Oliver Husser1, Costanza Pellegrini2, Won-Keun Kim3, Andreas Holzamer4, Thomas Pilgrim5, Stefan Toggweiler6, Ulrich Schäfer7, Johannes Blumenstein8, Florian Deuschl7, Tobias Rheude2, Michael Joner9, Michael Hilker4, Christian Hengstenberg10, Helge Möllmann8. 1. Klinik für Innere Medizin I, Kardiologie, St. Johannes-Hospital Dortmund, Dortmund, Germany. Electronic address: oliver.husser@gmail.com. 2. Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany. 3. Department of Cardiology, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany. 4. Klinik für Herz-, Thorax-, und herznahe Gefäßchirurgie, University of Regensburg Medical Center, Regensburg, Germany. 5. Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland. 6. Department of Cardiology, Kantonsspital, Luzern, Switzerland. 7. Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany. 8. Klinik für Innere Medizin I, Kardiologie, St. Johannes-Hospital Dortmund, Dortmund, Germany. 9. Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany; German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany. 10. Klinische Abteilung für Kardiologie, Universitätsklinik für Innere Medizin II, Medizinische Universität Wien, Vienna, Austria.
Abstract
OBJECTIVES: This study sought to evaluate the impact of the ACURATE neo (NEO) (Boston Scientific, Marlborough, Massachusetts) versus SAPIEN 3 (S3) (Edwards Lifesciences, Irvine, California) on permanent pacemaker implantation (PPI) in patients with pre-existing right bundle branch block (RBBB) after transcatheter aortic valve replacement. BACKGROUND: Pre-existing RBBB is the strongest patient-related predictor for PPI after transcatheter aortic valve replacement. No comparison of newer-generation transcatheter heart valves with regard to PPI in these patients exists. METHODS: This multicenter registry includes 4,305 patients; 296 (6.9%) had pre-existent RBBB and no pacemaker at baseline and formed the study population. The primary endpoint was new PPI at 30 days. The association of NEO versus S3 with PPI was assessed using binary logistic regression analyses and inverse probability treatment weighting in a propensity-matched population. RESULTS: The 30-day PPI rate was 39.2%. The S3 and NEO were used in 66.9% and 33.1%, respectively. The NEO was associated with lower rates of PPI compared with the S3 (29.6% vs. 43.9%; p = 0.025; odds ratio [OR]: 0.54; 95% confidence interval [CI]: 0.32 to 0.89; p = 0.018), after multivariable adjustment (OR: 0.48; 95% CI: 0.26 to 0.86; p = 0.014), and in the inverse probability treatment weighting analysis (OR: 0.37; 95% CI: 0.25 to 0.55; p < 0.001). There was no difference in device failure (8.2% vs. 6.6%; p = 0.792) or in-hospital course. In the propensity-matched population, PPI rate was also lower in the NEO versus S3 (23.1% vs. 44.6%; p = 0.016; OR: 0.37; 95% CI: 0.17 to 0.78; p = 0.010), with no difference in device failure (9.2% vs. 6.2%; p = 0.742). CONCLUSIONS: In patients with RBBB, risk of PPI was significantly lower with the NEO compared with the S3, suggesting the possibility of a patient tailored transcatheter heart valve therapy.
OBJECTIVES: This study sought to evaluate the impact of the ACURATE neo (NEO) (Boston Scientific, Marlborough, Massachusetts) versus SAPIEN 3 (S3) (Edwards Lifesciences, Irvine, California) on permanent pacemaker implantation (PPI) in patients with pre-existing right bundle branch block (RBBB) after transcatheter aortic valve replacement. BACKGROUND: Pre-existing RBBB is the strongest patient-related predictor for PPI after transcatheter aortic valve replacement. No comparison of newer-generation transcatheter heart valves with regard to PPI in these patients exists. METHODS: This multicenter registry includes 4,305 patients; 296 (6.9%) had pre-existent RBBB and no pacemaker at baseline and formed the study population. The primary endpoint was new PPI at 30 days. The association of NEO versus S3 with PPI was assessed using binary logistic regression analyses and inverse probability treatment weighting in a propensity-matched population. RESULTS: The 30-day PPI rate was 39.2%. The S3 and NEO were used in 66.9% and 33.1%, respectively. The NEO was associated with lower rates of PPI compared with the S3 (29.6% vs. 43.9%; p = 0.025; odds ratio [OR]: 0.54; 95% confidence interval [CI]: 0.32 to 0.89; p = 0.018), after multivariable adjustment (OR: 0.48; 95% CI: 0.26 to 0.86; p = 0.014), and in the inverse probability treatment weighting analysis (OR: 0.37; 95% CI: 0.25 to 0.55; p < 0.001). There was no difference in device failure (8.2% vs. 6.6%; p = 0.792) or in-hospital course. In the propensity-matched population, PPI rate was also lower in the NEO versus S3 (23.1% vs. 44.6%; p = 0.016; OR: 0.37; 95% CI: 0.17 to 0.78; p = 0.010), with no difference in device failure (9.2% vs. 6.2%; p = 0.742). CONCLUSIONS: In patients with RBBB, risk of PPI was significantly lower with the NEO compared with the S3, suggesting the possibility of a patient tailored transcatheter heart valve therapy.
Authors: Alberto Alperi; Guillem Muntané-Carol; Afonso B Freitas-Ferraz; Lucia Junquera; David Del Val; Laurent Faroux; François Philippon; Josep Rodés-Cabau Journal: Ann Cardiothorac Surg Date: 2020-11
Authors: Luigi Biasco; Enrico Cerrato; Gregorio Tersalvi; Giovanni Pedrazzini; Ben Wilkins; Francesco Faletra; Enrico Ferrari; Stefanos Demertzis; Gaetano Senatore; Angelo Di Leo; Ferdinando Varbella; Ole De Backer; Luis Nombela Franco Journal: Front Cardiovasc Med Date: 2020-03-20
Authors: Miriam Brinkert; Bart De Boeck; Simon F Stämpfli; Mathias Wolfrum; Federico Moccetti; Adrian Attinger-Toller; Matthias Bossard; Florim Cuculi; Richard Kobza; Stefan Toggweiler Journal: Open Heart Date: 2020-11