- 作者：Rodrigo Bagur ; MD鈦?/sup> ; Josep Rodé ; s-Cabau ; MD鈦?/sup> ; josep.rodes@criucpq.ulaval.ca ; Ronen Gurvitch ; MBBS&dagger ; ; É ; ric Dumont ; MD鈦?/sup> ; James L. Velianou ; MD&Dagger ; ; Juan Manazzoni ; MD鈦?/sup> ; Stefan Toggweiler ; MD&dagger ; ; Anson Cheung ; MD&dagger ; ; Jian Ye ; MD&dagger ; ; Madhu K. Natarajan ; MD&Dagger ; ; Kevin R. Bainey ; MD鈦?/sup> ; Robert DeLarochelliè ; re ; MD鈦?/sup> ; Daniel Doyle ; MD鈦?/sup> ; Philippe Pibarot ; DVM ; PhD鈦?/sup> ; Pierre Voisine ; MD鈦?/sup> ; Mé ; lanie Cô ; té ; MSc鈦?/sup> ; Franç ; ois Philippon ; MD鈦?/sup> ; John G. Webb ; MD&dagger ;
- 关键词：aortic stenosis ; pacemaker implantation ; transcatheter aortic valve implantation ; valve replacement
- 刊名：JACC ; Cardiovascular Interventions
- 出版年：2012
- 期刊代码：pca198_19368798
- 类别：med
- 出版时间：May, 2012
- 卷：5
- 期：5
- 页码：540-551
- 文件大小：2223 K
Objectives
The aim of this study was to compare the incidence and predictive factors of complete atrioventricular block (AVB) and permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR).Background
No data exist on the need for PPI after TAVI versus SAVR in patients with similar baseline electrocardiographic (ECG) findings.
Methods
A total of 411 patients with severe aortic stenosis (AS) and no prior pacemaker who underwent TAVI with the balloon-expandable Edwards valve (Edwards Lifesciences, Irvine, California) were matched (1:1) with 411 elderly patients with severe AS who underwent isolated SAVR on the basis of baseline ECG findings. The incidence, reasons, and predictive factors for PPI within 30 days after the procedure were compared between groups.
Results
Mean age was similar in both groups (p = 0.11), and the TAVI group had a higher Society of Thoracic Surgeons score (p < 0.001). The rate of new PPI was higher after TAVI (7.3%) compared with SAVR (3.4%), p = 0.014. Complete AVB and severe symptomatic bradycardia, respectively, were the reasons for PPI in the TAVI (5.6%and 1.7%, respectively) and SAVR (2.7%and 0.7%, respectively) groups (p = 0.039 for complete AVB, p = NS for symptomatic bradycardia). The presence of baseline right bundle branch block was the only variable associated with PPI in the TAVI group (odds ratio: 8.61, 95%confidence interval: 3.14 to 23.67, p < 0.0001), whereas no variable was found in the SAVR group.
Conclusions
Transcatheter aortic valve implantation was associated with a higher rate of complete AVB and PPI compared with SAVR in elderly patients with severe AS and similar baseline ECG findings. The presence of baseline right bundle branch block correlated with the need for PPI in the TAVI group.