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

Abstract

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.

Electrocardiogram-based prediction of conduction disturbances after transcatheter aortic valve replacement with convolutional neural network

“… 36 , 38 These risks should be given special attention since TAVR is increasingly being used in younger and healthier population. Patients should be informed of these risks and the long-term implications, as well as the associated extra cost, 39 before deciding on the most appropriate procedure. Operators can also minimize these risks by adopting coping strategies such as using balloon-expandable valves, avoiding unnecessary balloon dilation, and restricting prosthesis oversizing.…”

Novel Method for Implantation of Balloon Expandable Transcatheter Aortic Valve Replacement to Reduce Pacemaker Rate—Line of Lucency Method

“…[21][22][23] Importantly, implantation of a permanent pacemaker following TAVR is associated with longer hospital and intensive care unit (ICU) stays, increased overall cost, risk of heart failure, and rehospitalization. 24,25 Independent predictors of PPMI in previous reports have included preexisting conduction abnormalities, implant depth, and need for repositioning of self-expanding implants. 10,11,26 Given the association of deep implantation with higher rates of PPMI, studies of modified implantation techniques have focused on reducing PPMI by achieving high implantation, with variable results.…”

Anatomical Considerations and Emerging Strategies for Reducing New Onset Conduction Disturbances in Percutaneous Structural Heart Disease Interventions

“…32 PPM implantation following TAVR is not only associated with increased risk of death and heart failure, but is associated with a reduction in quality of life and increased cost. 38,39 Thus, an emerging body of clinical research indicates the persistence and negative prognostic significance of new onset conduction disturbances following TAVR.…”