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Pacemaker Implantation After Balloon‐ or Self‐Expandable Transcatheter Aortic Valve Replacement in Patients With Aortic Stenosis

Authors :
Arnaud Bisson
Alexandre Bodin
Julien Herbert
Thibaud Lacour
Christophe Saint Etienne
Bertrand Pierre
Nicolas Clementy
Pierre Deharo
Dominique Babuty
Laurent Fauchier
Source :
Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 9, Iss 9 (2020)
Publication Year :
2020
Publisher :
Wiley, 2020.

Abstract

Background The incidence of conduction abnormalities requiring permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR) with early and later generation prostheses remains debated. Methods and Results Based on the administrative hospital‐discharge database, we collected information for all patients treated with TAVR between 2010 and 2019 in France. We compared the incidence of PPI after TAVR according to the type and generation of valve implanted. A total of 49 201 patients with aortic stenosis treated with TAVR using the balloon‐expandable (BE) Edwards SAPIEN valve (early Sapien XT and latest Sapien 3) or the self‐expanding (SE) Medtronic CoreValve (early CoreValve and latest Evolut R) were found in the database. Mean (SD) follow‐up was 1.2 (1.5 years) (median [interquartile range] 0.6 [0.1–2.0] years). PPI after the procedure was reported in 13 289 patients, among whom 11 010 (22.4%) had implantation during the first 30 days. In multivariable analysis, using early BE TAVR as reference, adjusted odds ratio (95% CI) for PPI during the first 30 days was 0.88 (0.81–0.95) for latest BE TAVR, 1.40 (1.27–1.55) for early SE TAVR, and 1.17 (1.07–1.27) for latest SE TAVR. Compared with early BE TAVR, the adjusted hazard ratio for PPI during the whole follow‐up was 1.01 (0.95–1.08) for latest BE TAVR, 1.30 (1.21–1.40) for early SE TAVR, and 1.25 (1.18–1.34) for latest SE TAVR. Conclusions In patients with aortic stenosis treated with TAVR, our systematic analysis at a nationwide level found higher rates of PPI than previously reported. BE technology was independently associated with lower incidence rates of PPI both at the acute and chronic phases than SE technology. Recent generations of TAVR were not independently associated with different rates of PPI than early generations during the overall follow‐up.

Details

Language :
English
ISSN :
20479980
Volume :
9
Issue :
9
Database :
Directory of Open Access Journals
Journal :
Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
Publication Type :
Academic Journal
Accession number :
edsdoj.9dea2a71a8874df08ae9bfa015f20945
Document Type :
article
Full Text :
https://doi.org/10.1161/JAHA.120.015896