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Title: Long-Term Outcomes in Patients With New Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement.
Authors: Chamandi, Chekrallah
Barbanti, Marco
Munoz-Garcia, Antonio
Latib, Azeem
Nombela-Franco, Luis
Gutiérrez-Ibanez, Enrique
Veiga-Fernandez, Gabriela
Cheema, Asim N
Cruz-Gonzalez, Ignacio
Serra, Vicenç
Tamburino, Corrado
Mangieri, Antonio
Colombo, Antonio
Jiménez-Quevedo, Pilar
Elizaga, Jaime
Laughlin, Gerard
Lee, Dae-Hyun
Garcia Del Blanco, Bruno
Rodriguez-Gabella, Tania
Marsal, Josep-Ramon
Côté, Mélanie
Philippon, François
Rodés-Cabau, Josep
Keywords: aortic stenosis;left ventricular ejection fraction;pacemaker;transcatheter aortic valve replacement
metadata.dc.subject.mesh: Aged
Aged, 80 and over
Aortic Valve
Aortic Valve Stenosis
Arrhythmias, Cardiac
Balloon Valvuloplasty
Cardiac Pacing, Artificial
Heart Failure
Heart Valve Prosthesis
Pacemaker, Artificial
Patient Readmission
Prospective Studies
Prosthesis Design
Risk Factors
Stroke Volume
Time Factors
Transcatheter Aortic Valve Replacement
Treatment Outcome
Ventricular Function, Left
Issue Date: 2018
Abstract: This study sought to evaluate the long-term clinical impact of permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR). Conduction disturbances leading to PPI are common following TAVR. However, no data exist regarding the impact of PPI on long-term outcomes post-TAVR. This was a multicenter study including a total of 1,629 patients without prior PPI undergoing TAVR (balloon- and self-expandable valves in 45% and 55% of patients, respectively). Follow-up clinical, echocardiographic, and pacing data were obtained at a median of 4 years (interquartile range: 3 to 5 years) post-TAVR. PPI was required in 322 (19.8%) patients within 30 days post-TAVR (26.9% and 10.9% in patients receiving self- and balloon-expandable CoreValve and Edwards systems, respectively). Up to 86% of patients with PPI exhibited pacing >1% of the time during follow-up (>40% pacing in 51% of patients). There were no differences between patients with and without PPI in total mortality (48.5% vs. 42.9%; adjusted hazard ratio [HR]: 1.15; 95% confidence interval [CI]: 0.95 to 1.39; p = 0.15) and cardiovascular mortality (14.9% vs. 15.5%, adjusted HR: 0.93; 95% CI: 0.66 to 1.30; p = 0.66) at follow-up. However, patients with PPI had higher rates of rehospitalization due to heart failure (22.4% vs. 16.1%; adjusted HR: 1.42; 95% CI: 1.06 to 1.89; p = 0.019), and the combined endpoint of mortality or heart failure rehospitalization (59.6% vs. 51.9%; adjusted HR: 1.25; 95% CI: 1.05 to 1.48; p = 0.011). PPI was associated with lesser improvement in LVEF over time (p = 0.051 for changes in LVEF between groups), particularly in patients with reduced LVEF before TAVR (p = 0.005 for changes in LVEF between groups). The need for PPI post-TAVR was frequent and associated with an increased risk of heart failure rehospitalization and lack of LVEF improvement, but not mortality, after a median follow-up of 4 years. Most patients with new PPI post-TAVR exhibited some degree of pacing activity at follow-up.
metadata.dc.identifier.doi: 10.1016/j.jcin.2017.10.032
Appears in Collections:Producción 2020

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