Author + information
- Divyanshu Mohananey,
- Stephanie Mick,
- Amar Krishnaswamy,
- E. Murat Tuzcu and
- Samir Kapadia
Background: Conduction abnormalities and need for permanent pacemaker (PPM) are frequent complications of transcatheter aortic valve replacement (TAVR). While the incidence and predictors of PPM implantation have been well studied, data is conflicting on its clinical impact.
Methods: A comprehensive search of the PubMed, EMBASE and Google scholar was performed. Risk ratio (RR) or Standardized mean difference (SMD) was calculated for each outcome using fixed effects model unless heterogeneity was >25%, in which case a random effects model was used.
Results: We identified 20 observational studies with a total of 10,724 patients. We found no significant difference in all-cause mortality at 30 days [RR 0.82 (0.66 – 1.03)], 1 year [RR 1.04 (0.92 – 1.20)] or at longest follow up [RR 1.05 (0.90-1.21)]. Risk of stroke at 30 days [RR 1.3 (0.71 – 2.39)], stroke at 1 year [RR 0.61 (0.31 – 1.21)], myocardial infarction (MI) at 30 days [RR 0.61 (0.23 – 1.60)], MI at 1 year [RR 0.98 (0.40 -2.43)] and major bleeding at 30 days [RR 0.87 (0.38 – 1.99)] was also similar between the two groups. Improvement in left ventricular ejection fraction (LVEF) on follow up was significantly greater in patients without PPM [SMD -0.3 (-0.46- -0.15)]. There was no impact of age, Euroscore, LVEF, gender and type of prosthesis on all-cause mortality at 30 days or 1 year using meta-regression techniques.
Conclusions: Patients with PPM do not have an increased risk of all-cause mortality, stroke or MI but have a decreased improvement in LVEF after TAVR.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Interventional Cardiology: TAVR 3
Abstract Category: 17. Interventional Cardiology: Aortic Valve Disease
Presentation Number: 1243-195
- 2017 American College of Cardiology Foundation