| Part 1:Incidence of Permanent Pacemaker Implantation in Patients undergoing Transcatheter Aortic Valve ReplacementObjectives:The conduction abnormalities needing permanent pacemaker implantation(PPMI)is one of most common complication of transcatheter aortic valve replacement(TAVR).It is reasonable to pay more attention to PPMI,as the broader indication of TAVR has been emerging in relatively younger and lower surgical risk population.We aim to investigate the incidence of PPMI in patients with self-expandable valve undergoing TAVR.Methods:Patients were consecutively enrolled from March 11,2013 to October 31,2018 in cardiovascular department of the Second Affiliated Hospital of Zhejiang University School of medicine.Patients with previous pacemaker,surgical aortic prosthesis restenosis,quadricuspid aortic valve morphology and converted to open-heart surgery were excluded.We recorded the incidence of PPMI of TAVR and compared the differences of clinical data between patients with and without PPMI.Results:A total of 256 patients were included,38 patients(14.8%)received PPM implantation within 30 days after TAVR procedure.Baseline characteristics were similar between two groups with exception of higher prior PCI,PVD and baseline RBBB proportion(21.1%vs.8.7%,P=0.05;44.7%vs.18.4%,P<0.05;17.1%vs.6.9%,P=0.05;respectively),worse cardiac function in the PPMI group when compared to patients without PPMI(17.1%vs.6.9%,p=0.05).In 38 patients received PPMI,only 7 patients had BAV and remaining 31 patients with TAV.The proportion of TAV patients was much higher compared to BAV patients in PPMI group(18.4%vs.81.6%,p<0.05).There was a statistically difference in the implantation depth at NC and LC sinus side between PPMI and no PPMI group(7.7±4.5 mm vs.4.9±4.8 mm,p<0.05;9.1±3.8 mm vs.7.1±4.9 mm,p=0.03;respectively).Conclusion:The incidence of PPMI in patients with self-expandable valve undergoing TAVR was 14.8%.The proportion of BAV was much lower than TAV in PPMI group.The implantation depth was deeper in patients received PPMI.Part 2:Predictors and Prognosis of Permanent Pacemaker Implantation in Patients undergoing Transcatheter Aortic Valve ReplacementObjectives:Previous study suggests that the proportion of TAV is higher in patients with PPMI.However,the incidence of PPMI between patients with BAV and TAV remains controversial.Therefore,we thought to explore the predictors of PPMI in patients received self-expandable valve undergoing TAVR.Methods:Patients were consecutively enrolled from March 11,2013 to October 31,2018 in cardiovascular department of the Second Affiliated Hospital of Zhejiang University School of medicine.Patients with previous pacemaker,surgical aortic prosthesis restenosis,quadricuspid aortic valve morphology and converted to open-heart surgery were excluded.Candidate variables for the multivariable regression model were required to have clinical relevance and a p value<0.1.Results:A total of 256 patients were included,the incidence of PPMI in our population was 14.8%.Interestingly,patients with BAV presented a significantly lower PPMI rate compared to patients with TAV(6.4%vs.21.2%,p<0.05).Multivariate logistic regression revealed that baseline RBBB(OR 8.346,95%CI 2.173-32.051,P=0.002),TAV(OR 4.681,95%CI 1.526-14.365,P=0.007),implantation depth at NC sinus side(OR 1.271,95%CI 1.059-1.527,P=0.010)were independent predictors of PPMI after TAVR procedure.PPMI group was not associated with significantly higher all-cause mortality at 30-day or at 1-year(0.0%vs.33%,p=0.55;0.0%vs.11.1%,p=0.13).There was also no significant difference in LVEF between the two groups at 1-year follow-up(59.0±12.9%vs.63.2±7.5%,P=0.11).Conclusion:The incidence of PPMI in patients with BAV was significantly lower compared to TAV patients who received self-expandable valve undergoing TAVR.Independent predictors of PPMI included baseline RBBB,TAV and implantation depth at NC sinus side.TAVR in BAV with supra-annular structure based sizing strategy might decrease the risk of PPMI. |
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