Incidence, Predictors, and Prognostic Impact of New Permanent Pacemaker Implantation After TAVR With Self-Expanding Valves.
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Pagnesi Matteo, Kim Won-Keun, Baggio Sara, Scotti Andrea, Barbanti Marco, De Marco Federico, Adamo Marianna, Eitan Amnon, Estévez-Loureiro Rodrigo, Conradi Lenard, Toggweiler Stefan, Mylotte Darren, Veulemans Verena, Søndergaard Lars, Wolf Alexander, Giannini Francesco, Maffeo Diego, Pilgrim Thomas, Montorfano Matteo, Zweiker David, Ferlini Marco, Kornowski Ran, Hildick-Smith David, Taramasso Maurizio, Abizaid Alexandre, Schofer Joachim, Sinning Jan-Malte, Van Mieghem Nicolas M, Wöhrle Jochen, Khogali Saib, Van der Heyden Jan A S, Wood David A, Ielasi Alfonso, MacCarthy Philip, Brugaletta Salvatore, Hamm Christian W, Costa Giuliano, Testa Luca, Massussi Mauro, Alarcón Robert, Schäfer Ulrich, Brunner Stephanie, Reimers Bernhard, Lunardi Mattia, Zeus Tobias, Vanhaverbeke Maarten, Naber Christoph K, Di Ienno Luca, Buono Andrea, Windecker Stephan, Schmidt Albrecht, Lanzillo Giuseppe, Vaknin-Assa Hana, Arunothayaraj Sandeep, Saccocci Matteo, Siqueira Dimytri, Brinkmann Christina, Sedaghat Alexander, Ziviello Francesca, Seeger Julia, Rottbauer Wolfgang, Brouwer Jorn, Buysschaert Ian, Jelisejevas Julius, Bharucha Apurva, Regueiro Ander, Metra Marco, Colombo Antonio, Latib Azeem, Mangieri Antonio
Аннотация
BACKGROUND: Need for PPI is frequent post-TAVR, but conflicting data exist on new-generation SEV and on the prognostic impact of PPI.
METHODS: This study included 3,211 patients enrolled in the multicenter NEOPRO (A Multicenter Comparison of Acurate NEO Versus Evolut PRO Transcatheter Heart Valves) and NEOPRO-2 (A Multicenter Comparison of ACURATE NEO2 Versus Evolut PRO/PRO+ Transcatheter Heart Valves 2) registries (January 2012 to December 2021) who underwent transfemoral TAVR with SEV. Implanted transcatheter heart valves (THV) were Acurate neo (n = 1,090), Acurate neo2 (n = 665), Evolut PRO (n = 1,312), and Evolut PRO+ (n = 144). Incidence and predictors of new PPI and 1-year outcomes were evaluated.
RESULTS: New PPI was needed in 362 patients (11.3%) within 30 days after TAVR (8.8%, 7.7%, 15.2%, and 10.4%, respectively, after Acurate neo, Acurate neo2, Evolut PRO, and Evolut PRO+). Independent predictors of new PPI were Society of Thoracic Surgeons Predicted Risk of Mortality score, baseline right bundle branch block and depth of THV implantation, both in patients treated with Acurate neo/neo2 and in those treated with Evolut PRO/PRO+. Predischarge reduction in ejection fraction (EF) was more frequent in patients requiring PPI (P = 0.014). New PPI was associated with higher 1-year mortality (16.9% vs 10.8%; adjusted HR: 1.66; 95% CI: 1.13-2.43; P = 0.010), particularly in patients with baseline EF <40% (P for interaction = 0.049).
CONCLUSIONS: New PPI was frequently needed after TAVR with SEV (11.3%) and was associated with higher 1-year mortality, particularly in patients with EF <40%. Baseline right bundle branch block and depth of THV implantation independently predicted the need of PPI.