The risk of permanent pacemaker implantation (PPI) following valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) is relatively low, according to new data published in the Journal of the American College of Cardiology. That risk decreases even more when newer-generation transcatheter heart valves (THVs) are used.
“ViV TAVR is a less invasive alternative to redo surgery for treating patients with degenerated aortic bioprostheses,” wrote lead author Alberto Alperi, MD, of the Quebec Heart and Lung Institute at Laval University in Canada, and colleagues. “A lower PPI rate has been reported in ViV-TAVR procedures, but scarce data exist on potential differences according to different THV types.”
Alperi et al. tracked data from nearly 2,000 patients who underwent ViV TAVR from 2007 to 2020. The mean patient age was 77.6 years old. None of the patients had prior PPI at the time of their procedure. All data was taken from the VIVID registry, a collaboration of more than 180 different centers from all over the world.
Overall, the team found, PPI after ViV TAVR was reported in 6.4% of patients. When a newer-generation THV was used—meaning any devices other than CoreValve, Cribier-Edwards, Sapien and Sapien XT—that number dropped to 4.7%. The team also noted that there were no significant differences in procedures completed using newer-generation balloon-expanding THVs and self-expanding THVs.
Older age, larger THVs and previous right bundle branch block were all associated with a heightened risk of PPI after ViV TAVR.
“To our knowledge, this is the first study reporting a significant correlation between age and PPI after ViV-TAVR,” the authors wrote. “We think that the broader range of ages observed in our cohort compared with other TAVR trials and registries may have contributed to detecting this association.”
Acute kidney injury was more common among patients requiring PPI. Also, mortality after 30 days was 4.7% for the patients requiring PPI and 2.7% for patients who did not require PPI. This was not seen as a statistically significant difference.
After a median follow-up duration of 12 months, on the other hand, requiring PPI was associated with a significantly greater risk of mortality than patients who did not require PPI.
Click here to read the full analysis in the Journal of the American College of Cardiology.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.