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Site-Level Variation and Predictors of Permanent Pacemaker Implantation Following TAVR in the Evolut Low-Risk Trial.
Gada, Hemal; Vora, Amit N; Tang, Gilbert H L; Mumtaz, Mubashir; Forrest, John K; Laham, Roger J; Yakubov, Steven J; Deeb, G Michael; Rammohan, Chad; Huang, Jian; Reardon, Michael J.
Afiliação
  • Gada H; Department of Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle, Wormleysburg, PA, United States of America. Electronic address: hemalgada@gmail.com.
  • Vora AN; Department of Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle, Wormleysburg, PA, United States of America.
  • Tang GHL; Department of Cardiovascular Surgery, Mount Sinai Health System, NY, New York, United States of America.
  • Mumtaz M; Department of Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle, Wormleysburg, PA, United States of America.
  • Forrest JK; Department of Internal Medicine (Cardiology), Yale University School of Medicine, New Haven, CT, United States of America.
  • Laham RJ; Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America.
  • Yakubov SJ; Department of Interventional Cardiology, Riverside Methodist-Ohio Health, Columbus, OH, United States of America.
  • Deeb GM; Department of Cardiac Surgery, University of Michigan Hospitals, Ann Arbor, MI, United States of America.
  • Rammohan C; El Camino Hospital, Department of Interventional Cardiology, Mountain View, CA, United States of America.
  • Huang J; Department of Statistics, Medtronic, Minneapolis, MN, United States of America.
  • Reardon MJ; Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Institute, Houston, TX, United States of America.
Cardiovasc Revasc Med ; 47: 48-54, 2023 Feb.
Article em En | MEDLINE | ID: mdl-36266154
We evaluated predictors of permanent pacemaker implantation (PPI) following self-expanding transcatheter aortic valve replacement (TAVR), examined site-to-site variability of PPI rates, and explored the relationship of implantation methods on the need for PPI. Despite the benefits of TAVR compared to surgical aortic valve replacement, increased PPI remains a limitation. A total of 699 patients without baseline PPI were included in the study. Clinical, echocardiographic, and procedural characteristics were compared in patient with and without new PPI. Clinical outcomes were assessed at 30 days and 1 year. Funnel plots were constructed to display site-to- site variability and identify outliers in PPI. Clinical outcomes were similar in patients with and without PPI. Predictors of a new PPI within 7 days included a baseline right bundle branch block (p < 0.001) and not using general anesthesia (p = 0.003). There was substantial site to site variability in the rate of PPI. Patients at sites with a lower PPI rate had shallower implantation depth at the non-coronary (p < 0.001) and the left coronary sinus (p < 0.001), and fewer patients with an implantation depth > 5 mm below the annulus (p = 0.004). In low-risk patients undergoing TAVR with Evolut valves, baseline conduction disorders and implant depth were important predictors of PPI. Implantation method may have contributed to this variability in PPI rates across clinical sites.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Estenose da Valva Aórtica / Marca-Passo Artificial / Substituição da Valva Aórtica Transcateter Tipo de estudo: Etiology_studies / Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Estenose da Valva Aórtica / Marca-Passo Artificial / Substituição da Valva Aórtica Transcateter Tipo de estudo: Etiology_studies / Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article