Quality of life outcomes in transcatheter aortic valve replacement patients requiring pacemaker implantation

Abstract

BackgroundPermanent pacemaker implantation is the most common complication after Transcatheter aortic valve replacement (TAVR) and is associated with worse outcomes and mortality. However, its impact on quality‐of‐life (QoL) outcomes remains unknown.MethodsWe included 383 consecutive patients undergoing TAVR from January 2012 to 2016 who completed a baseline Kansas City Cardiomyopathy Questionnaire (KCCQ‐12) health survey. The clinical, laboratory, angiographic, QoL, mortality, and occurrence of poor outcomes (KCCQ‐12 score < 45 or KCCQ decrease of ≥10 points) were obtained.ResultsThe mean age was 83 ± 8 years, 51% were men, and majority were Caucasians (n = 364, 95%). Permanent pacemaker (PPM) was implanted in 11.5% of patients post‐TAVR. PPM patients were more likely to have prior conduction disease including RBBB (25% vs 12%, P = .02) and PQ interval >250 ms (11% vs 5%, P = .07). One‐month median KCCQ‐12 scores were significantly lower among PPM patients (84.7 vs 68.8, P = .04), but did not differ significantly at 1‐year (86.5 vs 90.6, P = .5) post‐TAVR. Occurrence of poor outcomes did not differ significantly among those with or without PPM at 1 month (11% vs 7%, P = .39) and 1 year (13% vs 9%, P = .45), respectively. However, patients with poor QoL outcomes at 1 month post‐TAVR also had significantly worse mortality during follow‐up in unadjusted (31.3% vs 4.5%, P < .001) and adjusted (HR = 5.30, 95% [CI: 1.85‐15.22, P = .002])analyses, respectively.ConclusionPermanent pacemaker implantation is associated with short‐term reduction in QoL without long‐term implications post‐TAVR. Patients with poor QoL post‐TAVR also have significantly higher mortality.

Impact of Bundle Branch Block on Permanent Pacemaker Implantation after Transcatheter Aortic Valve Implantation: A Meta-Analysis

“…Table 1 shows the baseline characteristics of the included studies. The 36 studies included a total of 55,851 patients in the final analysis, from 2005 to 2018 [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ]. The mean age of the patients was 81.9 years, with a mean STS score of 8.3.…”

Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: A Cost Analysis

“…Our facility exclusively utilizes the balloon expandable delivery systems of the Edwards Lifesciences Sapien line of devices, for which prior studies have identified a lower risk of post-implant conduction defects (around 5%) when compared to self-expanding device delivery systems (around 12%-39%) [28]. Our cohort compared well to previously published cohorts, with 19 patients (4.97%) necessitated pacing therapy [29]. Baseline characteristics between study groups were non-significant based on t-test and chi-squared testing, with the exception of underlying conduction abnormalities.…”

Evaluating treatment-specific post-discharge quality-of-life and cost-effectiveness of TAVR and SAVR: Current practice & future directions

“…Several studies outside of the PARTNER and CoreValve cohorts have further established that TAVR patients experience significant gains in QoL and functional recovery, with older patients and those needing a permanent pacemaker seeing smaller improvements [32] , [33] . Recent meta -analyses have documented that HRQOL and functional capacity improve after TAVR, despite better baseline functioning in recent studies and that non-TF TAVR patients’ trajectories are similar to those of SAVR patients [34] , [35] .…”