Sá Michel Pompeu, Jacquemyn Xander, Sun Tian, Van den Eynde Jef, Tasoudis Panagiotis, Erten Ozgun, Sicouri Serge, Torregrossa Gianluca, Clavel Marie-Annick, Pibarot Philippe, Ramlawi Basel
Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania.
Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania.
J Soc Cardiovasc Angiogr Interv. 2022 Aug 13;1(5):100434. doi: 10.1016/j.jscai.2022.100434. eCollection 2022 Sep-Oct.
Permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR) is relatively frequent, and its impact on outcomes during follow-up remains a matter of discussion. Previous meta-analyses have yielded conflicting results.
To compare late outcomes in patients after TAVR with and without PPI, PubMed/MEDLINE, Embase, and Google Scholar were searched for studies that reported rates of mortality/survival, rehospitalization for heart failure (HF), stroke, and/or endocarditis accompanied by at least 1 Kaplan-Meier curve for any of these outcomes. We adopted a 2-stage approach to reconstruct individual patient data on the basis of the published Kaplan-Meier graphs.
Twenty-eight studies with Kaplan-Meier curves met our eligibility criteria and included a total of 50,282 patients (7232 who underwent PPI and 42,959 who did not undergo PPI). Patients who underwent PPI after TAVR had a significantly higher risk of mortality (hazard ratio [HR], 1.21; 95% CI, 1.14-1.28; < .001) and HF-related rehospitalization (HR, 1.30; 95% CI, 1.17-1.45; < .001) over time. We did not observe statistically significant differences in the incidence of stroke (HR, 1.07; 95% CI, 0.55-2.08; = .849) and endocarditis (HR, 0.98; 95% CI, 0.61-1.57; = .925) during follow-up.
Patients who undergo PPI after TAVR experience higher risk of mortality and HF-related rehospitalization over time. These findings provide support for the implementation of procedural strategies to prevent heart conduction disorder and, thus, avoid PPI at the time of TAVR.
经导管主动脉瓣置换术（TAVR）后永久性起搏器植入（PPI）相对常见，其对随访期间预后的影响仍存在争议。既往的荟萃分析得出了相互矛盾的结果。
为比较TAVR术后接受和未接受PPI患者的远期预后，检索了PubMed/MEDLINE、Embase和谷歌学术，查找报告了死亡率/生存率、因心力衰竭（HF）再次住院、中风和/或心内膜炎发生率且至少有1条这些结局的Kaplan-Meier曲线的研究。我们采用两阶段方法，根据已发表的Kaplan-Meier图重建个体患者数据。
28项有Kaplan-Meier曲线的研究符合我们的纳入标准，共纳入50282例患者（7232例接受PPI，42959例未接受PPI）。TAVR术后接受PPI的患者随着时间推移死亡风险（风险比[HR]，1.21；95%置信区间[CI]，1.14-1.28；P<0.001）和HF相关再住院风险（HR，1.30；95%CI，1.17-1.45；P<0.001）显著更高。随访期间，我们未观察到中风（HR，1.07；95%CI，0.55-2.08；P = 0.849）和心内膜炎（HR，0.98；95%CI，0.61-1.57；P = 0.925）发生率有统计学显著差异。
TAVR术后接受PPI的患者随着时间推移死亡风险和HF相关再住院风险更高。这些发现为实施预防心脏传导障碍的手术策略提供了支持，从而避免在TAVR时进行PPI。
