Buntaro Fujita1, Tobias Schmidt2, Sabine Bleiziffer3, Timm Bauer4, Andreas Beckmann5, Raffi Bekeredjian6, Helge Möllmann7, Thomas Walther8, Sandra Landwehr9, Christian Hamm10, Friedhelm Beyersdorf11, Hugo A Katus12, Wolfgang Harringer13, Stephan Ensminger1, Christian Frerker2. 1. Department of Cardiac and Thoracic Vascular Surgery, University of Schleswig-Holstein, Lübeck, Germany. 2. Department of Internal Medicine III, University of Cologne, Cologne, Germany. 3. Clinic for Cardiovascular Surgery, German Heart Center Munich, Munich, Germany. 4. Department of Cardiology, University of Giessen, Giessen, Germany. 5. German Society of Thoracic, Cardiac and Vascular Surgery, Berlin, Germany. 6. Department of Cardiology, Robert-Bosch Hospital, Stuttgart, Germany. 7. Department of Internal Medicine I, St.-Johannes-Hospital, Dortmund, Germany. 8. Department of Thoracic, Cardiac and Vascular Surgery, University of Frankfurt, Frankfurt, Germany. 9. BQS Institute for Quality and Patient Safety, Düsseldorf, Germany. 10. Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany. 11. Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Medical Faculty of the University of Freiburg, Freiburg, Germany. 12. Department of Cardiology, University of Heidelberg, Heidelberg, Germany. 13. Department of Cardiac, Thoracic and Vascular Surgery, Klinikum Braunschweig, Brunswick, Germany.
Abstract
OBJECTIVES: The purpose of this study was to evaluate the incidence of new pacemaker implantation (NPMI) after surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR), and investigate its influence on 1-year mortality. METHODS: Patients who were enrolled in 'The German Aortic Valve Registry' undergoing isolated TAVR or SAVR between 2011 and 2015 were analysed. The rate of NPMI was analysed for both groups and multivariable Cox regression analysis was performed to investigate the possible independent association between NPMI and 1-year mortality. RESULTS: Twenty thousand eight hundred and seventy-two patients who underwent TAVR and 17 750 patients who received SAVR were included in this study. The rate of NPMI was 16.6% after TAVR and 3.6% after SAVR. In the TAVR group, NPMI was associated with significantly increased 1-year mortality in univariable Cox regression analysis [hazard ratio (HR) 1.29, confidence interval (CI) 1.18-1.41; P < 0.001]. This association persisted after adjustment for confounding factors (HR 1.29, CI 1.16-1.43; P < 0.001). In the SAVR group, NPMI significantly increased 1-year mortality in univariable analysis as well (HR 1.55, CI 1.08-2.22; P = 0.02), whereas after multivariable adjustment, NPMI did not emerge as an independent risk factor (HR 1.29, 0.88-1.89; P = 0.19). NPMI was not associated with 30-day mortality in both procedure groups. CONCLUSIONS: The rate of NPMI was markedly higher after TAVR compared with SAVR and was independently associated with 1-year mortality after TAVR, whereas this was not significant after SAVR. As 30-day mortality was not different for TAVR and SAVR, the subsequent procedure of an NPMI itself seems not to increase the risk of mortality.
OBJECTIVES: The purpose of this study was to evaluate the incidence of new pacemaker implantation (NPMI) after surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR), and investigate its influence on 1-year mortality. METHODS:Patients who were enrolled in 'The German Aortic Valve Registry' undergoing isolated TAVR or SAVR between 2011 and 2015 were analysed. The rate of NPMI was analysed for both groups and multivariable Cox regression analysis was performed to investigate the possible independent association between NPMI and 1-year mortality. RESULTS: Twenty thousand eight hundred and seventy-two patients who underwent TAVR and 17 750 patients who received SAVR were included in this study. The rate of NPMI was 16.6% after TAVR and 3.6% after SAVR. In the TAVR group, NPMI was associated with significantly increased 1-year mortality in univariable Cox regression analysis [hazard ratio (HR) 1.29, confidence interval (CI) 1.18-1.41; P < 0.001]. This association persisted after adjustment for confounding factors (HR 1.29, CI 1.16-1.43; P < 0.001). In the SAVR group, NPMI significantly increased 1-year mortality in univariable analysis as well (HR 1.55, CI 1.08-2.22; P = 0.02), whereas after multivariable adjustment, NPMI did not emerge as an independent risk factor (HR 1.29, 0.88-1.89; P = 0.19). NPMI was not associated with 30-day mortality in both procedure groups. CONCLUSIONS: The rate of NPMI was markedly higher after TAVR compared with SAVR and was independently associated with 1-year mortality after TAVR, whereas this was not significant after SAVR. As 30-day mortality was not different for TAVR and SAVR, the subsequent procedure of an NPMI itself seems not to increase the risk of mortality.
Authors: Paolo Berretta; Luca Montecchiani; Fabio Vagnarelli; Mariano Cefarelli; Jacopo Alfonsi; Carlo Zingaro; Filippo Capestro; Michele D Pierri; Alessandro D'alfonso; Marco Di Eusanio Journal: Ann Cardiothorac Surg Date: 2020-09