COMPARISON OF IN-HOSPITAL OUTCOMES OF TRANSCATHETER AORTIC VALVE REPLACEMENT IN PATIENTS WITH PREEXISTING COMPARED TO POSTOPERATIVE PERMANENT PACEMAKER IMPLANTATION

Abstract

Background Conduction abnormalities requiring placement of a permanent pacemaker (PPM) after transcatheter aortic valve replacement (TAVR) is not uncommon. Data on outcomes in patients with pre-procedural implanted PPM is lacking. Methods This retrospective cohort study based on the NIS included all patients ≥ 18 years who underwent TAVR from 2011 to 2017. Statistical analysis was performed comparing baseline characteristics and in-hospital outcomes between individuals with pre-TAVR PPM and post-TAVR implantation of PPM. Patients with pre- or post-procedure implantable cardiac defibrillators were excluded. Results A total of 149,642 patients underwent TAVR, of which 16,127 (10.8%) had a pre-existing PPM, and 16,678 (11.1%) had a PPM implanted while hospitalized. Mean age was higher in the pre-TAVR PPM (84±6 vs. 82±7 years), with a higher proportion of males (57% vs. 55% p<0.001 for both). The Pre-TAVR PPM group had higher rates of atrial tachyarrhythmias, heart failure, strokes, coronary artery disease, prior percutaneous coronary intervention and prior coronary artery bypass graft (p<0.001 for all). The post-TAVR PPM group had increased prevalence of diabetes, thrombocytopenia, obesity and end-stage renal disease (p<0.001 for all). No difference was found in hypertension, dyslipidemia, chronic kidney disease, peripheral artery disease or pulmonary hypertension. The main indication for implantation of PPM during hospitalization was complete heart block (63.9%). There was an increase in cardiac arrest, cardiogenic shock, acute kidney injury, acute coronary syndrome, infections, major bleeding, transfusions, thromboembolism, hospital charges, and longer length of stay in the group who had a post-TAVR PPM (p<0.001 for all). However, paravalvular leakage was higher in patients with pre-TAVR PPM (p<0.001). When controlled for pertinent comorbidities, In-hospital all-cause mortality rates were significantly higher in patients with post-TAVR PPM (2.5% vs. 1.6%; OR 1.52 [CI 1.29-1.78] p<0.001). Conclusion Despite higher cardiovascular risk and disease in patients with pre-TAVR PPM, patients with post-TAVR PPM have shown an increase in-hospital morbidity and mortality.