Clinical effects of permanent pacemaker implantation after transcatheter aortic valve implantation: Insights from the nationwide FRANCE-TAVI registry - 21/03/24
, Dominique Boulmier a, Romain Didier b, Guillaume Leurent a, Marc Bedossa a, Jacques Tomasi c, Guillaume Cayla d, Hakim Benamer e, Sylvain Beurtheret f, Jean-Philippe Verhoye c, Philippe Commeau g, Thierry Lefèvre e, Bernard Iung h, Hélène Eltchaninoff i, Jean-Philippe Collet j, Nicolas Dumonteil k, Florence Du Chayla l, Margaux Gouysse l, Martine Gilard b, Hervé Le Breton afor the
FRANCE-TAVI, STOP-AS investigators2
Graphical abstract |
Highlights |
• | French nationwide analysis of 36,549 TAVI recipients. |
• | Approximately one fifth of patients underwent PPI within 30days of TAVI. |
• | In-hospital PPI was not associated with 30-day survival. |
• | PPI within 30days of TAVI was associated with a higher 5-year risk of HHF. |
• | PPI within 30days of TAVI was associated with a higher 5-year risk of mortality. |
• | Further efforts are needed to mitigate the risk of PPI after TAVI. |
Abstract |
Background |
The influence of permanent pacemaker implantation upon outcomes after transcatheter aortic valve implantation (TAVI) remains controversial.
Aims |
To evaluate the impact of permanent pacemaker implantation after TAVI on short- and long-term mortality, and on the risk of hospitalization for heart failure.
Methods |
Data from the large FRANCE-TAVI registry, linked to the French national health single-payer claims database, were analysed to compare 30-day and long-term mortality rates and hospitalization for heart failure rates among patients with versus without permanent pacemaker implantation after TAVI. Multivariable regressions were performed to adjust for confounders.
Results |
A total of 36,549 patients (mean age 82.6years; 51.6% female) who underwent TAVI from 2013 to 2019 were included in the present analysis. Among them, 6999 (19.1%) received permanent pacemaker implantation during the index hospitalization, whereas 232 (0.6%) underwent permanent pacemaker implantation between hospital discharge and 30days after TAVI, at a median of 11 (interquartile range: 7–18) days. In-hospital permanent pacemaker implantation was not associated with an increased risk of death between discharge and 30days (adjusted odds ratio: 0.91, 95% confidence interval: 0.64–1.29). At 5years, the incidence of all-cause death was higher among patients with versus without permanent pacemaker implantation within 30days of the procedure (adjusted hazard ratio: 1.13, 95% confidence interval: 1.07–1.19). Permanent pacemaker implantation within 30days of TAVI was also associated with a higher 5-year rate of hospitalization for heart failure (adjusted subhazard ratio: 1.17, 95% confidence interval: 1.11–1.23).
Conclusions |
Permanent pacemaker implantation after TAVI is associated with an increased risk of long-term hospitalization for heart failure and all-cause mortality. Further research to mitigate the risk of postprocedural permanent pacemaker implantation is needed as TAVI indications expand to lower-risk patients.
Le texte complet de cet article est disponible en PDF.Keywords : Transcatheter aortic valve implantation, Permanent pacemaker, Mortality, Heart failure, Conduction disturbances
Plan
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Vol 117 - N° 3
P. 213-223 - mars 2024 Retour au numéro
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