Predictors of permanent pacemaker requirement after transcatheter aortic valve implantation: Insights from a Brazilian Registry

Gensas, Caroline Saltz; Caixeta, Adriano; Siqueira, Dimytri; Carvalho, Lucila; Sarmento‐Leite, Rogério; Mangione, José Armando; Lemos, Pedro A.; Colafranceschi, Alexandre Siciliano; Caramori, Paulo; Ferreira, Maria Cristina Duarte; Abizaid, Alexandre; Brito, Fábio Sândoli de

doi:10.1016/j.ijcard.2014.05.020

Cited by 45 publications

(35 citation statements)

References 30 publications

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“…21 Of note, in a previous analysis of the Brazilian registry, with fewer patients and mostly with the CoreValve bioprosthesis, BAVP was associated with an increased need for permanent pacemaker implantation. 15 This finding, which was not replicated in our expanded series, make us think that pacemaker implantation after TAVR may be influenced by multiple factors, including liberality of indication, previous conduction disturbances, and technical factors such depth of implantation of the THV and also BAVP. Therefore, we think that avoiding any conduction disturbance should always be desired and precluding BAVP might be particularly advisable in some situations during CoreValve implants, for instance, in patients with previous right bundle branch block, to reduce the risk of advanced AV block and the need for a permanent pacemaker implantation.…”

Section: Discussionmentioning

confidence: 65%

“…12 Furthermore, preparing the aortic valve with BAVP, especially in those patients with a larger burden of valve calcification, may offer more room and further decrease the risks of hemodynamic instability during device delivery, facilitating the proper position of the THV, potentially leading to a more precise deployment with better outcomes. [13][14][15] In addition, preparation of the aortic valve could facilitate full and symmetrical expansion of the device, ultimately resulting in less paravalvular leak and minimal transaortic gradient. Finally, during balloon inflation for BAVP, there is the possibility of performing aortography that can assist in the evaluation of aortic annulus size and also assess the potential risk of coronary obstruction.…”

Section: Discussionmentioning

confidence: 99%

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Direct Transcatheter Heart Valve Implantation Versus Implantation With Balloon Predilatation

Bernardi

Ribeiro

Carvalho

et al. 2016

Circ: Cardiovascular Interventions

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T ranscatheter aortic valve replacement (TAVR) is a complex multistep procedure that has been established as a treatment option for patients with severe aortic stenosis, considered to be inoperable or at high surgical risk. 1 In experienced centers, there has been a trend toward a simplification of the procedure, moving from general anesthesia and surgical cutdown for the femoral access, to a more minimalistic approach with conscious sedation, local anesthesia, and a fully percutaneous approach.2 Likewise, during the early days of TAVR, balloon aortic valve predilatation (BAVP) was considered an essential step to prepare the calcified aortic valve for the correct positioning and deployment of bulkier transcatheter heart valves (THV). Nonetheless, in line with this trend of making the procedure more straightforward, together with the greater experience of the operators and improvement of devices and technique, the need for predilatation has been questioned. Background-Direct

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Direct Transcatheter Heart Valve Implantation Versus Implantation With Balloon Predilatation

Bernardi

Ribeiro

Carvalho

et al. 2016

Circ: Cardiovascular Interventions

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“…Our search yielded 23 studies [12][13][14]16,17,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] with 20 287 patients and 2553 PPM implantations published between the years 2010 and 2016 (Table). (Figure 2).…”

Section: Resultsmentioning

confidence: 99%

“…[46][47][48][49] Among studies included in our analysis, only 3 had follow-up 12 Urena et al, 16 Buellesfeld et al, 26 Ledwoch et al, 29 and Maan et al Impact of Post-TAVR Pacemaker longer than 3 years. 23,31,36 In addition, higher cumulative ventricular pacing percentage has been shown to be a strong predictor of negative outcomes. 47 However, Van der Boon et al 50 showed that over 50% of patients with PPM after TAVR are not pacemaker dependent on 1-year follow-up.…”

Section: Downloaded Frommentioning

confidence: 99%

“…The center of the diamond represents the point estimate and the width represents 95% confidence interval (CI). Studies included in these analyses are Dizon et al, 13 Biner et al, 14 Urena et al, 16 Weber et al, 17 Carrabba et al, 21 Houthuizen et al, 25 Van Mieghem et al, 28 Gensas et al, 31 Kostopoulou et al, 34 Engborg et al, 36 and Kawaguchi et al 37 CI indicates confidence interval; MH, Mantel-Haenszel; and PPM, permanent pacemaker. Impact of Post-TAVR Pacemaker…”

Section: All-cause Mortality Cardiovascular Mortality MI and Strokmentioning

confidence: 99%

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Clinical and Echocardiographic Outcomes Following Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement

Mohananey

Jobanputra

Kumar

et al. 2017

Circ: Cardiovascular Interventions

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Background— Transcatheter aortic valve replacement has become the procedure of choice for inoperable, high-risk, and many intermediate-risk patients with aortic stenosis. Conduction abnormalities are a common finding after transcatheter aortic valve replacement and often result in permanent pacemaker (PPM) implantation. Data pertaining to the clinical impact of PPM implantation are controversial. We used meta-analysis techniques to summarize the effect of PPM implantation on clinical and echocardiographic outcomes after transcatheter aortic valve replacement. Methods and Results— Data were summarized as Mantel–Haenszel relative risk (RR) and 95% confidence intervals (CIs) for dichotomous variables and as standardized mean difference and 95% CI for continuous variables We used the Higgins I 2 statistic to evaluate heterogeneity. We found that patients with and without PPM have similar all-cause mortality (RR, 0.85; 95% CI, 0.70–1.03), cardiovascular mortality (RR, 0.84; 95% CI, 0.59–1.18), myocardial infarction (RR, 0.47; 95% CI, 0.20–1.11), and stroke (RR, 1.26; 95% CI, 0.70–2.26) at 30 days. The groups were also comparable in all-cause mortality (RR, 1.03; 95% CI, 0.92–1.16), cardiovascular mortality (RR, 0.69; 95% CI, 0.39–1.24), myocardial infarction (RR, 0.58; 95% CI, 0.30–1.13), and stroke (RR, 0.70; 95% CI, 0.47–1.04) at 1 year. We observed that the improvement in left ventricular ejection fraction was significantly greater in the patients without PPM (standardized mean difference, 0.22; 95% CI, 0.12–0.32). Conclusions— PPM implantation is not associated with increased risk of all-cause mortality, cardiovascular mortality, stroke, or myocardial infarction both at short- and long-term follow-up. However, PPM is associated with impaired left ventricular ejection fraction recovery post-transcatheter aortic valve replacement.

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Surgical cutdown versus percutaneous access in transfemoral transcatheter aortic valve implantation: Insights from the Brazilian TAVI registry

Bernardi

Gomes

Brito

et al. 2015

Cathet Cardio Intervent

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Predictors of permanent pacemaker requirement after transcatheter aortic valve implantation: Insights from a Brazilian Registry

Cited by 45 publications

References 30 publications

Direct Transcatheter Heart Valve Implantation Versus Implantation With Balloon Predilatation

Direct Transcatheter Heart Valve Implantation Versus Implantation With Balloon Predilatation

Clinical and Echocardiographic Outcomes Following Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement

Surgical cutdown versus percutaneous access in transfemoral transcatheter aortic valve implantation: Insights from the Brazilian TAVI registry

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