Author + information
There exists divergence between guideline recommendation and the current trends toward reducing hospitalization after TAVR.
Patients undergoing TAVR were identified by ICD-9-CM procedure codes for trans-femoral/ trans-aortic (35.05) (TF-TAVR) and trans-apical (35.06) (TA-TAVR) implantation of aortic valve in Nationwide Readmission Database. The primary outcome is pacemaker implantation within 30 days after TAVR. Multivariate logistic regression was performed with the selected variables via stepwise logistic regression to identify predictors for pacemaker implantation within 30 days after TAVR.
Total 6523 patients (national estimate=13363) underwent TAVR at 214 hospitals in the United States from January to November 2014. Of those, 944 patients required pacemaker implantation within 30 days after TAVR (30-day pacemaker implantation rate= 14.5%). 894 patients (94.7%) had pacemaker implantation in the initial hospitalization while 50 patients (5.3%) were readmitted for pacemaker implantation after being discharged from the initial hospitalization. TF-TAVR, complete AVB, sinoatrial node dysfunction, Wenckebach AVB, Mobitz AVB, other bilateral BBB, trifascicular block, LBBB, First degree AVB, RBBB were identified as independent predictors of 30-day pacemaker implantation after TAVR.
Most pacemaker implantations after TAVR were performed within short observation period in the United States. Access site and peri-procedural conduction abnormalities were independent predictors of 30-day pacemaker implantation after TAVR.
STRUCTURAL: Valvular Disease: Aortic