Author + information
- Received January 4, 2012
- Revision received February 28, 2012
- Accepted March 19, 2012
- Published online August 7, 2012.
- Lutz Buellesfeld, MD⁎,
- Stefan Stortecky, MD⁎,
- Dik Heg, PhD†,
- Sven Hausen, MD‡,
- Ralf Mueller, MD§,
- Peter Wenaweser, MD⁎,
- Thomas Pilgrim, MD⁎,
- Steffen Gloekler, MD⁎,
- Ahmed A. Khattab, MD⁎,
- Christoph Huber, MD⁎,
- Thierry Carrel, MD⁎,
- Balthasar Eberle, MD∥,
- Bernhard Meier, MD⁎,
- Peter Boekstegers, MD§,
- Peter Jüni, MD†,
- Ulrich Gerckens, MD¶,
- Eberhard Grube, MD‡ and
- Stephan Windecker, MD⁎,†,⁎ ()
- ↵⁎Reprints requests and correspondence:
Dr. Stephan Windecker, Department of Cardiology, Bern University Hospital, Freiburgstrasse, 3010 Bern, Switzerland
Objectives This study sought to assess the impact of permanent pacemaker (PPM) implantation on clinical outcomes among patients undergoing transfemoral transcatheter aortic valve implantation (TAVI).
Background TAVI is associated with atrioventricular-conduction abnormalities requiring PPM implantation in up to 40% among patients treated with self-expanding prostheses.
Methods Between 2007 and 2010, 353 consecutive patients (mean age: 82.6 ± 6.1 years, log EuroSCORE: 25.0 ± 15.0%) with severe aortic stenosis underwent transfemoral TAVI at 2 institutions. Clinical outcomes were compared among 3 groups: (1) patients requiring PPM implantation after TAVI (PPM after TAVI), (2) patients without PPM before or after TAVI (no PPM), and (3) patients with PPM before TAVI (PPM before TAVI). The primary endpoint was all-cause mortality at 12 months, and an age-, sex-, and origin-matched standardized population served as controls.
Results Of 353 patients, 98 patients (27.8%) belonged to the PPM after TAVI group, 48 patients (13.6%) belonged to the PPM before TAVI group, and 207 patients (58.6%) belonged to the no PPM group. The PPM before TAVI patients had a significantly higher baseline risk compared with the PPM after TAVI and no PPM patients (coronary artery disease: 77.1% vs. 52.7% and 58.2%, respectively, p = 0.009; atrial fibrillation: 43.8% vs. 22.7% and 20.4%, respectively, p = 0.005). At 12 months of follow-up, all-cause mortality was similar in all 3 groups (PPM after TAVI group: 19.4%, PPM before TAVI group: 22.9%, no PPM group: 18.0%) in unadjusted analyses (p = 0.77) and adjusted analyses (p = 0.90). Compared with the standardized population, adjusted hazard ratios for death were 2.37 (95% confidence interval [CI]: 1.51 to 3.72) for the PPM after TAVI group, 2.75 (95% CI: 1.52 to 4.97) for the PPM before TAVI group, and 2.24 (95% CI: 1.62 to 3.09) for the no PPM group.
Conclusions Although prognosis remains impaired compared with an age-, sex-, and origin-matched standardized population, periprocedural PPM implantation does not seem to affect clinical outcomes adversely among patients undergoing transfemoral TAVI.
Dr. Buellesfeld is a consultant and proctor for Medtronic. Dr. Wenaweser is a proctor and receives honoraria from Medtronic CoreValve and Edwards LifeSciences. Dr. Khattab has received speaker honoraria and proctor fees from Medtronic CoreValve and Edwards LifeSciences. Dr. Meier has received research grants from Medtronic and Abbott. Dr. Jüni is an unpaid member of steering groups and executive committees of trials funded by Abbott Vascular, Biosensors, Cordis, and Medtronic. Drs. Grube, Boekstegers, and Gerckens are proctors and consultants for Medtronic. Dr. Windecker has received honoraria and consultant fees from Edwards LifeSciences and Medtronic CoreValve. Dr. Eberle has received honoraria from Medtronic Corevalve. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Buellesfeld and Stortecky contributed equally to this work.
- Received January 4, 2012.
- Revision received February 28, 2012.
- Accepted March 19, 2012.
- American College of Cardiology Foundation