Abstract
Abstract Background: Transcatheter aortic valve implantation (TAVI) has become a therapeutic option for high-risk or non-operable patients with severe symptomatic aortic stenosis. Atrioventricular conduction disturbances requiring permanent pacemaker (PPM) are a common and clinically important complication. Objectives: To evaluate the incidence of conduction disorders (CDs) after TAVI and the need for subsequent PPM implantation. To identify the predictors of postoperative PPM implantation. Methods: Retrospective study. All patients who underwent TAVI in a public hospital from December/2011 to June/2016 were included. Multivariate analysis was conducted to establish the predictor of permanent pacemaker implantation. Survival curves were constructed by the Kaplan-Meyer method. Statistically significant variables were those with p value < 0.05. Results: 64 patients with AS underwent TAVI. Eleven patients were excluded. TAVI induced a new CD in 40 (77%) of the remaining 53 patients. The most common new CDs were 3rd degree AV block (32%) and left bundle branch block (30%). Sixteen patients (30,2%) underwent PPM implantation during the index hospitalization. On univariate analysis the risk factors for PPM implantation were CoreValve® use (OR: 1,76; P = 0,005), larger prosthesis implantation (P = 0,015), presence of a QRS ≥ 120 ms (OR: 5,62; P = 0,012), and 1st degree AV block (OR: 13; P = 0.008). On multivariate analysis the presence of 1st degree AV block predicted the need for PPM. Conclusion: TAVI induced CDs requiring PPM in 30% of the patients. The presence of 1st degree AV block predicted the need for PPM.
Highlights
Aortic stenosis (AoS) is the most common valve disease in developed countries, affecting approximately 3% of the population older than 75.1 In Brazil, with an increase in life expectancy, a significant increase in cases of degenerative AoS is expected for the coming years.[2]The mortality rate of patients with symptomatic AoS is approximately 50% in the first 2 years with no surgical treatment.[3,4] Aortic valve replacement is associated with low mortality when performed in patients without severe comorbidities.[5]
The only variable considered to be an independent predictor of the need for pacemaker implantation after Transcatheter aortic valve implantation (TAVI) was the presence of first-degree AVB before implantation of the prosthesis. (Odds ratio: 13.00; 95% CI 1.95 to 86.80; p = 0.008)
TAVI caused the development of conduction disorders in the vast majority of patients
Summary
Aortic stenosis (AoS) is the most common valve disease in developed countries, affecting approximately 3% of the population older than 75.1 In Brazil, with an increase in life expectancy, a significant increase in cases of degenerative AoS is expected for the coming years.[2]The mortality rate of patients with symptomatic AoS is approximately 50% in the first 2 years with no surgical treatment.[3,4] Aortic valve replacement is associated with low mortality when performed in patients without severe comorbidities.[5]. Transcatheter aortic valve implantation (TAVI) is a recently developed technique for the treatment of symptomatic patients with severe AoS considered to be inoperable or at high surgical risk.[8,9,10,11,12,13] The 2 types of aortic valve prosthesis most used for percutaneous. Transcatheter aortic valve implantation (TAVI) has become a therapeutic option for high-risk or nonoperable patients with severe symptomatic aortic stenosis. The most common new CDs were 3rd degree AV block (32%) and left bundle branch block (30%). On multivariate analysis the presence of 1st degree AV block predicted the need for PPM. Conclusion: TAVI induced CDs requiring PPM in 30% of the patients. (Int J Cardiovasc Sci. 2019;32(5):492-504) Keywords: Atrioventricular Block; Bundle-Branch Block; Aortic Valve Stenosis/therapy; Transcatheter Aortic Valve Implantation/methods The presence of 1st degree AV block predicted the need for PPM. (Int J Cardiovasc Sci. 2019;32(5):492-504) Keywords: Atrioventricular Block; Bundle-Branch Block; Aortic Valve Stenosis/therapy; Transcatheter Aortic Valve Implantation/methods
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