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Survival relative to pacemaker status after transcatheter aortic valve implantation

Research output: Contribution to journalArticlepeer-review

Aung Myat, Florence Mouy, Luke Buckner, James Cockburn, Andreas Baumbach, Philip MacCarthy, Adrian P. Banning, Nick Curzen, Roland Hilling-Smith, Daniel J. Blackman, Michael Mullen, Mark de Belder, Ian Cox, Jan Kovac, Ganesh Manoharan, Azfar Zaman, Douglas Muir, David Smith, Stephen Brecker, Mark Turner & 11 more Saib Khogali, Iqbal S. Malik, Osama Alsanjari, Francesca D'Auria, Simon Redwood, Bernard Prendergast, Uday Trivedi, Derek Robinson, Peter Ludman, Adam de Belder, David Hildick-Smith

Original languageEnglish
Pages (from-to)E444-E452
JournalCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS
Volume98
Issue number3
DOIs
Accepted/In press2021
PublishedSep 2021

Bibliographical note

Funding Information: The work was supported by the NHS National Institute for Health Research through an Academic Clinical Lectureship (Ref.: CL‐2016‐27‐001) currently undertaken by Dr. Aung Myat at Brighton and Sussex Medical School, Brighton, United Kingdom. Funding Information: Dr. Adrian P. Banning is partially funded by the NHS National Institute for Health Research Oxford Biomedical Research Center, Oxford, United Kingdom. Funding Information: Adrian P. Banning reports institutional funding from Boston Scientific for a Fellowship. Daniel J. Blackman is a Consultant and Proctor for Medtronic and Boston Scientific. Nick Curzen holds unrestricted research grants from Boston Scientific. Philip MacCarthy declares consulting/proctorship contracts with Edwards Lifesciences and research support from Boston Scientific. Douglas Muir is a Proctor for Edwards Lifesciences and Abbott Vascular. Jan Kovac is a Proctor and Consultant for Edwards Lifesciences, Medtronic, Boston Scientific and Abbott. David Smith is a Consultant and Proctor for Abbott. Stephen Brecker is a Clinical Advisor/Consultant for Medtronic and Boston Scientific. Mark Turner is a proctor for Medtronic pulmonary valves currently, and has been a proctor for Edwards Lifesciences pulmonary valves in the past, but no longer holds a contract with them. He is also a Consultant and Advisory Board Member for St Jude (now Abbott), and has previously received educational meeting support from Edwards Lifesciences, Medtronic and Abbott. Saib Khogali is a Proctor for Boston Scientific and Medtronic. Simon Redwood declares Proctor and Lecture fees from Edwards Lifesciences. Bernard Prendergast declares unrestricted research grants and lecture fees from Edwards Lifesciences. David Hildick‐Smith has advisory and proctoring contracts with Boston Scientific, Edwards and Medtronic. Aung Myat, Luke Buckner, Florence Mouy, James Cockburn, Andreas Baumbach, Michael Mullen, Mark de Belder, Roland Hilling‐Smith, Ian Cox, Azfar Zaman, Ganesh Manoharan, Iqbal S. Malik, Timothy Williams, Osama Alsanjari, Francesca D'Auria, Uday Trivedi, Derek Robinson, Peter Ludman, and Adam de Belder report no conflicts to declare pertaining to this manuscript. Publisher Copyright: © 2021 Wiley Periodicals LLC. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors

Abstract

Objectives: To determine whether a permanent pacemaker (PPM) in situ can enhance survival after transcatheter aortic valve implantation (TAVI), in a predominantly inoperable or high risk cohort. Background: New conduction disturbances are the most frequent complication of TAVI, often necessitating PPM implantation before hospital discharge. Methods: We performed an observational cohort analysis of the UK TAVI registry (2007–2015). Primary and secondary endpoints were 30-day post-discharge all-cause mortality and long-term survival, respectively. Results: Of 8,651 procedures, 6,815 complete datasets were analyzed. A PPM at hospital discharge, irrespective of when implantation occurred (PPM 1.68% [22/1309] vs. no PPM 1.47% [81/5506], odds ratio [OR] 1.14, 95% confidence interval [CI] 0.71–1.84; p =.58), or a PPM implanted peri- or post-TAVI only (PPM 1.44% [11/763] vs. no PPM 1.47% [81/5506], OR 0.98 [0.51–1.85]; p =.95) did not significantly reduce the primary endpoint. Patients with a PPM at discharge were older, male, had right bundle branch block at baseline, were more likely to have received a first-generation self-expandable prosthesis and had experienced more peri- and post-procedural complications including bailout valve-in-valve rescue, bleeding and acute kidney injury. A Cox proportional hazards model demonstrated significantly reduced long-term survival in all those with a PPM, irrespective of implantation timing (hazard ratio [HR] 1.14 [1.02–1.26]; p =.019) and those receiving a PPM only at the time of TAVI (HR 1.15 [1.02–1.31]; p =.032). The reasons underlying this observation warrant further investigation. Conclusions: A PPM did not confer a survival advantage in the first 30 days after hospital discharge following TAVI.

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