Predictors and clinical outcomes of permanent pacemaker implantation after transcatheter aortic valve replacement: the PARTNER (Placement of AoRtic TraNscathetER Valves) trial and registry. []

MedStar author(s):
Citation: Jacc: Cardiovascular Interventions. 8(1 Pt A):60-9, 2015 Jan.PMID: 25616819Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleSubject headings: *Aortic Valve | *Aortic Valve Stenosis/th [Therapy] | *Arrhythmias, Cardiac/th [Therapy] | *Cardiac Catheterization/ae [Adverse Effects] | *Cardiac Pacing, Artificial | *Heart Valve Prosthesis Implantation/ae [Adverse Effects] | *Pacemaker, Artificial | Aged | Aged, 80 and over | Aortic Valve Stenosis/di [Diagnosis] | Aortic Valve Stenosis/mo [Mortality] | Aortic Valve Stenosis/pp [Physiopathology] | Aortic Valve/pp [Physiopathology] | Arrhythmias, Cardiac/di [Diagnosis] | Arrhythmias, Cardiac/et [Etiology] | Arrhythmias, Cardiac/mo [Mortality] | Arrhythmias, Cardiac/pp [Physiopathology] | Cardiac Catheterization/is [Instrumentation] | Cardiac Catheterization/mo [Mortality] | Cardiac Catheterization/mt [Methods] | Cardiac Pacing, Artificial/ae [Adverse Effects] | Cardiac Pacing, Artificial/mo [Mortality] | Female | Heart Valve Prosthesis | Heart Valve Prosthesis Implantation/is [Instrumentation] | Heart Valve Prosthesis Implantation/mo [Mortality] | Heart Valve Prosthesis Implantation/mt [Methods] | Humans | Kaplan-Meier Estimate | Length of Stay | Logistic Models | Male | Multivariate Analysis | Odds Ratio | Patient Readmission | Prosthesis Design | Randomized Controlled Trials as Topic | Registries | Retrospective Studies | Risk Factors | Time Factors | Treatment OutcomeLocal holdings: Available online through MWHC library: 2008 - presentISSN:
  • 1936-8798
Abstract: BACKGROUND: Cardiac conduction disturbances requiring PPM are a frequent complication of TAVR. However, limited data is available regarding this complication after TAVR with a balloon-expandable valve.CONCLUSIONS: PPM was required in 8.8% of patients without prior PPM who underwent TAVR with a balloon-expandable valve in the PARTNER trial and registry. In addition to pre-existing right bundle branch block, the prosthesis to LV outflow tract diameter ratio and the LV end-diastolic diameter were identified as novel predictors of PPM after TAVR. New PPM was associated with a longer duration of hospitalization and higher rates of repeat hospitalization and mortality or repeat hospitalization at 1 year. (THE PARTNER TRIAL: Placement of AoRtic TraNscathetER Valves Trial; NCT00530894).Copyright � 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.METHODS: The study included patients without prior pacemaker who underwent TAVR in the PARTNER (Placement of AoRtic TraNscathetER Valves) trial and registry and investigated predictors and clinical effect of new PPM.OBJECTIVES: The purpose of this study was to identify predictors and clinical implications of permanent pacemaker (PPM) implantation after transcatheter aortic valve replacement (TAVR).RESULTS: Of 2,559 TAVR patients, 586 were excluded due to pre-existing PPM. A new PPM was required in 173 of the remaining 1,973 patients (8.8%). By multivariable analysis, predictors of PPM included right bundle branch block (odds ratio [OR]: 7.03, 95% confidence interval [CI]: 4.92 to 10.06, p < 0.001), prosthesis diameter/left ventricular (LV) outflow tract diameter (for each 0.1 increment, OR: 1.29, 95% CI: 1.10 to 1.51, p = 0.002), LV end-diastolic diameter (for each 1 cm, OR: 0.68, 95% CI: 0.53 to 0.87, p = 0.003), and treatment in continued access registry (OR: 1.77, 95% CI: 1.08 to 2.92, p = 0.025). Patients requiring PPM had a longer mean duration of post-procedure hospitalization (7.3 +/- 2.7 days vs. 6.2 +/- 2.8 days, p = 0.001). At 1 year, new PPM was associated with significantly higher repeat hospitalization (23.9% vs. 18.2%, p = 0.05) and mortality or repeat hospitalization (42.0% vs. 32.6%, p = 0.007). There was no difference between groups in LV ejection fraction at 1 year.All authors: Babaliaros V, Dizon JM, Douglas PS, El-Chami MF, Hahn RT, Herrmann HC, Kodali SK, Leon MB, Mack M, Makkar RR, Miller DC, Moses JW, Nazif TM, PARTNER Publications Office, Pichard A, Smith CR, Szeto WY, Tuzcu EM, Webb JG, Williams MR, Xu KDigital Object Identifier: Date added to catalog: 2016-01-13
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article Available 25616819

Available online through MWHC library: 2008 - present

BACKGROUND: Cardiac conduction disturbances requiring PPM are a frequent complication of TAVR. However, limited data is available regarding this complication after TAVR with a balloon-expandable valve.

CONCLUSIONS: PPM was required in 8.8% of patients without prior PPM who underwent TAVR with a balloon-expandable valve in the PARTNER trial and registry. In addition to pre-existing right bundle branch block, the prosthesis to LV outflow tract diameter ratio and the LV end-diastolic diameter were identified as novel predictors of PPM after TAVR. New PPM was associated with a longer duration of hospitalization and higher rates of repeat hospitalization and mortality or repeat hospitalization at 1 year. (THE PARTNER TRIAL: Placement of AoRtic TraNscathetER Valves Trial; NCT00530894).Copyright � 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

METHODS: The study included patients without prior pacemaker who underwent TAVR in the PARTNER (Placement of AoRtic TraNscathetER Valves) trial and registry and investigated predictors and clinical effect of new PPM.

OBJECTIVES: The purpose of this study was to identify predictors and clinical implications of permanent pacemaker (PPM) implantation after transcatheter aortic valve replacement (TAVR).

RESULTS: Of 2,559 TAVR patients, 586 were excluded due to pre-existing PPM. A new PPM was required in 173 of the remaining 1,973 patients (8.8%). By multivariable analysis, predictors of PPM included right bundle branch block (odds ratio [OR]: 7.03, 95% confidence interval [CI]: 4.92 to 10.06, p < 0.001), prosthesis diameter/left ventricular (LV) outflow tract diameter (for each 0.1 increment, OR: 1.29, 95% CI: 1.10 to 1.51, p = 0.002), LV end-diastolic diameter (for each 1 cm, OR: 0.68, 95% CI: 0.53 to 0.87, p = 0.003), and treatment in continued access registry (OR: 1.77, 95% CI: 1.08 to 2.92, p = 0.025). Patients requiring PPM had a longer mean duration of post-procedure hospitalization (7.3 +/- 2.7 days vs. 6.2 +/- 2.8 days, p = 0.001). At 1 year, new PPM was associated with significantly higher repeat hospitalization (23.9% vs. 18.2%, p = 0.05) and mortality or repeat hospitalization (42.0% vs. 32.6%, p = 0.007). There was no difference between groups in LV ejection fraction at 1 year.

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