Mortality Outcomes in Patients With Cardiac Implantable Electronic Devices Before and After Transcatheter Aortic Valve Replacement

Transcatheter aortic valve replacement (TAVR) carries a risk of high-grade AV block requiring cardiac implantable electronic device (CIED) implantation, which has been associated with a higher mortality rate. However, the outcomes of TAVR in patients with preexisting CIEDs are not well understood. W...

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Bibliographic Details
Published in:The American journal of cardiology 2023-10, Vol.205, p.1-9
Main Authors: Madanat, Luai, Seeley, Elizabeth, Mando, Ramy, Shah, Kuldeep, Hanson, Ivan, Renard, Brian M., Abbas, Amr E., Keeley, Jacob, Haines, David E., Mehta, Nishaki K.
Format: Article
Language:English
Subjects:
all-cause mortality
Aorta
Aortic stenosis
Aortic valve
Cardiac arrhythmia
Cardiovascular disease
CIED
Congestive heart failure
Electronic equipment
Heart rate
Heart valves
Hemoglobin
Hospitals
Kidney diseases
Morbidity
Mortality
Multivariate analysis
pacemaker
Pacemakers
Patients
risk stratification
Statistical analysis
TAVR
Thorax
Tomography
Transplants & implants
Variables
Vein & artery diseases
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Summary:Transcatheter aortic valve replacement (TAVR) carries a risk of high-grade AV block requiring cardiac implantable electronic device (CIED) implantation, which has been associated with a higher mortality rate. However, the outcomes of TAVR in patients with preexisting CIEDs are not well understood. We conducted a retrospective analysis of consecutive patients who underwent TAVR from December 2014 to December 2019 at our institution. Patients were categorized into 3 groups: preexisting CIED pre-TAVR (group 1), CIED implanted within 30 days after TAVR (group 2), and no CIED implanted (group 3). Cox proportional hazard was conducted to determine the primary end point of all-cause mortality. A total of 366 patients were included, of whom 93 (25.4%), 51 (13.9%), and 222 (60.7%) comprised group 1, 2, and 3, respectively. The median follow-up time was 2.3 years. The all-cause mortality rate was higher in group 1 than group 2 (hazard ratio [HR] 2.60, 95% confidence interval [CI] 1.09 to 6.18, p = 0.03) and group 3 (HR 1.96, 95% CI 1.24 to 3.08, p = 0.004). On the multivariate analysis, there was no statistically significant difference in mortality among the groups (group 1 vs group 2: HR 1.95, 95% CI 0.70 to 5.44, p = 0.20 and group 1 vs group 3: HR 1.27, 95% CI 0.66 to 2.43, p = 0.47). Preoperative hemoglobin ≤12 g/100 ml was an independent predictor of all-cause mortality (HR 1.75, 95% CI 1.10 to 2.80, p = 0.02). Group 1 had a higher 1 year congestive heart failure readmission rate (29%) than group 2 (17.6%) and group 3 (8.1%; p
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2023.07.098