Association Between Body Mass Index and Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement (TAVR) with Edwards SAPIEN™ 3 TAVR Valves: A Single-Center Experience

Abstract

Background: Transcatheter aortic valve replacement (TAVR) can be complicated with a high-degree atrioventricular block requiring a permanent pacemaker (PPM) in 5% - 25% of patients. Association between body mass index (BMI) and pacemaker implantation has not been extensively studied. We compared standard BMI classes with the odds of requiring a PPM implantation in patients undergoing TAVR with Edwards SAPIEN™ 3 valves (ESV3) (Edwards Lifesciences, Irvine, CA, USA). Methods: Our study involved a single-center retrospective cohort analysis of 449 patients undergoing TAVR from December 2012 to April 2018. First, we excluded patients with a TAVR procedure done with valves other than the ESV3 (127 patients). Second, patients with a prior PPM or an implantable cardioverter-defibrillator (37 patients) were excluded. Finally, patients with an aborted procedure and surgical conversion were excluded (16 patients). The final sample size was 269. The primary outcome was pacemaker implantation. Statistical analysis was done using the Chi-square test, T-test, and adjusted logistic regression. Results: Of the 269 patients (50.6% males; mean age of 79.5 ± 8.7 years; mean Society of Thoracic Surgeons (STS) score: 6.2), pacemaker implantation was performed in 17 patients (6.3%). Time to pacemaker implantation was 1.3 days. Patients were divided into four categories based on their BMI: as underweight (BMI < 25; 67 patients), normal (BMI: 25 to ≤ 30; 87 patients), overweight (BMI: 30 to ≤ 35; 60 patients), and obese (BMI ≥ 35; 55 patients). Pacemaker implantation was significantly higher in patients with a BMI of > 30 (13 vs. 4, p = 0.037). After logistic linear regression, the odds of getting a PPM after TAVR were significantly higher in patients who were overweight (odds ratio (OR): 12.77, p = 0.024; confidence interval (CI): 1.39 - 17.25) and obese (OR: 15.02, p = 0.036, CI: 1.19 - 19.92). Conclusions: Our study demonstrates that increased BMI is a possible risk factor for a high-degree atrioventricular block in patients receiving ESV3.

Heart valve surgery and the obesity paradox: A systematic review

“…1,11,15,21,25,27,29,40,41,43,48,50 The previous literature regarding the obesity paradox has focused primarily on CABG and TAVR. 1,9,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] The literature regarding valve surgery and the obesity paradox has grown in recent years. This systematic review of the relevant literature has demonstrated several important points.…”

“…To date, numerous studies have demonstrated the obesity paradox in postoperative outcomes after cardiac surgery, although most have focused predominantly on coronary artery bypass grafting (CABG) and transcatheter aortic valve replacement (TAVR). 1,9,11,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Surgical valve repair and replacement have been less prominently explored with respect to the influence of obesity on postoperative outcomes. Herein, we look to compile and review the data published to date investigating the impact of obesity on surgical and transcatheter valve repair and replacement.…”

Machine learning method for predicting pacemaker implantation following transcatheter aortic valve replacement

“…Conduction system injury necessitating PPI is the most common complication following TAVR. Previous studies have reported risk factors such as age, gender, BMI, LVOT diameter, membranous septum height, pre‐procedural ECG features (RBBB, LBBB, and first‐degree AV block), as well as procedural factors like valve type, implantation depth, and balloon dilation 3,12–15 . To the best of our knowledge, there are only two studies of modest sample sizes of 467 patients 16 and 611 patients 17 that have investigated post‐procedural ECG characteristics as potential determinants of PPI risk following TAVR.…”

(Permanent pacemaker implantation in patients undergoing TAVR - single center study between years 2009 and 2021)

“…V jedné studii byl vysoký index tělesné hmotnosti (BMI prokázán) jako rizikový faktor pro implantaci kardiostimulátoru. 38 Avšak BSA nefi gurovalo v žádné z větších studií, ačkoliv je jedním z měření rutinně prováděných u pacientů s aortální stenózou, užitečné k její kvantifi kaci.…”