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Incidence, Predictors, and Outcomes of Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement: Analysis From the U.S. Society of Thoracic Surgeons/American College of Cardiology TVT Registry.

Publication ,  Journal Article
Fadahunsi, OO; Olowoyeye, A; Ukaigwe, A; Li, Z; Vora, AN; Vemulapalli, S; Elgin, E; Donato, A
Published in: JACC Cardiovasc Interv
November 14, 2016

OBJECTIVES: The purpose of this study was to evaluate the incidence, predictors, and clinical outcomes of permanent pacemaker (PPM) implantation following transcatheter aortic valve replacement (TAVR). BACKGROUND: Conduction abnormalities leading to PPM implantation are common complications following TAVR. Whether PPM placement can be predicted or is associated with adverse outcomes is unclear. METHODS: A retrospective cohort study of patients undergoing TAVR in the United States at 229 sites between November 2011 and September 2014 was performed using the Society of Thoracic Surgeons/American College of Cardiology TVT Registry and the Centers for Medicare and Medicaid Services database. RESULTS: PPM placement was required within 30 days of TAVR in 651 of 9,785 patients (6.7%) and varied among those receiving self-expanding valves (25.1%) versus balloon-expanding valves (4.3%). Positive predictors of PPM implantation were age (per 5-year increment, odds ratio: 1.07; 95% confidence interval [CI]: 1.01 to 1.15), prior conduction defect (odds ratio: 1.93; 95% CI: 1.63 to 2.29), and use of self-expanding valve (odds ratio: 7.56; 95% CI: 5.98 to 9.56). PPM implantation was associated with longer median hospital stay (7 days vs. 6 days; p < 0.001) and intensive care unit stay (56.7 h vs. 45.0 h; p < 0.001). PPM implantation was also associated with increased mortality (24.1% vs. 19.6%; hazard ratio [HR]: 1.31; 95% CI: 1.09 to 1.58) and a composite of mortality or heart failure admission (37.3% vs. 28.5%; hazard ratio HR: 1.33; 95% CI: 1.13 to 1.56) at 1 year but not with heart failure admission alone (16.5% vs. 12.9%; HR: 1.23; 95% CI: 0.92 to 1.63). CONCLUSIONS: Early PPM implantation is a common complication following TAVR, and it is associated with higher mortality and a composite of mortality or heart failure admission at 1 year.

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Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

November 14, 2016

Volume

9

Issue

21

Start / End Page

2189 / 2199

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Time Factors
  • Risk Factors
  • Retrospective Studies
  • Registries
  • Prosthesis Design
  • Proportional Hazards Models
  • Patient Readmission
 

Citation

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Fadahunsi, O. O., Olowoyeye, A., Ukaigwe, A., Li, Z., Vora, A. N., Vemulapalli, S., … Donato, A. (2016). Incidence, Predictors, and Outcomes of Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement: Analysis From the U.S. Society of Thoracic Surgeons/American College of Cardiology TVT Registry. JACC Cardiovasc Interv, 9(21), 2189–2199. https://doi.org/10.1016/j.jcin.2016.07.026
Fadahunsi, Opeyemi O., Abiola Olowoyeye, Anene Ukaigwe, Zhuokai Li, Amit N. Vora, Sreekanth Vemulapalli, Eric Elgin, and Anthony Donato. “Incidence, Predictors, and Outcomes of Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement: Analysis From the U.S. Society of Thoracic Surgeons/American College of Cardiology TVT Registry.JACC Cardiovasc Interv 9, no. 21 (November 14, 2016): 2189–99. https://doi.org/10.1016/j.jcin.2016.07.026.
Journal cover image

Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

November 14, 2016

Volume

9

Issue

21

Start / End Page

2189 / 2199

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Time Factors
  • Risk Factors
  • Retrospective Studies
  • Registries
  • Prosthesis Design
  • Proportional Hazards Models
  • Patient Readmission