Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2018
Long-term pacemaker dependency and impact of pacing on mortality following transcatheter aortic valve replacement with the LOTUS valve.
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Alasti Mohammad, Rashid Hashrul, Rangasamy Karthikeyan, Kotschet Emily, Adam David, Alison Jeff, Gooley Robert, Zaman Sarah
Аннотация
OBJECTIVES: To determine permanent pacemaker (PPM) dependency following transcatheter aortic valve replacement (TAVR) with the Lotus™ valve system (Boston Scientific), and the impact of PPM implantation on long-term morbidity and mortality.
BACKGROUND: Conduction abnormalities are among the most common complications following TAVR. Limited studies have assessed pacing dependency following TAVR.
METHODS: Consecutive patients (n = 166) with severe aortic stenosis who underwent TAVR with the Lotus valve system were prospectively recruited from a single-center. PPMs were implanted according to standard clinical criteria. Patients were followed in-hospital and at 1, 3, 6, and 12 months to determine pacemaker dependency and clinical outcomes.
RESULTS: Fourteen patients with a pre-existing PPM (8%) were excluded with the remaining 152 patients aged 83.6 ± 5.6 years and 46% male. PPMs were implanted 3.8 ± 4 days post-TAVR in 38/152 patients (25%). Indication for PPM was complete heart block in 29 (76%) of patients. At 30-day and one-year follow up, 57% and 38% of patients were pacemaker dependent, respectively. The mean ventricular pacing percentage decreased in the first three months after PPM implantation and remained relatively stable after that.
CONCLUSION: Only 38% of Lotus recipients who require a PPM following TAVR with the Lotus valve remain pacing dependent at one year.
BACKGROUND: Conduction abnormalities are among the most common complications following TAVR. Limited studies have assessed pacing dependency following TAVR.
METHODS: Consecutive patients (n = 166) with severe aortic stenosis who underwent TAVR with the Lotus valve system were prospectively recruited from a single-center. PPMs were implanted according to standard clinical criteria. Patients were followed in-hospital and at 1, 3, 6, and 12 months to determine pacemaker dependency and clinical outcomes.
RESULTS: Fourteen patients with a pre-existing PPM (8%) were excluded with the remaining 152 patients aged 83.6 ± 5.6 years and 46% male. PPMs were implanted 3.8 ± 4 days post-TAVR in 38/152 patients (25%). Indication for PPM was complete heart block in 29 (76%) of patients. At 30-day and one-year follow up, 57% and 38% of patients were pacemaker dependent, respectively. The mean ventricular pacing percentage decreased in the first three months after PPM implantation and remained relatively stable after that.
CONCLUSION: Only 38% of Lotus recipients who require a PPM following TAVR with the Lotus valve remain pacing dependent at one year.