Wienemann Hendrik, Geyer Martin, Stukenberg Malte, Waezsada Sara, Patel Kush P, Kuhn Elmar W, Rogmann Marc Adrian, Pinto Duane S, Conradi Lenard, Bleiziffer Sabine, Baldus Stephan, Baumbach Andreas, Rudolph Tanja K, Adam Matti
Clinic III for Internal Medicine, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
Department of Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany.
EuroIntervention. 2025 Jun 16;21(12):e681-e691. doi: 10.4244/EIJ-D-24-01117.
The JenaValve Trilogy System (JVTS) is the only dedicated transcatheter heart valve system approved for treating patients with aortic regurgitation (AR). Recently, several studies have revealed high rates of permanent pacemaker implantation (PPI) exceeding 20% in patients with AR.
The aim of this study was to evaluate the incidence and risk factors for new PPI after transcatheter aortic valve implantation (TAVI) with the JVTS.
This retrospective multicentre registry included 141 patients without prior PPI who underwent transfemoral TAVI with the JVTS. Comparative analyses were performed regarding baseline and procedural parameters between patients with and without new PPI at discharge. Logistic regression models were fitted to identify predictors of PPI.
The median age of patients was 81 (interquartile range [IQR] 76-85) years, 41% were female, and the median European System for Cardiac Operative Risk Evaluation (EuroSCORE) II was 3.6% (IQR 2.0-6.4). All patients presented with ≥moderate AR. At discharge, 34 patients (24.1%) required a new PPI. Pre-existing first-degree atrioventricular block and right bundle branch block were identified as independent predictors of new PPI. Anatomical characteristics, including annular and left ventricular outflow tract perimeters, were not predictive. Procedural factors such as implantation depth and valve oversizing were also not statistically different between patients with or without new PPI.
Overall, 24.1% of patients undergoing TAVI with the JVTS required a new PPI. While rates of new PPI were strongly associated with pre-existing first-degree atrioventricular block and right bundle branch block using the JVTS, no modifiable risk factors were identified.
耶拿瓣膜三部曲系统（JVTS）是唯一获批用于治疗主动脉瓣反流（AR）患者的专用经导管心脏瓣膜系统。最近，多项研究显示AR患者永久性起搏器植入（PPI）率超过20%。
本研究旨在评估采用JVTS进行经导管主动脉瓣植入术（TAVI）后新发性PPI的发生率及危险因素。
这项回顾性多中心注册研究纳入了141例既往未行PPI且接受经股动脉JVTS-TAVI的患者。对出院时新发PPI患者与未新发PPI患者的基线和手术参数进行比较分析。采用逻辑回归模型确定PPI的预测因素。
患者的中位年龄为81岁（四分位间距[IQR]76 - 85岁），41%为女性，欧洲心脏手术风险评估系统（EuroSCORE）II的中位数为3.6%（IQR 2.0 - 6.4）。所有患者均表现为≥中度AR。出院时，34例患者（24.1%）需要新发性PPI。既往存在的一度房室传导阻滞和右束支传导阻滞被确定为新发性PPI的独立预测因素。包括瓣环和左心室流出道周长在内的解剖特征无预测性。植入深度和瓣膜尺寸过大等手术因素在新发PPI患者与未新发PPI患者之间也无统计学差异。
总体而言，接受JVTS-TAVI的患者中有24.1%需要新发性PPI。虽然使用JVTS时新发性PPI的发生率与既往存在的一度房室传导阻滞和右束支传导阻滞密切相关，但未发现可改变的危险因素。
