent Pacemaker ◽  
Multivariable Logistic Regression Model ◽  
Permanent Pacemaker Implantation ◽  
Valve Size

Objective Cardiac conduction system disturbances potentially leading to permanent pacemaker implantation are significant postoperative complications after aortic valve replacement. The aim of this study was to assess the impact of sutureless prosthetic valve oversizing on permanent pacemaker implantation rate. Methods This multicenter retrospective study included 306 patients who underwent minimally invasive aortic valve replacement with the Perceval sutureless valve. Oversizing was determined by the implanted valve size indexed to body surface area. Data were analyzed with a multivariable logistic regression model. Results This study confirmed excellent postoperative results for minimally invasive aortic valve replacement with right anterior minithoracotomy approach and rapid deployment sutureless valves. Mortality rate was 1%. Eighteen (5.9%) patients received a new permanent pacemaker. Multivariable logistic regression model ( P = 0.05) found oversizing as significant risk factor ( P = 0.017) for permanent postoperative pacemaker implantation independent of patient age. There was a significant negative correlation between the indexed implanted valve size and the mean and peak postoperative transvalvular gradients ( P < 0.001). Conclusions Oversizing of sutureless prosthetic aortic valves is a risk factor for postoperative permanent pacemaker implantation. Proper sizing of Perceval is important to avoid complications and ensure optimal valve performance.

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