Permanent pacemaker implantation after transcatheter self-expanding aortic valve replacement: data from a single-center registry

Background. Transcatheter aortic valve replacement is a safe and effective procedure in patients with severe aortic stenosis who are at high surgical risk. One of the most commonly diagnosed complications after transcatheter aortic valve replacement is postoperative complete heart block, requiring in most cases the permanent pacemaker implantation.Aim. The study aims to identify independent prognostic factors of permanent pacemaker implantation after transcatheter aortic valve replacement.Methods. This retrospective study included 336 patients who underwent transcatheter self-expanding aortic valve replacement between 2015 and 2021. 28 patients (8.3%) after procedure required the permanent pacemaker implantation. Patients with a previously implanted permanent pacemaker, surgical aortic valve replacement, transcatheter aortic valve replacement in history and patients after conversion of endovascular intervention to surgical replacement were excluded from the study.Results. The mean age of patients was 75.4 ± 7.4 years. Diabetes mellitus (50.0 versus 28.6%, p = 0.03), baseline right bundle-branch block (32.1 versus 3.9%, p < 0.05), and smaller length of the interventricular membranous septum (5.5 ± 2.2 and 6.9 ± 1.8 mm, p < 0.05) were more common in the permanent pacemaker implantation patient group. The groups were comparable in terms of other clinical, demographic and instrumental characteristics. There were no statistically significant differences between the groups in major procedural complications. Independent prognostic factors of permanent pacemaker implantation were baseline complete right bundle-branch block (OR 21.01, 95% CI 5.86–75.42, p < 0,001), mean transcatheter aortic valve implantation depth below the aortic annulus (OR 1.42, 95% CI 1.16–1.74, p = 0.001) and the length of the interventricular membranous septum (OR 0.7, 95% CI 0.50–0.95, p = 0.02).Conclusion. The frequency permanent pacemaker implantation after transcatheter aortic valve replacement procedure depends on some initial clinical factors, procedural aspects, and postoperative conduction disorders. In this registry, independent prognostic factors of a permanent pacemaker implantation were the baseline complete right bundle-branch block, mean transcatheter aortic valve implantationdepth and the length of the interventricular membranous septum. Received 19 March 2022. Revised 18 April 2022. Accepted 19 April 2022. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Contribution of the authorsConception and study design: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. Badoian, R.U. Ibragimov, A.P. Gorgulko, S.N. Manukian, Sh.Sh. ZaynobidinovData collection and analysis: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. BadoianStatistical analysis: A.A. Baranov, A.G. Badoian, D.A. KhelimskiiDrafting the article: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. Badoian, R.U. Ibragimov, A.P. Gorgulko, S.N. Manukian, Sh.Sh. ZaynobidinovCritical revision of the article: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. Badoian, R.U. Ibragimov, A.P. Gorgulko, S.N. Manukian, Sh.Sh. ZaynobidinovFinal approval of the version to be published: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. Badoian, R.U. Ibragimov, A.P. Gorgulko, S.N. Manukian, Sh.Sh. Zaynobidinov