Pacemaker implantation rate after transcatheter aortic valve implantation with early and new-generation devices: a systematic review

Rosendael, Philippe J. van; Delgado, Victoria; Bax, Jeroen J.

doi:10.1093/eurheartj/ehx785

Cited by 228 publications

(166 citation statements)

References 82 publications

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“…Consistent with the literature, we found a higher rate of vascular complications and the need for permanent pacemaker placement with TAVR. However, both of these complications will likely continue to decline and may not pose a disadvantage with TAVR rather than a SAVR approach. Also consistent with previous literature, we found ilio‐femoral access to be protective, likely due to the less invasive nature of this approach, and the fact that those undergoing alternative access TAVR often have a higher burden of disease.…”

Section: Discussionsupporting

confidence: 88%

Clinical impact of baseline chronic kidney disease in patients undergoing transcatheter or surgical aortic valve replacement

Pineda

Harrison

Kleiman

et al. 2018

Cathet Cardio Intervent

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Objectives To assess the treatment effect of TAVR versus SAVR on clinical outcomes to 3 years in patients stratified by chronic kidney disease (CKD) by retrospectively studying patients randomized to TAVR or SAVR. Background The impact of CKD on mid‐term outcomes of patients undergoing TAVR versus SAVR is unclear. Methods Patients randomized to TAVR or SAVR in the CoreValve US Pivotal High Risk Trial were retrospectively stratified by eGFR: none/mild or moderate/severe CKD. To evaluate the impact of baseline CKD in TAVR patients only, all patients undergoing an attempted TAVR implant in the US Pivotal Trial and CAS were stratified by baseline eGFR into none/mild, moderate, and severe CKD. The primary endpoint was major adverse cardiovascular and renal events (MACRE), a composite of all‐cause mortality, myocardial infarction, stroke/TIA, and new requirement of dialysis. Results Moderate/severe CKD was present in 62.7% and 60.7% of high‐risk patients randomized to TAVR or SAVR, respectively. Baseline characteristics were similar between TAVR and SAVR patients in both CKD subgroups, except for higher rates of diabetes and higher serum creatinine in SAVR patients. Among high‐risk patients with moderate/severe CKD, TAVR provided a lower 3‐year MACRE rate compared with SAVR: 42.1% vs. 51.0, P = .04. Of 3,733 extreme‐ and high‐risk TAVR patients, 39.9% had none/mild, 53.8% moderate, and 6.4% severe CKD. Worsening baseline CKD was associated with increased 3‐year MACRE rates [none/mild 51.5%, moderate 54.5%, severe 63.1%, P = .001]. Conclusions TAVR results in lower 3‐year MACRE versus SAVR in high‐risk patients with moderate/severe CKD. In patients undergoing TAVR, worsening CKD increases mid‐term mortality and MACRE. Randomized trials of TAVR vs. SAVR in patients with moderate‐severe CKD would help elucidate the best treatment for these complex patients. Trial Registration CoreValve US Pivotal Trial: NCT01240902. CoreValve Continued Access Study: NCT01531374.

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Section: Discussionsupporting

confidence: 88%

Clinical impact of baseline chronic kidney disease in patients undergoing transcatheter or surgical aortic valve replacement

Pineda

Harrison

Kleiman

et al. 2018

Cathet Cardio Intervent

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“…However, the rates of pacemaker implantation have remained high, between 4.0% and 24.0% with the new-generation Edwards Sapien 3 device, and higher (14.7%–26.7%) for the new Medtronic Evolut R 23. Differences in pacemaker implantation rates with different TAVI devices relate to the different mechanisms of valve deployment (self-expandable vs balloon expandable), valve stent radial forces and valve positioning relative to the conduction tissue.…”

Section: What Are the Remaining Challenges For Tavi In Low-risk Patiementioning

confidence: 99%

Transcatheter aortic valve implantation in low-risk patients: is it too early?

Sousa-Uva

2019

Heart

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The median age of patients treated by transcatheter aortic valve implantation (TAVI) is falling across Europe, and low-risk patients with severe aortic stenosis (AS) represent 80% of patients with severe AS undergoing surgical aortic valve replacement (SAVR). There are few data for TAVI in low-risk patients, but there are four ongoing randomised trials of SAVR versus TAVI. The key issues relate to pacemaker implantation rates and the associated potential longer term deleterious effects, and the need to minimise vascular complications and paravalvular leak. Valve leaflet thrombosis and paucity of data on valve durability remain a concern. Given the higher incidence of bicuspid aortic valves in younger patients, outcomes of TAVI in this setting need clarification and are discussed.

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“…Prior RBBB and implantation depth have already been identified as predictors of conduction disturbances and PPI after TAVR, regardless of the prosthesis used …”

mentioning

confidence: 99%

Choose to fly higher rather than pacing around

Musumeci

Aranzulla

2020

Cathet Cardio Intervent

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Key Points Pre‐existing right bundle branch block and the depth of the prosthesis in the left ventricle are predictors of permanent pacemaker implantation (PPI) following transcatheter aortic valve replacement. The recapturable capability of the Evolut R system allows higher and more precise valve implantation and this was associated with halved incidence of PPI as compared with the CoreValve. Larger studies are needed to assess the feasibility of systematic very high implantation (depth in the left ventricle outflow tract ≤3 mm) of the Evolut R and the associated rate of PPI.

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Pacemaker implantation rate after transcatheter aortic valve implantation with early and new-generation devices: a systematic review

Abstract: The rate of PPI after TAVI with new-generation devices is highly variable. Specific recommendations for implantation of each prosthesis, taking into consideration the presence of pre-existent conduction abnormalities and anatomical factors, may be needed to reduce the risk of PPI.

Cited by 228 publications

References 82 publications

Clinical impact of baseline chronic kidney disease in patients undergoing transcatheter or surgical aortic valve replacement

Clinical impact of baseline chronic kidney disease in patients undergoing transcatheter or surgical aortic valve replacement

Transcatheter aortic valve implantation in low-risk patients: is it too early?

Choose to fly higher rather than pacing around

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