Association of Clinical and Economic Outcomes With Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement

Aljabbary, Talal; Qiu, Feng; Masih, Shannon; Fang, Jiming; Elbaz‐Greener, Gabby; Austin, Peter C.; Rodés‐Cabau, Josep; Ko, Dennis T.; Singh, Sheldon M.; Wijeysundera, Harindra C.

doi:10.1001/jamanetworkopen.2018.0088

Cited by 52 publications

(40 citation statements)

References 58 publications

(123 reference statements)

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“…Heart block after TAVR continues to be a significant contributor to morbidity and length of stay after the procedure. 6 This phenomenon is thought to be multifactorial and related to device-specific issues, deployment technique, anatomic changes such as calcification in left ventricle outflow tract, and annulus and pre-existing conduction disturbances. Baseline ECG abnormalities such as first-degree AVB, left anterior hemiblock, and right bundle branch block as well as intraprocedural AVB are predictors for implantation of PM after TAVR.…”

Section: Discussionmentioning

confidence: 99%

Remote Ambulatory Cardiac Monitoring Before and After Transcatheter Aortic Valve Replacement

et al. 2020

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Remote ambulatory cardiac monitoring (rACM) could identify high-grade atrioventricular block (AVB) before and after transcatheter aortic valve replacement (TAVR). Retrospective analysis of patients undergoing TAVR, with 14-day rACM before and after TAVR, was performed. Of 62 patients undergoing TAVR, 41 patients had rACM before TAVR. Three patients had asymptomatic AVB leading to planned pacemaker (PM) implant. After TAVR, 23 patients had rACM, with 1 patient requiring a PM implant for asymptomatic AVB. Five patients underwent unplanned PM after TAVR. Using rACM, almost half of PM implants in TAVR recipients were identified electively. High-grade AVB requiring PM was identified in nearly 10% of patients before TAVR.

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Section: Discussionmentioning

confidence: 99%

Remote Ambulatory Cardiac Monitoring Before and After Transcatheter Aortic Valve Replacement

et al. 2020

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“…In a population-based cohort study of 1263 patients who underwent TAVI, implantation of a new permanent pacemaker was associated with significantly greater all-cause mortality (43.9% vs 31.7%; HR, 1.40, 95% CI 1.01 to 1.94, p=0.04), all-cause readmission and all-cause emergency department visits, and a significantly greater readmission for heart failure (33.9% vs 19.1%; HR, 1.90, 95% CI 1.53 to 2.36, p<0.001) 24. Opposite to these findings, a meta-analysis of 24 studies showed that patients with and without PPM have similar all-cause mortality 25.…”

Section: What Are the Remaining Challenges For Tavi In Low-risk Patiementioning

confidence: 97%

Transcatheter aortic valve implantation in low-risk patients: is it too early?

Sousa-Uva

2019

Heart

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The median age of patients treated by transcatheter aortic valve implantation (TAVI) is falling across Europe, and low-risk patients with severe aortic stenosis (AS) represent 80% of patients with severe AS undergoing surgical aortic valve replacement (SAVR). There are few data for TAVI in low-risk patients, but there are four ongoing randomised trials of SAVR versus TAVI. The key issues relate to pacemaker implantation rates and the associated potential longer term deleterious effects, and the need to minimise vascular complications and paravalvular leak. Valve leaflet thrombosis and paucity of data on valve durability remain a concern. Given the higher incidence of bicuspid aortic valves in younger patients, outcomes of TAVI in this setting need clarification and are discussed.

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“…The majority of data show a higher cost with PPM implantation post-TAVR [12]. However, studies have shown no significant cost difference after PPM implantation in the TAVR population [23]. One recent study has shown no significant difference in cost at one year after TAVR [23].…”

Section: Introductionmentioning

confidence: 99%

Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: A Cost Analysis

Ahmad

Patel

Loc

et al. 2019

Cureus

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Background Transcatheter aortic valve replacement (TAVR) can be complicated with a complete atrioventricular block requiring permanent pacemaker (PPM) implantation. The cost of index hospitalization for such patients is higher than usual. However, the magnitude of this increased cost is uncertain. We have looked at our five-year TAVR experience to analyze the detailed cost for PPM implantation in TAVR. Methods This study is a retrospective analysis of patients undergoing TAVR at our tertiary care center from December 2012 to April 2018. The initial sample size was 449. We excluded patients with prior PPM or an implantable cardioverter defibrillator (37). Patients who had their procedure aborted or required a cardiopulmonary bypass (16) and those with missing data variables (14) were excluded. The final sample size was 382. The cost for admission was calculated as the US dollars incurred by the hospital. Cohort costs were categorized as a direct cost, which is patient based, and an indirect cost, which represents overhead costs and is independent of patient volume. Patients were divided into two groups based on the placement of PPM after TAVR. Chi-square test, t-test, and logistic linear regression were used for the statistical analysis. Results Of 382 patients, 19 (4.9%) required PPM after TAVR. Baseline variables, including age, gender, and BMI, were not statistically significant. The PPM group had a significantly longer intensive care unit (ICU) stay (48.6 hours vs. 36.7 hours; p<0.001) and total stay in the hospital (4.2 days vs. 3.4 days; p=0.047). PPM implantation after TAVR increased cost on an average of $10,213 more than a typical TAVR admission (p=0.04). The direct cost was also significantly high for the PPM group ($7,087; p=0.02). On detailed analysis, almost all major cost categories showed a higher cost for pacemaker patients when compared with control. Conclusions PPM implantation adds a significant cost burden to TAVR admissions.

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Association of Clinical and Economic Outcomes With Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement

Cited by 52 publications

References 58 publications

Remote Ambulatory Cardiac Monitoring Before and After Transcatheter Aortic Valve Replacement

Remote Ambulatory Cardiac Monitoring Before and After Transcatheter Aortic Valve Replacement

Transcatheter aortic valve implantation in low-risk patients: is it too early?

Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: A Cost Analysis

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