| Autor: |
Moskowitz, Gil, Giustino, Gennaro, Ailawadi, Gorav, Chu, Michael W, Gillinov, A. Marc, Miller, Marissa, O?Gara, Patrick T, Taddei-Peters, Wendy C, Lala, Anuradha, Mancini, Donna M, DeRose, Joseph, Gelijns, Annetine C, Moskowitz, Alan J, Egorova, Natalia |
| Zdroj: |
Circulation (Ovid); November 2019, Vol. 140 Issue: Supplement 1 pA15592-A15592, 1p |
| Abstrakt: |
Introduction:Conduction disturbances requiring permanent pacemaker (PPM) implantation are relatively frequent complications of surgical aortic valve replacement (SAVR). However, their impact on long-term outcomes is controversial.Objectives:We sought to investigate the long-term impact on outcomes of PPM implantation after isolated SAVR.Methods:All patients undergoing isolated SAVR were analyzed using a mandatory New York State hospital discharge database between 1996 and 2015. Primary endpoints of interest were all-cause mortality, rehospitalization for heart failure (HF), and the composite of all-cause mortality or rehospitalization for HF. Cox multivariable regression modeling was used to adjust for baseline confounders. Maximum follow-up time was 15 years (median 9 years).Results:A total of 29,461 patients were included with a mean age of 67.93?13.70. Of these, 1,624 (5.5%) required a PPM implantation during the index hospitalization. At 15 years, patients who required a PPM had higher risk of all-cause mortality (63.02% vs.42.99%; adjusted hazard ratio [adjHR]: 1.34; 95% confidence interval [CI]: 1.06-1.71; p=0.02), rehospitalization for HF (31.06% vs. 22.75%; adjHR: 1.24; 95% CI: 1.09-1.40; p<0.001) and the composite of all-cause mortality or rehospitalization of HF (73.02% vs. 52.07%; adjHR: 1.26; 95% CI: 1.16-1.37; p<0.001). The association between PPM and all-cause mortality was consistent across age strata (Figure). PPM implantation was not associated with increased risk of infective endocarditis, pulmonary embolism and need for tricuspid valve intervention during follow-up.Conclusions:Need for PPM implantation after SAVR is associated with long-term increased risk in mortality and rehospitalization for HF. These findings raise concern about the long-term effect of PPM after transcatheter aortic valve replacement, which should be evaluated as long-term follow-up data become available. |
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