INCIDENCE OF PERMANENT PACEMAKER IMPLANTATIONS AND NEW-ONSET INTRAVENTRICULAR CONDUCTION ABNORMALITIES AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT: A COMPARISON OF THE NOVEL SAPIEN 3 WITH THE SAPIEN XT PROSTHESIS

Background: Permanent pacemaker (PPM) implantation is the main complication of transcatheter aortic valve replacement (TAVR). Few studies have evaluated the requirement for PPM implantation due to ECG changes following TAVR in a Chinese population.Objective: Our study aimed to evaluate the incidence and predictors of PPM implantation in a cohort of Chinese patients with TAVR.Methods: We retrospectively evaluated 39 consecutive patients with severe native aortic stenosis referred for TAVR with a self-expandable prosthesis, the Venus A valve (Venus MedTech Inc., Hangzhou, China), from 2019 to 2021 at the Heart Center of Affiliated Zhongshan Hospital of Dalian University. Predictors of PPM implantation were identified using logistic regression.Results: In our study, the incidence of PPM implantation was 20.5%. PPM implantation occurs with higher risk in patients with negative creatinine clearance (CrCl), dyslipidemia, high Society of Thoracic Surgeons (STS) Morbimortality scores, and lead I T wave elevation. TAVR induced several cardiac electrical changes such as increased R wave and T wave changes in lead V5. The main independent predictors of PPM implantation were new-onset left bundle branch block (LBBB) (coef: 3.211, 95% CI: 0.899–7.467, p = 0.004) and lead I T wave elevation (coef: 11.081, 95% CI: 1.632–28.083, p = 0.016).Conclusion: New-onset LBBB and lead I T wave elevation were the main independent predictors of PPM implantation in patients undergoing TAVR. Clinical indications such as negative CrCl, dyslipidemia, high STS Morbimortality scores, and an increased T wave elevation before TAVR should be treated with caution to decrease the need for subsequent PPM implantation.

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Abstract 12997: Impact of Baseline Atrial Fibrillation/Flutter on Short- and Long-term Outcomes After Transcatheter Aortic Valve Replacement With Sapien-3 Valve

Circulation ◽

10.1161/circ.142.suppl_3.12997 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Yasser Sammour ◽

Hassan Mehmood Lak ◽

Sanchit Chawla ◽

Cameron Incognito ◽

Arnav Kumar ◽

...

Keyword(s):

Atrial Fibrillation ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Transcatheter Aortic Valve ◽

Sapien 3 ◽

New Onset

Introduction: Pre-existing atrial fibrillation has been linked with poor outcomes among patients undergoing transcatheter aortic valve replacement (TAVR). Objective: We sought to study the impact of baseline atrial fibrillation/flutter (AF) on outcomes after TAVR with SAPIEN-3 (S3) valve. Methods: All consecutive patients with severe symptomatic aortic stenosis who underwent TAVR with S3 valve at the Cleveland Clinic between April 2015 and December 2018 were included. Results: We included 1028 consecutive patients. Overall, the mean age of our study population was 81 ± 8.9 years, 58.8% were males, 95.8% were Caucasians. Pre-existing AF was present in 432 patients (42%). STS risk score was higher with AF compared to no AF (6.7 ± 3.8% vs. 5.4 ± 3.4%; p < 0.001). Baseline left ventricular ejection fraction (LVEF) was lower with AF (54% vs. 58%; p < 0.001). The rates of 30-day permanent pacemaker (PPM) implantation were similar between AF and no AF (11.4% vs. 9.4%; p = 0.326), as were the rates of new-onset left bundle branch block (LBBB) at discharge (9.6% vs. 9.4%; p = 0.901). There was also no difference in stroke rates at 30 days between the 2 groups (1.6% vs. 1%; p = 0.385). Post-TAVR mild or greater aortic regurgitation (AR) was higher with AF compared to no AF (21.5% vs. 16%; p = 0.022). LVEF was lower with AF at both 30 days (56% vs. 58.5%; p < 0.001) and 1 year (56% vs. 59%; p < 0.001). However, the change in LVEF (Δ) after TAVR was similar between AF and no AF (+1.1% vs. +1.4%; p = 0.624). At 2 years, all-cause death was higher with AF (22.9% vs. 12.8%; log-rank p = 0.011). There was no mortality difference between persistent versus paroxysmal AF (log-rank p = 0.714). Conclusions: Among our S3 TAVR patients, AF did not affect PPM, new-onset LBBB or stroke rates after the procedure. AF was associated with higher mild or greater AR at 30 days, as well as lower LVEF at both 30 days and 1 year compared to no AF. There was significantly higher all-cause mortality in the AF group at 2 years after TAVR.

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TCT-533 New Permanent Pacemaker Implantation Does Not Affect Survival After Transcatheter Aortic Valve Replacement With Sapien-3 Valve

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2019.08.635 ◽

2019 ◽

Vol 74 (13) ◽

pp. B526

Author(s):

Yasser Sammour ◽

Kimi Sato ◽

Arnav Kumar ◽

Kinjal Banerjee ◽

Manpreet Kaur ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Pacemaker Implantation ◽

Permanent Pacemaker ◽

Permanent Pacemaker Implantation ◽

Transcatheter Aortic Valve ◽

Sapien 3

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Systematic Approach to High Implantation of SAPIEN-3 Valve Achieves a Lower Rate of Conduction Abnormalities Including Pacemaker Implantation

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.120.009407 ◽

2021 ◽

Vol 14 (1) ◽

Cited By ~ 1

Author(s):

Yasser Sammour ◽

Kinjal Banerjee ◽

Arnav Kumar ◽

Hassan Lak ◽

Sanchit Chawla ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Permanent Pacemaker ◽

Doppler Velocity ◽

Severe Aortic Regurgitation ◽

Transcatheter Aortic Valve ◽

Conduction Abnormalities ◽

Sapien 3

Background: The conventional method of implanting balloon-expandable SAPIEN-3 (S3) valve results in a final 70:30 or 80:20 ratio of the valve in the aorta:left ventricular outflow tract with published rates of permanent pacemaker around 10%. We sought to evaluate whether higher implantation of S3 reduces conduction abnormalities including the need for permanent pacemaker. Methods: We included consecutive patients who underwent transfemoral transcatheter aortic valve replacement using S3 between April 2015 and December 2018 and compared outcomes with typical valve deployment strategy to our more contemporary high deployment technique (HDT). We excluded patients with nontransfemoral access or valve-in-valve. Results: Among 1028 patients, HDT was performed in 406 patients (39.5%). Mean implantation depth under the noncoronary cusp was significantly smaller with HDT compared with conventional technique (1.5±1.6 versus 3.2±1.9 mm; P <0.001). Successful implantation was achieved in 100% of the patients in both groups with no cases of conversion to open heart surgery, second valve implantation within the first transcatheter aortic valve replacement, or coronary occlusion during transcatheter aortic valve replacement. One patient (0.2%) had valve embolization with HDT ( P =0.216). Thirty-day permanent pacemaker rates were lower with HDT (5.5% versus 13.1%; P <0.001), as were rates of complete heart block (3.5% versus 11.2%; P <0.001) and new-onset left bundle branch block (5.3% versus 12.2%; P <0.001). There were no differences in mild (16.5% versus 15.9%; P =0.804), or moderate-to-severe aortic regurgitation (1% versus 2.7%; P =0.081) at 1 year. HDT was associated with slightly higher 1-year mean gradients (13.1±6.2 versus 11.8±4.9 mm Hg; P =0.042) and peak gradients (25±11.9 versus 22.5±9 mm Hg; P =0.026). However, Doppler velocity index was similar (0.47±0.15 versus 0.48±0.13; P =0.772). Conclusions: Our novel technique for balloon-expandable S3 valve positioning consistently achieves higher implantation resulting in substantial reduction in conduction abnormalities and permanent pacemaker requirement after transcatheter aortic valve replacement without compromising procedural safety or valve hemodynamics. Operators should consider this as an important technique to improve patient outcomes.

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