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Pacemaker Implantation after Transcatheter Aortic Valve Implantation: is it a consequence of the type of prosthesis used?
Session:
SESSÃO DE POSTERS 51 - DIAGNÓSTICO E PROGNÓSTICO NA INTERVENÇÃO VALVULAR AÓRTICA PERCUTÂNEA
Speaker:
Tomás M. Carlos
Congress:
CPC 2025
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.4 Valvular Heart Disease – Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Tomás M. Carlos; Luísa Gomes Rocha; Gonçalo Costa; Diogo Fernandes; Joana Guimarães; Gonçalo Terleira Batista; Tatiana Santos; Bernardo Resende; Mafalda Griné; Luís Leite; Marco Costa; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Introduction:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Transcatheter aortic valve implantation (TAVI) provides substantial clinical benefits, although it is also associated with certain adverse events, namely the need for pacemaker implantation (PI). Risk factor for PI include pre-existing conduction abnormalities and calcium distribution. This study assessed the influence of specific TAVI prosthesis on the incidence and timing of PI within 30 days post-procedure.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Methods:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">We conducted a single-centre retrospective study of 628 patients undergoing TAVI from March 2020 to September 2023. Patients were categorized into five groups based on the prosthesis used, and baseline characteristics were compared. Primary outcomes were the 30-day PI rate and time to its implantation. Statistical analysis included non-parametric tests, Kaplan-Meier survival analysis and Cox regression.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Results:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Five different TAVI prostheses were used, with <em>Evolut®</em> being the most depicted (44.1%). Baseline characteristics included pre-TAVI conduction disturbances, particularly a higher prevalence of right bundle branch block (RBBB) in the <em>Sapien 3 Ultra</em>® cohort (21.4%). Aortic valve calcium score was also higher in <em>Sapien 3 Ultra® </em>and <em>Evolut® </em>cohorts (<em>p</em>=0.001). Overall, 118 patients (18.8%) required PI, and its incidence varied significantly by valve type (<em>p</em>=0.006), with <em>Navitor</em>® (29.4%) and <em>Sapien 3 Ultra</em>® (23.3%) showing the highest rates. Median time to PI did not differ statistically between valves (<em>p</em>=0.079), although <em>Navitor</em>® showed a trend toward delayed PI (3.5 days, IQR 5.0). Kaplan-Meier analysis revealed significant variation in 30-day PI-free survival (log-rank test, <em>p</em>=0.001), with <em>Portico</em>® achieving the highest rate (96.0%). <em>Navitor</em>® exhibited a tendency for prolonged pacemaker-free survival decline over time compared to other valves. After adjusting for confounding factors and using <em>Portico</em>® valve as reference, Cox regression suggested that <em>Navitor</em>® was associated with a higher PI risk (HR 10.66, CI 1.45-78.40, <em>p</em>=0.020).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Conclusion:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><em>Sapien 3 Ultra</em>® and <em>Navitor</em>® valves were linked to higher PI rates. In <em>Sapien 3 Ultra</em>®, this was attributed to higher calcium score and pre-existing conduction disturbances, whereas <em>Navitor</em>®’s increased PI risk appeared to be primarily related to its intrinsic properties, which contributed to a higher incidence of post-TAVI <em>de novo </em>rhythm disturbances. Additionally, <em>Navitor</em>® showed a trend toward a longer time to PI and a more prolonged decline in pacemaker-free survival over time.</span></span></p>
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