Valve Oversizing in TAVI and Risk for Post-TAVI Pacemaker Implantation

Patients who have valve oversizing during transcatheter aortic valve implantation (TAVI) are at increased risk for permanent pacemaker implantation (PPI), according to results of a study published in Open Heart.

Data for this study were sourced from the CONDUCT (ClinicalTrials.gov Identifier: NCT03497611) registry, which collected data from 4 centers in Europe. In this study, data were collected between 2019 and 2021 and risk factors for receiving PPI after TAVI were evaluated. Valve oversizing was defined as an annulus area smaller than the minimum valve size area range.

The overall study population comprised 75% women and the mean age was 79.9±6.3 years.

Among the 300 included patients, 42 received post-TAVI PPI. Stratified by PPI, more pacemaker recipients had diabetes (42.9% vs 26.0%; P =.024), chronic obstructive pulmonary disease (COPD; 16.7% vs 6.2%; P =.028), decreased left ventricular ejection fraction (47.5% vs 51.2%; P =.014), and higher systolic pulmonary artery pressure (mean, 48.8 vs 39.5 mm Hg; P =.010) compared with nonrecipients, respectively.

During TAVI, the PPI recipients had significantly larger valve sizes (mean, 27.3 vs 26.6 mm; P =.027) and more had valve oversizing (17.6% vs 11.7%; P =.029) compared with nonrecipients, respectively. All other procedural details were similar between groups.

Following TAVI, fewer PPI recipients had no or trace paravalvular regurgitation (64.3% vs 84.7%; P =.004) and they had a longer time to discharge (mean, 8.6 vs 5.0 days; P <.001), lengths of stay in the intensive care unit (mean, 65.7 vs 16.3 hours; P <.001), and time in the general ward (mean, 6.9 vs 5.3 days; P =.004) compared with patients who did not receive PPI, respectively.

In the univariate analyses, predictors for PPI included diabetes, COPD, atrial fibrillation, prolonged QRS duration, complete right bundle branch block (RBBB), aortic annulus calcification, and valve size. In the multivariate analyses, complete RBBB (odds ratio [OR], 6.775; 95% CI, 2.531-18.140; P <.001) and valve size of 29 mm (OR, 3.4; 95% CI, 1.4-8.5; P =.008) remained significant predictors for PPI risk.

The major limitation of this study is the small sample size of patients who received PPI.

 “…only valve sizing persisted to be a major, avoidable risk factor for PPI,” the study authors wrote. “The valve type, implantation depth and postdelivery balloon dilatation all affected PPI rates, but without statistical significance, potentially already reflecting the refined implantation techniques in the participating centers.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.