TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) IS ASSOCIATED WITH A HIGHER RATE OF PERMANENT PACEMAKER IMPLANTATION COMPARED TO SURGICAL AORTIC VALVE REPLACEMENT (SAVR): A PROPENSITY MATCHED ANALYSIS
Occurrence of conduction abnormalities requiring permanent pacemaker implantation (PPI) is a serious complication after both transcatheter (TAVR) & surgical (SAVR) aortic valve replacement.
Nationwide Inpatient Sample was queried from August 2011 to December 2012 using ICD-9 codes 35.05 & 35.06 for TAVR and 35.21 & 35.22 for SAVR. Patients undergoing other valve surgeries, bypass grafting & those with prior pacemakers or defibrillators were excluded. Propensity matching was performed (1:1) to match TAVR & SAVR cohorts on age, gender, right bundle branch block (RBBB), first degree AV block, bifascicular or trifascicular block, hospital region, teaching hospital status & hospital bed size. Logistic regression was performed to identify predictors of PPI. Differences in the two cohorts were tested using chi-square test.
Total 2,990 patients (1,495 in TAVR group & 1,495 in SAVR group) were included, with mean age 80.2 +/- 9.0 years, 50.4% females & 83.2% Caucasians. RBBB (OR 2.3, 95% CI 1.4-4.0, p = 0.002) & bifascicular or trifascicular block (OR 6.9, 95% CI 2.8-17.0, p<0.001) were predictors of PPI in TAVR group. 146 (9.8%) patients in the TAVR group underwent PPI compared to 98 (6.6%) patients in the SAVR group (p = 0.001).
PPI rates are higher after TAVR (with predominantly balloon expandable valves) compared to SAVR, after matching on demographic, EKG & hospital characteristics. This suggests greater damage to cardiac conduction system with TAVR compared to SAVR.
Published In/Presented At
Shah, N., Patel, A., Patel, N., Agarwal, V., Garg, J., Patel, N., & Cox, D. (2016, April). TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) IS ASSOCIATED WITH A HIGHER RATE OF PERMANENT PACEMAKER IMPLANTATION COMPARED TO SURGICAL AORTIC VALVE REPLACEMENT (SAVR): A PROPENSITY MATCHED ANALYSIS. Journal of the American College of Cardiology. 67(13). Supplement 243. DOI: 10.1016/S0735-1097(16)30244-3.
Department of Medicine, Department of Medicine Faculty, Cardiology Division