Department of Medicine, Reading Health System, West Reading, Pennsylvania.
Children's Hospital Los Angeles, Los Angeles, California.
JACC Cardiovasc Interv. 2016 Nov 14;9(21):2189-2199. doi: 10.1016/j.jcin.2016.07.026.
The purpose of this study was to evaluate the incidence, predictors, and clinical outcomes of permanent pacemaker (PPM) implantation following transcatheter aortic valve replacement (TAVR).
Conduction abnormalities leading to PPM implantation are common complications following TAVR. Whether PPM placement can be predicted or is associated with adverse outcomes is unclear.
A retrospective cohort study of patients undergoing TAVR in the United States at 229 sites between November 2011 and September 2014 was performed using the Society of Thoracic Surgeons/American College of Cardiology TVT Registry and the Centers for Medicare and Medicaid Services database.
PPM placement was required within 30 days of TAVR in 651 of 9,785 patients (6.7%) and varied among those receiving self-expanding valves (25.1%) versus balloon-expanding valves (4.3%). Positive predictors of PPM implantation were age (per 5-year increment, odds ratio: 1.07; 95% confidence interval [CI]: 1.01 to 1.15), prior conduction defect (odds ratio: 1.93; 95% CI: 1.63 to 2.29), and use of self-expanding valve (odds ratio: 7.56; 95% CI: 5.98 to 9.56). PPM implantation was associated with longer median hospital stay (7 days vs. 6 days; p < 0.001) and intensive care unit stay (56.7 h vs. 45.0 h; p < 0.001). PPM implantation was also associated with increased mortality (24.1% vs. 19.6%; hazard ratio [HR]: 1.31; 95% CI: 1.09 to 1.58) and a composite of mortality or heart failure admission (37.3% vs. 28.5%; hazard ratio HR: 1.33; 95% CI: 1.13 to 1.56) at 1 year but not with heart failure admission alone (16.5% vs. 12.9%; HR: 1.23; 95% CI: 0.92 to 1.63).
Early PPM implantation is a common complication following TAVR, and it is associated with higher mortality and a composite of mortality or heart failure admission at 1 year.
本研究旨在评估经导管主动脉瓣置换术（TAVR）后永久性心脏起搏器（PPM）植入的发生率、预测因素和临床结局。
导致 PPM 植入的传导异常是 TAVR 后的常见并发症。是否可以预测 PPM 植入或其与不良结局相关尚不清楚。
采用美国胸外科医师学会/美国心脏病学会 TVT 注册中心和医疗保险和医疗补助服务数据库，对 2011 年 11 月至 2014 年 9 月期间在美国 229 个地点接受 TAVR 的患者进行了一项回顾性队列研究。
在 9785 例患者中，有 651 例（6.7%）在 TAVR 后 30 天内需要植入 PPM，植入率在接受自膨式瓣膜的患者中为 25.1%，而在接受球囊扩张式瓣膜的患者中为 4.3%。PPM 植入的阳性预测因素包括年龄（每增加 5 岁，比值比：1.07；95%置信区间 [CI]：1.01 至 1.15）、既往传导异常（比值比：1.93；95%CI：1.63 至 2.29）和使用自膨式瓣膜（比值比：7.56；95%CI：5.98 至 9.56）。PPM 植入与更长的中位住院时间（7 天 vs. 6 天；p<0.001）和重症监护病房住院时间（56.7 小时 vs. 45.0 小时；p<0.001）相关。PPM 植入还与更高的死亡率（24.1% vs. 19.6%；风险比 [HR]：1.31；95%CI：1.09 至 1.58）和 1 年时死亡率或心力衰竭入院的复合终点（37.3% vs. 28.5%；HR：1.33；95%CI：1.13 至 1.56）相关，但与心力衰竭入院（16.5% vs. 12.9%；HR：1.23；95%CI：0.92 至 1.63）无关。
TAVR 后早期植入 PPM 是一种常见并发症，与 1 年时更高的死亡率和死亡率或心力衰竭入院的复合终点相关。
