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. 2024 Jan 1:210:146-152.
doi: 10.1016/j.amjcard.2023.10.018. Epub 2023 Oct 12.

Impact of Pacemaker Implantation After Transcatheter Aortic Valve Replacement on Long-Term Survival in Patients With Bicuspid Aortic Valve

Francesco De Felice  1 , Luca Paolucci  2 , Vincenzo Cesario  2 , Carmine Musto  2 , Marco Stefano Nazzaro  2 , Diana Chin  2 , Rocco Stio  2 , Mauro Pennacchi  2 , Domenico Gabrielli  2 , Claudia Fiorina  3 , Mauro Massussi  3 , Marco Angelillis  4 , Giulia Costa  4 , Giuseppe Bruschi  5 , Massimo Fineschi  6 , Diego Maffeo  7 , Marta Barletta  8 , Damiano Regazzoli  9 , Matteo Montorfano  10
Affiliations

Impact of Pacemaker Implantation After Transcatheter Aortic Valve Replacement on Long-Term Survival in Patients With Bicuspid Aortic Valve

Francesco De Felice et al. Am J Cardiol. .

Abstract

Limited data are available about the impact of permanent pacemaker (PPM) implantation on long-term survival in patients with a bicuspid aortic valve (BAV) and severe aortic stenosis (AS) treated with transcatheter aortic valve replacement (TAVR). We aimed to evaluate the long-term clinical outcomes of patients with BAV with AS who underwent periprocedural PPM implantation after TAVR with a self-expandable prosthesis. Data from patients with BAV and severe AS who underwent TAVR between April 2009 and January 2022 and followed in the framework of the One Hospital ClinicalService-CoreValve Project were collected. Patients were categorized in 2 groups according to PPM implantation after TAVR ("PPM" group) or not ("no PPM" group). The coprimary end points were all-cause death and a composite of cardiac mortality, rehospitalization because of cardiac causes, stroke, and myocardial infarction. Overall, 106 patients were considered (74 in the "no PPM" group and 32 in the "PPM" group). No statistically significant difference was found between the groups in terms of follow-up and baseline characteristics. Patients in the PPM group were more likely to show baseline conduction abnormalities (p = 0.023). Patients in the PPM group were more often treated with older generation prosthesis than those in the no PPM group (28.1% vs 5.4%, respectively, p = 0.013). At 2 years of follow-up, all-cause death in the no PPM and PPM groups occurred in 20.0% and 10.0% of patients, respectively (hazard ratio 0.37, 95% confidence interval 0.08 to 1.67). Similarly, no difference was evident for the composite end point between the 2 groups (no PPM vs PPM: 8 [14.6%] vs 6 [19.3%], hazard ratio 1.67, 95% CI 0.58 to 4.81). In conclusion, patients with severe AS and BAV treated with TAVR complicated by PPM implantation are not exposed to an increased risk of major adverse events at 2 years of follow-up.

Keywords: bicuspid aortic valve disease; pacemaker; transcatheter aortic valve replacement.

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Conflict of interest statement

Declaration of Competing Interest Dr. Matteo Montorfano received consultant fees from Abbott, Boston, Kardia, and Medtronic. The remaining authors have no competing interest to declare.