Long-term outcome after TAVI and the impact of new left bundle branch block or pacemaker implantation on survival

Abstract

Aim: Previous studies on outcome after transcatheter aortic valve implantation (TAVI) have focused on the first 30 days as well as first year after the procedure. Recently new LBBB has been discussed to have a negative impact on long-term outcome. This study aimed at definition of long term outcome up to 5 years after TAVI as well as the impact of new LBBB or pacemaker implantation on the outcome. Methods: 376 consecutive patients with symptomatic aortic valve prospectively included. 205 patients were treated using a CoreValve prosthesis and 171 patients were treated with an Edwards Sapien prosthesis. 162 pts developed a new LBBB or required pacemaker implantation, in 205 neither a new LBBB was observed nor a new pacemaker war required. Patients were followed-up on a yearly basis. Results: Survival at 1 year follow-up was 81%, at two year follow-up 72%, at three year follow-up 67% and at four year follow-up 60%. NYHA functional class showed a marked improvement from 3.1±0.6 before TAVI to 1.8±0.7 at latest follow-up. Impaired left ventricular function (ejection fraction <40%) was associated with impaired survival at follow-up (p=0.012). There was no difference in long-term survival between patients with new LBBB or pacemaker implantation and those without new LBBB or pacemaker (see figure). ![Figure][1] Survival after TAVI Conclusion: Survival more than one year after TAVI is good with a yearly mortality of less than 10%. A new LBBB or pacemaker implantation after TAVI has no negative impact on long-term survival. [1]: pending:yes