Predictors and Permanency of Cardiac Conduction Disorders and Necessity of Pacing after Transcatheter Aortic Valve Implantation | Semantic Scholar (2024)

FAQs

What are the risk factors for requirement of permanent pacemaker implantation after aortic valve replacement? ›

Risk factors associated with early pacemaker implantation include preoperative bundle branch block, older age, and a high burden of comorbidities. After surgical AVR, the prevalence of new permanent pacemaker implantation is 3% to 5%,^4-6 whereas the prevalence after transcatheter AVR is 9% to 26%.

The observed survival rate for the TAVI cohort at 30 days, 1-year and 5-years is 95.7%, 86.9% and 46.2%, respectively (supplement Table 5). The survival rate for TAVI patients is lower than that of the general.

However, the prevalence of permanent pacemaker implantation after TAVR ranges from 9% to 26% (1-4). The high risk of requiring permanent pacemaker implantation following TAVR can be explained by the adjacent position of the aortic valve annulus to the conduction system.

TAVI results in worsening of conduction parameters, especially the occurrence of new LBBB, in most patients. This worsening is the result of direct damage on the AV node or His bundle and is related to the initial valvuloplasty or prosthesis deployment.

One-year all-cause mortality was not increased for patients with a new permanent pacemaker (HR: 1.64; 95% CI: 0.72-3.74). However, the all-cause mortality rate at 5 years after TAVR was 47% and 33% in patients with and without a new permanent pacemaker, respectively (HR: 1.58; 95% CI: 1.01-2.46).

Surgical aortic valve replacement (SAVR) is one of the most commonly performed cardiac surgical procedures worldwide. The incidence of postoperative conduction abnormalities that require permanent pacemaker (PPM) implantation varies and can occur in up to 3% to 11.8% of patients.

Median survival time was 10.9 years (95% confidence interval: 10.6-11.2 years) in low-risk, 7.3 years (7.0-7.9 years) in intermediate-risk, and 5.8 years (5.4-6.5 years) in high-risk patients.

Risks of TAVR

Still, the procedure carries some risk, which our team thoroughly explains beforehand and works hard to avoid: Valve leaks: Sometimes blood leaks around the new valve because the replacement is not big enough, did not fully expand, or has interference from calcium buildup.

There is research that shows patients who undergo TAVR have reduction in symptoms, improvement in ability to take care of themselves, improved heart function, and improvement in overall quality of life at 30 days. Most patients are able to return to work within two weeks after the procedure.

Overall heart health: People who have problems with more than one valve or have conditions such as aortic aneurysm or coronary artery disease may not be good candidates for TAVR.

Is cardiac rehab necessary after TAVR? ›

Cardiac rehabilitation is recommended for patients who undergo TAVR just as it is for heart attack survivors and stent recipients.

In general, the cost of TAVI/TAVR treatment in India is much less than that of the same procedure and care in the US and other developed nations. In India, TAVI/TAVR treatment typically costs between Rs. 21,00,000 ($25,000) and Rs. 35,00,000 ($42,000).

Conclusions. TAVI is associated with significant early improvement in QOL, which is sustained at 1 year. The inclusion of QOL can support treatment decisions and patient-centred evaluation.

Transcatheter aortic valve implantation (TAVI)

The main advantages of this technique are that the heart doesn't need to be stopped, so a heart-lung (bypass) machine doesn't need to be used, and it avoids making a large cut (incision) in your chest.

Conduction abnormalities requiring permanent pacemaker (PPM) implantation and development of new left bundle branch block (LBBB) remain the most common TAVR complications.

Conclusion: Infectious endocarditis cardiac surgery patients often require a postoperative permanent pacemaker. Preoperative conduction abnormality, S. aureus infection, abscess, tricuspid valve involvement, and prior valvular surgery are strong predictors of postoperative permanent pacemaker placement.