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A Comparison of Self-Expanding and Balloon-Expandable Valves in Pacemaker Implantation Rates in TAVI
Session:
SESSÃO DE POSTERS 05 - TAVI 1
Speaker:
Mariana Caetano Coelho
Congress:
CPC 2025
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.4 Interventional Cardiology - Other
Session Type:
Cartazes
FP Number:
---
Authors:
Mariana Caetano Coelho; Fernando Nascimento Ferreira; Miguel Abrantes de Figueiredo; Francisco Albuquerque; Francisco Cardoso; Rúben Baptista Ramos; Inês Rodrigues; António José Fiarresga; Rui Cruz Ferreira; Duarte Nuno Cacela
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Introduction: Permanent pacemaker implantation (PPI) is a common complication after transcatheter aortic valve implantation (TAVI), with incidence rates ranging from 10% to 30%. While PPI rates have declined due to advances in TAVI techniques, the risk differences between self-expanding valves (SEVs) and balloon-expandable valves (BEVs) remain unclear. Some studies associate SEVs, like the Evolut series, with higher PPI risk than BEVs, like the SAPIEN series, but results are inconsistent. Factors such as valve oversizing, calcifications, and anatomical variations also contribute to conduction disturbances. The comparative risk of PPI between SEVs and BEVs requires further investigation.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Aim: We aimed to evaluate the relationship between pacemaker implantation rates in BEVs and SEVs in patients undergoing TAVI within the immediate postoperative period (up to 1 week). Additionally, it assessed the correlation between PPI and factors such as aortic valve oversizing and native aortic valve calcium.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Methods: We retrospectively analyzed records of 184 patients without prior permanent pacemakers who underwent TAVI in 2024. BEVs were implanted in 29.9% of cases (8 Myval and 47 Sapien 3/Ultra), while SEVs were used in 70% of patients, including 34 Portico, 35 ACURATE, 58 CoreValve Evolut R/Pro, and 2 Vienna.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Population analyses: Baseline characteristics were similar between patients receiving BEVs or SEVs. PR intervals >200ms did not differ significantly (p = 0.16). Right bundle branch block (RBBB) was present in 39 BEV patients (16%) and 6 SEV patients (10.7%) (p =0.319), while left bundle branch block (LBBB)rates were also similar (p=0.972). Aortic valve calcium scores were comparable (BEV: 2716 ± 172 vs. SEV: 1973 ± 110 Agatston units, p = 0.871). Although valve oversize was greater in SEVs, the difference was not statistically significant.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Outcomes: PPI rates were significantly higher in SEVs than BEVs during early follow-up (7 vs. 34, p = 0.05). Independent predictors for pacemaker implantation included RBBB, first-degree AV block, and atrial fibrillation, with significant associations (RBBB:15 vs.11, p= 0.001; AVB: 8vs 23, p=0.02; AF:20vs.43, p=0.035). No associations were found between PPI rates and pre-/post-dilation, valve oversize, or calcium score.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Conclusions:<strong> </strong>BEVs had lower pacemaker implantation rates in the early post-TAVI period. While SEVs offer flexibility for complex anatomies, their higher PPI risk should be weighed, especially in patients prone to conduction disturbances.</span></span></p>
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