Department of Cardiology, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467-2401 USA.
J Invasive Cardiol. 2020 Dec;32(12):E362-E369. doi: 10.25270/jic/20.00270.
The aim of this study was to describe the rate of complications secondary to permanent pacemaker (PPM) implantation after transcatheter aortic valve implantation (TAVI).
Patients were identified by retrospective review of a dedicated TAVI database at a single center between 2008 and 2015. Clinical and procedural data were collected to determine the incidence and severity of the main adverse events following this procedure. The overall population included 736 patients and 123 (16.7%) underwent PPM implantation. Three patients were excluded from the final analysis due to PPM implantation occurring at other institutions post discharge. The final population consisted of 120 patients (16.3%).
Self- and mechanically expandable valves were associated with a higher risk of PPM after TAVI compared with balloon-expandable valves (23.9% vs 27.5% vs 7.6%, respectively; P<.001). Year of procedure and operator's experience did not affect the PPM-related complication rate. A high rate of major bleeding complications (n = 29; 24.1%) was observed. Major bleeding occurred more frequently in patients who received PPM implantation within the first 24 hours post TAVI than in the group of patients who required a PPM >24 hours post TAVI (38.2% vs 12.3%, respectively; P<.01). Patients who experienced a major bleeding event following PPM insertion were more frequently on triple-antithrombotic therapy (51.7% vs 9.9%; P<.001).
PPM-related complications are common in elderly patients after TAVI, and some of these adverse events can be life threatening. Particular attention is required in the periprocedural management of these patients.
本研究旨在描述经导管主动脉瓣置换术（TAVI）后永久性心脏起搏器（PPM）植入的并发症发生率。
通过回顾 2008 年至 2015 年期间在一家中心的专用 TAVI 数据库，确定患者的身份。收集临床和程序数据，以确定该程序后主要不良事件的发生率和严重程度。总人群包括 736 例患者，其中 123 例（16.7%）接受了 PPM 植入。由于 3 例患者出院后在其他机构植入 PPM，因此将其排除在最终分析之外。最终人群由 120 例患者（16.3%）组成。
与球囊扩张瓣膜相比，自膨式和机械扩张瓣膜与 TAVI 后 PPM 的风险增加相关（分别为 23.9%、27.5%和 7.6%；P<.001）。手术年份和术者经验并不影响与 PPM 相关的并发症发生率。观察到大量大出血并发症（n=29；24.1%）。与 TAVI 后 24 小时内需要 PPM 的患者相比，TAVI 后 24 小时内植入 PPM 的患者发生大出血的频率更高（分别为 38.2%和 12.3%；P<.01）。在植入 PPM 后发生大出血事件的患者中，更多的患者接受三联抗血栓治疗（51.7%比 9.9%；P<.001）。
在 TAVI 后，老年患者中 PPM 相关并发症很常见，其中一些不良事件可能危及生命。这些患者的围手术期管理需要特别注意。
