Predictors of permanent pacemaker implantation for transcatheter self-expandable aortic valve implant in the cusp overlap era.

Autor: Mendiz OA; Interventional Cardiology Department, Cardiology and Cardiovascular Surgery Institute (ICCYC), Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina., Fava C; Interventional Cardiology Department, Cardiology and Cardiovascular Surgery Institute (ICCYC), Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina., Müller LI; Cardiology Department, Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina., Lev GA; Interventional Cardiology Department, Cardiology and Cardiovascular Surgery Institute (ICCYC), Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina., Heredia G; Interventional Cardiology Department, Cardiology and Cardiovascular Surgery Institute (ICCYC), Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina., Gómez SE; Interventional Cardiology Department, Cardiology and Cardiovascular Surgery Institute (ICCYC), Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina., Cedeño J; Interventional Cardiology Department, Cardiology and Cardiovascular Surgery Institute (ICCYC), Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina., Pérez JM; Interventional Cardiology Department, Cardiology and Cardiovascular Surgery Institute (ICCYC), Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina., Lamelas P; Interventional Cardiology Department, Cardiology and Cardiovascular Surgery Institute (ICCYC), Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina.; Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
Jazyk: angličtina
Zdroj: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions [Catheter Cardiovasc Interv] 2024 Nov; Vol. 104 (5), pp. 1071-1078. Date of Electronic Publication: 2024 Aug 18.
DOI: 10.1002/ccd.31176
Abstrakt: Background: Predictors of permanent pacemaker implantation (PPMI) after self-expanding transcatheter aortic valve implant (TAVI) were described. Is unknown if PPMI predictors remain in the era of high implants using the cusp overlap (COP).
Methods: Single-center, prospective, consecutive case series of patients undergoing self-expanding TAVI with the COP approach. The status of PPMI and other clinical events were ascertained at 30 days.
Results: A total of 261 patients were included (84% with Evolut, n = 219). Implant depth >4 mm was infrequent (13.8%). TAVI depth (OR 1.259; p = 0.005), first or second-degree auriculo-ventricular block (OR 3.406; p = 0.033), right-bundle (OR 15.477; p < 0.0001), and incomplete left-bundle branch block (OR 7.964; p = 0.036) were found to be independent predictors of PPMI. The risk of PPMI with deep implant and no electrical disturbances was 3%, and 0% with high implant and no prior electrical disturbances. Those who received PPMI had no statistically significant increased risk of death, myocardial infarction, stroke, bleeding events, or vascular complications at 30 days, but longer hospital stay (mean difference 1.43 days more, p = 0.003).
Conclusions: Implant depth and prior conduction abnormalities remain the main predictors of PPMI using self-expanding TAVI in the COP era. Patients with high implants and no prior conduction abnormalities may be candidates for early discharge after uneventful self-expanding TAVI, while the rest may need inpatient monitoring regardless of achieving a high implant. The need for PPMI was associated with longer hospital stays.
(© 2024 Wiley Periodicals LLC.)
Databáze: MEDLINE
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