AI Article Synopsis
- The study examined the incidence of permanent pacemaker implantation (PPI) after patients underwent rapid deployment aortic valve replacement using the Edwards Intuity valve system.
- Among the 708 patients analyzed, the overall PPI rate was 13.6%, with a notable 10.9% attributed to atrioventricular block, particularly in those with no pre-existing conduction issues.
- Factors linked to higher PPI rates included baseline right bundle branch block, female gender, larger valve sizes, and existing atrioventricular block, along with significant variability in PPI rates across different medical centers.
Article Abstract
Background: Expandable, rapid deployment aortic valves may interfere with the cardiac conduction system, which can lead to permanent pacemaker implantation (PPI). We sought to characterize PPI after rapid deployment aortic valve replacement with the Edwards Intuity valve system (Edwards Lifesciences, Irvine, CA) and investigate associated factors.
Methods: We analyzed 708 patients from 29 centers in the Multicenter Experience With Rapid Deployment Edwards Intuity Valve System for Aortic Valve Replacement (TRANSFORM) trial undergoing rapid deployment aortic valve replacement with or without coronary artery bypass graft surgery without preexisting pacemakers. Intrinsic conduction status was recorded as well as PPI incidence through 1 year. The PPI indications were categorized based on expert review of patient PPI source documents. Multivariate analysis was conducted to identify characteristics associated with PPI.
Results: After rapid deployment aortic valve replacement, the PPI incidence through 30 days (PPI) was 13.6%, with 10.9% due to atrioventricular block. In the 423 of 708 patients (59.7%) without any baseline conduction abnormalities, all-cause PPI was 8%, 5% for atrioventricular block. For PPIs inserted before discharge, the median time to PPI was 5 days, with 22% placed within 48 hours. Independent predictors of PPI were baseline right bundle branch block (odds ratio 7.35, p < 0.0001), female gender (2.62, p = 0.004), larger valve size (1.20, p = 0.016), and atrioventricular block (1.80, p = 0.062). Subset analysis revealed a greater than twofold difference in PPI among the largest enrolling centers.
Conclusions: Patient factors associated with PPI after rapid deployment aortic valve replacement were right bundle branch block, atrioventricular block, female gender, and larger valve size. Interestingly, a strong center-level effect was associated with PPI. This effect may reflect differences in practice patterns, such as postoperative drug management or timing to PPI. These findings provide a deeper understanding of PPI after rapid deployment aortic valve replacement and help guide clinical practice and patient management.
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| http://dx.doi.org/10.1016/j.athoracsur.2018.03.055 | DOI Listing |
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