Introduction
Material and methods
Study design and patient selection
Pacemaker implantation and periprocedural management
Study outcomes
Statistical analysis
Results
Patient cohort
Parameter | All | LVrEF | LVmrEF | LVpEF | p-value |
---|---|---|---|---|---|
n | 4385 | 698 | 305 | 3382 | |
Male, n (%) | 2055 (46.9) | 433 (62.0) | 175 (57.4) | 1447 (42.8) | < 0.001 |
Age, years | 81.4 ± 6.1 | 80.8 ± 7.3 | 81 ± 6 | 81.6 ± 5.8 | 0.149 |
BMI, kg / m2 | 27.3 ± 5.2 | 26.7 ± 5.2 | 27.5 ± 5.5 | 27.4 ± 5.1 | 0.002 |
Euroscore II | 5.9 ± 6.5 | 12.9 ± 11.2 | 7.3 ± 6.3 | 4.7 ± 4.3 | < 0.001 |
STS-Score | 5.7 ± 4.6 | 7.9 ± 7 | 6.2 ± 4.5 | 5.2 ± 3.7 | < 0.001 |
LVEF, % | 51.7 ± 9.4 | 34 ± 6.3 | 45.2 ± 1.5 | 55.9 ± 4.3 | < 0.001 |
Creatinine, mg/dl | 1.5 ± 1.3 | 1.5 ± 1.1 | 1.4 ± 0.9 | 1.2 ± 0.7 | < 0.001 |
NYHA I, n (%) | 117 (2.7) | 9 (1.3) | 4 (1.3) | 104 (3.1) | < 0.010 |
NYHA II, n (%) | 1299 (29.6) | 131 (18.8) | 73 (23.9) | 1095 (32.4) | |
NYHA III, n (%) | 2707 (61.7) | 449 (64.3) | 200 (65.6) | 2058 (60.9) | |
NYHA IV, n (%) | 262(6.0) | 109 (15.6) | 28 (9.2) | 125 (3.7) | |
CVD, n (%) | 642 (14.6) | 86 (12.3) | 42 (13.8) | 514 (15.2) | 0.133 |
PAD, n (%) | 537 (12.2) | 116 (16.6) | 46 (15.1) | 375 (11.1) | < 0.001 |
Hypertension, n (%) | 3988 (91.1) | 609 (87.2) | 287 (94.1) | 3097 (91.57) | < 0.001 |
Diabetes mellitus, n (%) | 1289 (29.5) | 250 (36.3) | 117 (38.4) | 927 (27.4) | < 0.001 |
Hyperlipidemia, n (%) | 3395 (80.3) | 525 (75.2) | 249 (81.6) | 2778 (82.1) | < 0.001 |
No CAD, n (%) | 1861 (42.2) | 241 (34.5) | 103 (33.8) | 1517 (44.9) | < 0.001 |
CAD, 1 vessel, n (%) | 887 (20.2) | 133 (19.1) | 72 (23.6) | 682 (20.2) | |
CAD, 2 vessel, n (%) | 635 (14.5) | 105 (15.0) | 56 (18.4) | 474 (14.0) | |
CAD, 3 vessel, n (%) | 1002 (22.9) | 219 (34.5) | 74 (24.3) | 709 (21.0) | |
Prior stent implantation, n (%) | 1449 (33.9) | 271 (38.8) | 122 (40) | 1056 (31.2) | < 0.001 |
Atrial Fibrillation, n (%) | 1618 (36.9) | 326 (46.7) | 148 (48.5) | 1135 (33.6) | < 0.001 |
Prior Stroke / TIA, n (%) | 3759 (85.7) | 580 (83.1) | 248 (81.3) | 2931 (86.7) | 0.004 |
Dialysis, n (%) | 127 (2.8) | 48 (6.9) | 11 (3.6) | 68 (2.0) | < 0.001 |
COPD, n (%) | 856 (19.5) | 154 (22.1) | 60 (19.7) | 642 (19.0) | 0.174 |
Parameter | LVrEF | LVmrEF | LVpEF | p-value |
---|---|---|---|---|
In-Hospital Mortality, n (%) | 24 (3.4) | 9 (3.0) | 54 (1.6) | 0.030 |
Mortality after 5 years, n (%) | 308 (44.1) | 103 (33.8) | 916 (27.1) | 0.001 |
Days on ICU | 2 (1–4) | 1 (1–3) | 1 (1–3) | < 0.001 |
Days in Hospital | 13 (8–18) | 11 (8–15) | 10 (8–14) | < 0.001 |
Conversion to transapical, n (%) | 4 (0.7) | 3 (1.0) | 8 (0.2) | 0.534 |
Conversion to sternotomy, n (%) | 5 (0.9) | 1 (0.3) | 28 (0.8) | |
Device embolisation, n (%) | 2 (0.4) | 1 (0.3) | 11 (0.3) | 0.288 |
VARC Bleeding minor | 32 (3.0) | 10 (3.3) | 101 (3.0) | 0.680 |
VARC bleeding major, n (%) | 16 (2.3) | 3 (1.0) | 68 (2.0) | |
VARC bleeding lifethreating, n (%) | 10 (1.4) | 3 (1.0) | 22 (0.7) | |
VARC vessel complication minor, n (%) | 16 (2.3) | 8 (2.6) | 123 (3.6) | 0.720 |
VARC vessel complication major, n (%) | 9 (1.3) | 6 (2.0) | 63 (1.9) | |
VARC vessel complication failure of closing device, n (%) | 1 (0.1) | 1 (0.3) | 12 (0.4) | |
VARC stroke non disabing, n (%) | 5 (0.7) | 1 (0.3) | 17 (0.5) | 0.930 |
VARC stroke disabing, n (%) | 4 (0.6) | 1 (0.3) | 19 (0.6) | |
Access transfemoral, n (%) | 557 (79.8) | 244 (80.0) | 2932 (86.7) | < 0.001 |
Access transapical, n (%) | 126 (18.1) | 59 (19.3) | 394(11.6) | < 0.001 |
Access transaortic, n (%) | 4 (0.6) | 1 (0.3) | 2 (0.1) | 0.006 |
Access transsubclavian, n (%) | 10 (1.4) | 1 (0.3) | 51 (1.5) | 0.261 |
Pacemaker implantation after TAVR, n (%) | 105 (15.0) | 48 (15.7) | 450 (13.3) | 0.171 |
Impact of LV function on patient survival
Impact of PMI on patient survival and LV function recovery
Object | Hazard ratio | upper 95% CI | lower 95% CI | p-value |
---|---|---|---|---|
CRT pacing | 0.30 | 0.951 | 0.095 | 0.041 |
Age | 0.99 | 1.029 | 0.954 | 0.621 |
Euroscore II | 1.02 | 1.044 | 0.996 | 0.109 |
Baseline creatinine | 1.23 | 1.472 | 1.029 | 0.023 |
Parameter | RV pacing | CRT | p-value |
---|---|---|---|
Patients, n (%) | 86 (81.9) | 19 (18.1) | |
QRS width prior TAVR, ms | 126 ± 28 | 129 ± 21 | 0.674 |
QRS width after TAVR prior PMI, ms | 146 ± 25 | 153 ± 23 | 0.305 |
QRS width after PMI, ms | 166 ± 28 | 145 ± 20 | 0.003 |
Pacing burden at discharge, ms | 79 ± 34 | 99 ± 1 | 0.001 |
PMI with ICD, n (%) | 5 (5.8) | 3 (15.8) | 0.16 |
LVEF prior TAVR, % | 34.4 ± 5.9 | 30 ± 6.3 | 0.004 |
LVEF at discharge, % | 21.5 ± 21.4 | 22.1 ± 16.3 | 0.919 |
LVEF four months after TAVR, % | 42.3 ± 8.5 | 45.1 ± 12.4 | 0.442 |
LVEF Change four months after TAVR, % | 6.1 ± 7.9 | 14.9 ± 13.4 | 0.075 |