Predictors of Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement
| Autor: | Matthew J. Hoyt, Roseanne Palmer, Jessica Hathaway, Michael L. Beach |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Leak Time Factors medicine.medical_treatment Transcatheter Aortic Valve Replacement Electrocardiography Valve replacement Risk Factors Internal medicine Odds Ratio medicine Humans Pacemaker Placement Risk factor Retrospective Studies Aged 80 and over Heart Valve Prosthesis Implantation medicine.diagnostic_test business.industry Retrospective cohort study Aortic Valve Stenosis Odds ratio medicine.disease Surgery Treatment Outcome Anesthesiology and Pain Medicine Heart Valve Prosthesis Aortic valve stenosis Cardiology Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of Cardiothoracic and Vascular Anesthesia. 29:1162-1166 |
| ISSN: | 1053-0770 |
| DOI: | 10.1053/j.jvca.2015.06.001 |
| Popis: | Objective Determine predictors of permanent pacemaker (PPM) implantation after transcatheter aortic valve replacement (TAVR). Design A retrospective chart review of patients undergoing TAVR at the authors’ institution. Extracted data included patient demographics, electrocardiogram, procedural, and echocardiographic data. Multivariate regression was performed to identify associations with PPM implantation. Setting Single-center academic hospital. Participants Patients undergoing TAVR. Interventions This study was retrospective. No interventions were performed on patients. Measurements and Main Results Baseline electrocardiogram, Society of Thoracic Surgeons score, age, and echocardiographic parameters were not predictors of PPM implantation. However, multiple deployments was a risk factor, and degree of paravalvular leak trended toward significance. Ten patients required placement of a 2nd valve, or valve-in-valve (VIV). Of the 10 patients with VIV, 5 (50%) required a PPM, compared with 8 (14%) of 56 patients with a single valve (OR 6.0, p = 0.02). PPM implantation occurred in 5 (42%) patients with no leak, 8 (19%) patients with trace leak, and no patients with mild or moderate leak (p = 0.085). In patients with no or trace leak, VIV increased the likelihood of PPM from 17.4% to 62.5% (OR 7.9, p = 0.006). For the 42 patients with trace leak, VIV increased the likelihood of PPM from 11.4% to 57.1% (OR 10.33, p = 0.005). Conclusions The authors found VIV placement, and likely degree of paravalvular leak, to be predictors of PPM placement. VIV and the degree of leak may be useful markers for postoperative prophylactic pacemaker placement. |
| Databáze: | OpenAIRE |
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