Abstract
Aims
Conduction disorders and permanent pacemaker implantation (PPI) continue to be an important issue in patients who undergo transcatheter aortic valve implantation (TAVI). The aim of this study was to investigate the incidence and clinical outcomes of new left bundle branch block (LBBB) and PPI after TAVI in a comparison between two self-expandable supra-annular transcatheter valves.
Methods and results
We report the data from an international, retrospective registry including 3862 consecutive patients who underwent TAVI with two self-expanding transcatheter heart valves (Medtronic Evolut R/PRO and Boston ACURATE neo). Patients with pre-existing left or right bundle branch block, any atrioventricular blocks or previous pacemaker implantation were excluded. Finally, we performed a propensity score matched analysis (PSM) to match the patients and overcome pre-procedural differences reaching 427 couples. New-onset Left Bundle Branch Block (LBBB) occurred with a rate of 13.1% (56/427) in the ACURATE group and 18.7% (80/427) in the Evolut group (P = 0.031). The incidence of new permanent pacemaker implantation was 16.4% (70/427) in the Evolut group and 6.8% (29/427) in the ACURATE group, respectively (P < 0.001). In the multivariate regression analysis, we found the valve recapture [odds ratio (OR): 4.66, 95% confidence interval (CI): 1.08–23.75, P = 0.042] as significant predictors for LBBB, and male sex (OR: 1.59, CI: 1.03–2.46, P = 0.036), ACURATE valve (OR: 0.34, CI: 0.20–0.57, P < 0.001) and post-procedure LBBB (OR: 4.38, CI: 2.78–6.85, P < 0.001) for PPI.
Conclusions
In our large multi-centre contemporary cohort of patients, new LBBB and PPI occurred more frequently in patients following TAVI with Evolut R/PRO vs. ACURATE valve. However, the choice of the valve seemed to influence only the rate of pacemaker implantation and not the incidence of new LBBB. Further data is required to clarify the impact of valve design on conduction abnormalities.
TCT-759 Valve Size as a Predictor of Permanent Pacemaker Implantation in Edwards Sapien 3 TAVR Valves: A Single Center Experience
