SPC365

When valve needs electrical wires – estimating pacemaker implantation after TAVR

Session: Comunicações Orais - Sessão 23 - Intervenção Valvular Aórtica Percutânea
Speaker: Ana Margarida Martins

Congress: CPC 2023
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 15. Valvular Heart Disease
Subtheme: 15.4 Valvular Heart Disease – Treatment
Session Type: Comunicações Orais
FP Number: ---
Authors: Ana Margarida Martins; Pedro Alves da Silva; Joana Brito; Beatriz Valente Silva; Catarina Oliveira; Beatriz Garcia; Ana Abrantes; Miguel Raposo; Catarina Gregório; João Fonseca; Fernando Ribeiro; Tiago Rodrigues; João Silva Marques; Miguel Nobre de Menezes; Pedro Carrilho Ferreira; Cláudia Jorge; Pedro Cardoso; Fausto J.Pinto

<p style="text-align:start"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span></p>

<p style="text-align:start"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Widespread availability and expanded indication of transcatheter aortic valve replacement (TAVR) modified the paradigm of aortic stenosis. Despite an elevated success rate, there are procedure related complications that need to be considered. One of the most frequent is conduction defects requiring permanent pacemaker (PPM) implantation resulting in prolonged hospital length of stay and hospitalization cost.</span></span></span></p>

<p style="text-align:start"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Several risk factors for PPM implantation after TAVR have been described, and, recently, the Emory Risk Score (ERS) was developed as a predictive tool for need of new PPM implantation post-TAVR in patients (pts) who implanted a balloon-expandable valve. &nbsp;</span></span></span></p>

<p style="text-align:start"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Our aim was to evaluate risk factors associated with PPM after TAVR and&nbsp;to validate the ERS in our population after implantation of both balloon-expandable and self-expanding valves.</span></span></span></p>

<p style="text-align:start"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span></p>

<p style="text-align:start"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="color:#212121"><span style="background-color:white">We conducted a retrospective, observational and single center study involving pts submitted to TAVR between 2018 and 2021. Clinical, ECG and procedural data was obtained at time of TAVR and during follow-up. The predictive discrimination of the scoring system for the risk for PPM placement after TAVR was evaluated using receiver-operating characteristic (ROC) curve analysis. To estimate additional predictors of PPM implantation we used Cox proportional hazards regression models. </span></span></span></span></span></p>

<p style="text-align:start"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong></span></span></span></p>

<p style="text-align:start"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">We gathered a total of 416 pts (mean age 82 &plusmn; 6,1 years, 55% female). The most frequently implanted valves were Evolut Pro and Sapien 3 ultra in 39,4% and 26,6% of pts. During follow-up 110 pts (26%) needed device implantation (94% double chamber pacemaker; 6% CRT-P or CRT-D), most frequently due to AV block. </span></span></span></p>

<p style="text-align:start"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">On univariate analysis, QRS width was the only factor predictive of pacemaker implantation (HR 1,018, 95% CI 1,007-1028; p=0.027). We found no other clinical, ECG or procedural characteristics to be predictive of device implantation.</span></span></span></p>

<p style="text-align:start"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The ERS is composed of 4 variables &ndash; history of syncope, right complete branch block, QRS width &gt; 140mseg and valve oversizing &gt; 16% - and revealed a good sensitivity and specificity in estimating device implantation. We applied this score to our population and ROC curve analysis showed a significant prediction capacity (AUC 0,761 95% CI 0,699-0,822, p=0,031). This analysis was also performed analysing separately both subgroups of self-expandable valves (Medtronic Evolut and Evolut R) and balloon expandable valves (Edwards Sapiens). ROC curve analysis in both showed a good correlation with events &ndash; Fig 1.</span></span></span></p>

<p style="text-align:start"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion</strong></span></span></span></p>

<p style="text-align:start"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">PPM is one of the most common complications following TAVR. In our population, the ERS accurately predicted the need for PPM. Routine use of such tools may stratify pts at higher risk of pacemaker implantation and thus best define patient allocation and resource utilization to reduce number of hospitalization days.</span></span></span></p>