Hemodynamic Impact and Outcome of Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Implantation

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• 作者：Simon Biner ; Yoav Michowitz ; Eran Leshem-Rubinow ; Yan Topilsky ; Eyal Ben-Assa ; Jason Shimiaie ; Shmuel Banai ; Gad Keren ; Arie Steinvil ; Ariel Finkelstein
• 刊名：The American Journal of Cardiology
• 出版年：1 January, 2014
• 年：2014
• 卷：113
• 期：1
• 页码：132-137
• 全文大小：191 K

文摘

Transcatheter aortic valve implantation (TAVI) frequently requires postprocedural permanent pacemaker (PPM) implantation. We evaluated clinical and hemodynamic impact of PPM after TAVI. Clinical and echocardiographic data were retrospectively analyzed in 230 consecutive patients who underwent TAVI and echocardiography at baseline and after 6聽months. Echocardiographic parameters included left ventricular ejection fraction (LVEF), left ventricular (LV) stroke volume, early mitral velocity/annulus velocity ratio (E/e鈥?, right ventricular index of myocardial performance, systolic pulmonary artery pressure (SPAP), and aortic, mitral, and tricuspid regurgitation grades. Clinical outcomes included 2-year survival and cardiovascular and PPM-related event-free survival. The Medtronic CoreValve and Edwards Sapien prosthesis were used in 201 and 29 patients, respectively. PPM was required in 58 patients (25.4%). Two-year and event-free survival rates were similar between patients with and without PPM. At 6聽months, patients with PPM demonstrated attenuated improvement in LVEF (鈭?.9 卤 8.7% vs 2.3 卤 10.8%, respectively, p聽= 0.03) and LV stroke volume (鈭? 卤 16 vs 4 卤 10聽ml/m², respectively, p聽= 0.015), a trend toward smaller reduction in systolic pulmonary artery pressure (鈭? 卤 12 vs聽鈭? 卤 10聽mm Hg, respectively, p聽= 0.09), and deterioration of right ventricular index of myocardial performance (鈭? 卤 17% vs 5 卤 26%, respectively, p聽= 0.05). The differences in post-TAVI aortic, mitral, and tricuspid regurgitation grades were insignificant. In conclusion, PPM implantation after TAVI is associated with reduced LVEF and impaired LV unloading. However, this unfavorable hemodynamic response does not affect the 2-year clinical outcome. The maintenance of clinical benefit appears to be driven by TAVI-related recovery of LV and right ventricular performance that mitigates unfavorable impact of PPM.