Long‐term pacemaker dependency and impact of pacing on mortality following transcatheter aortic valve replacement with the LOTUS valve

Alasti, Mohammad; Rashid, H.; Rangasamy, Karthikeyan; Kotschet, Emily; Adam, David; Alison, J.; Gooley, Robert; Zaman, Sarah

doi:10.1002/ccd.27463

Cited by 22 publications

(6 citation statements)

References 23 publications

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“…In cohort studies of patients receiving a mix of TAVR prostheses, long-term dependency ranged from 27% (68) to 68.4% (69). A study in patients receiving CoreValve self-expandable valve showed a 46.7% long-term dependency (70), whereas in a cohort of patients undergoing TAVR with a Lotus valve, 57% and 38% of patients were pacemakerdependent at 30-day and 1-year, respectively (71). Thus, a transient effect of inflammation, edema, ischemia or direct injury may show a subsequent recovery in a substantial number of patients, suggesting a short period of rhythm monitoring could be advisable before PPM is implanted after TAVR, in order to avoid unnecessary PPM when attempting to shorten hospital stays.…”

Section: Permanent Pacemaker Implantationmentioning

confidence: 99%

Current issues in transcatheter aortic valve replacement

et al. 2020

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Background: aortic stenosisAortic stenosis (AS) is one of the most common forms of valvular disease in Western countries (1-3). It shows a consistent association with age, with prevalence ranging from 0.2% in the 50-59-year group to 9.8% in the 80-89-year cohort (4). Its prevalence is expected to increase due to higher life expectancy and population aging (5,6). It is also the most common reason for heart valve replacement (7).In a recent editorial paper (8), Eugene Braunwald put in perspective the medical advances in severe AS therapy over the last 50 years since the publication of his seminal study on AS natural history (9). Patients with severe AS had a good survival during a long latency period with "increasing obstruction and myocardial overload" until being about 60 years old. Then severe symptoms appeared and survival was poor, with most patients having heart failure, syncope and/or angina, and dying in a few years. With surgery being then the only available etiological treatment, the aim was to identify the patients approaching to such turning point to recommend surgery even with its associated risk with early prostheses.Even though this typical course has been confirmed over the years (10-12), the survival curve has shown a clear-cut shift to the right with progressive symptoms appearing now in patients in their 7th to 9th decade (6). Medical advances have now led most AS patients to what Braunwald calls a "promised land" with a long survival and good quality

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Section: Permanent Pacemaker Implantationmentioning

confidence: 99%

Current issues in transcatheter aortic valve replacement

et al. 2020

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“…The analysis reported VpDep rates of 43% and 50% at 1 month and 1 year respectively. In a trial evaluated the incidence of VpDep following Lotus valve implantation, 3 a cut point of 40 bpm was used to define VpDep. At 30-day and 1-year, 57% and 38% were pacing dependent respectively.…”

Section: Discussionmentioning

confidence: 99%

The Incidence, Predictors, and Mortality Impact of Ventricular Pacing Dependency after Transcatheter Aortic Valve Replacement: A Prospective Cohort

Apiyasawat

Chandavimol

Soontornmanokati

et al. 2022

Preprint

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BackgroundAtrioventricular conduction disturbance occurs in a significant number of patients underwent transcatheter aortic valve replacement (TAVR). However, not all of the cases persistently depend on ventricular pacing. ObjectiveTo study the incidence, predictors, and outcomes of new ventricular pacing dependency (VpDep) after TAVR. DesignProspective, single-center, cohort trial MethodsThe first 130 consecutive transfemoral TAVR cases, except 3 with prior cardiac electronic implantable devices (CIEDs) who depended on ventricular pacing, were analyzed. The endpoints were VpDep at 1 month and all-cause mortality at the end of follow-up in 2021. The effects of variables on VpDep and all-cause mortality were evaluated using multivariate binary logistic regression and Cox-regression analysis, . CC-BY-NC 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

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“…It is necessary to investigate the impact of PPM implantation on long-term outcomes before the indications for TAVR are expanded to include lower risk populations, as the follow-up duration in most included studies was not long enough to show the deleterious effects of PPM implantation. In addition, more than half of the patients implanted with a PPM after TAVR were not pacemaker dependent, while pacemaker dependency is a predictor of heart failure (42).…”

Section: Discussionmentioning

confidence: 99%

Impact of postprocedural permanent pacemaker implantation on clinical outcomes after transcatheter aortic valve replacement: a systematic review and meta-analysis

Xi¹,

Liu²,

Liang³

et al. 2019

J Thorac Dis

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Background: The incidence of conduction disturbances requiring permanent pacemaker (PPM) implantation following transcatheter aortic valve replacement (TAVR) have remained a common concern.The purpose of this study was to evaluate the impact of postprocedural PPM implantation following TAVR on clinical outcomes. Methods: We performed a systematic search in PubMed and EMBASE databases for studies that reported raw data on clinical outcomes of patients with and without PPM implantation after TAVR and followed up patients for 10 months or longer. The primary endpoint was all-cause death. The secondary endpoints were cardiovascular death, heart failure and a composite of stroke and myocardial infarction (MI). Results: Data from 20 studies with a total of 21,666 patients undergoing TAVR, of whom 12.5% required PPM implantation after intervention, were analysed and the mean duration follow-up was 16.9 months. The rate of PPM ranged from 6.2% to 32.8% among different studies. A total of 6,753 (31.2%) patients underwent TAVR with self-expandable prosthesis and 14,913 (68.8%) with balloon-expandable prosthesis.The incidence of postprocedural PPM implantation was higher with the self-expandable prosthesis (n=1,717, 25.4%) compared with the balloon-expandable prosthesis (n=996, 6.7%). PPM after TAVR was associated with a higher risk of all-cause death (RR: 1.13; 95% CI: 1.01-1.25; P=0.03) but not incidence of stroke and MI (RR: 0.85; 95% CI: 0.64-1.13; P=0.27). Conclusions: In patients undergoing TAVR, the PPM implantation after intervention was associated higher all-cause mortality but not cardiovascular mortality, heart failure and stroke or MI, which remain an unsolved issue of TAVR.

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Long‐term pacemaker dependency and impact of pacing on mortality following transcatheter aortic valve replacement with the LOTUS valve

Abstract: Only 38% of Lotus recipients who require a PPM following TAVR with the Lotus valve remain pacing dependent at one year.

Cited by 22 publications

References 23 publications

Current issues in transcatheter aortic valve replacement

Current issues in transcatheter aortic valve replacement

The Incidence, Predictors, and Mortality Impact of Ventricular Pacing Dependency after Transcatheter Aortic Valve Replacement: A Prospective Cohort

Impact of postprocedural permanent pacemaker implantation on clinical outcomes after transcatheter aortic valve replacement: a systematic review and meta-analysis

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