Long-term clinical impact of permanent pacemaker implantation in patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis

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Abstract

Aims

The aims of this study is to assess by an updated meta-analysis the clinical outcomes related to permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) at long-term (≥12 months) follow-up (LTF).

Methods and results

A comprehensive literature research was performed on PubMed and EMBASE. The primary endpoint was all-cause death. Secondary endpoints were rehospitalization for heart failure, stroke, and myocardial infarction. A subgroup analysis was performed according to the Society of Thoracic Surgeon—Predicted Risk of Mortality (STS-PROM) score. This study is registered with PROSPERO (CRD42021243301). A total of 51 069 patients undergoing TAVI from 31 observational studies were included. The mean duration of follow-up was 22 months. At LTF, PPI post-TAVI was associated with a higher risk of all-cause death [risk ratio (RR) 1.18, 95% confidence interval (CI) 1.10–1.25; P < 0.001] and rehospitalization for heart failure (RR 1.32, 95% CI 1.13–1.52; P < 0.001). In contrast, the risks of stroke and myocardial infarction were not affected. Among the 20 studies that reported procedural risk, the association between PPI and all-cause death risk at LTF was statistically significant only in studies enrolling patients with high STS-PROM score (RR 1.25, 95% CI 1.12–1.40), although there was a similar tendency of the results in those at medium and low risk.

Conclusion

Patients necessitating PPI after TAVI have a higher long-term risk of all-cause death and rehospitalization for heart failure as compared to those who do not receive PPI.

Graphical Abstract

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Most cited references 57

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Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients

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Among patients with aortic stenosis who are at intermediate or high risk for death with surgery, major outcomes are similar with transcatheter aortic-valve replacement (TAVR) and surgical aortic-valve replacement. There is insufficient evidence regarding the comparison of the two procedures in patients who are at low risk.

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Transcatheter aortic-valve replacement (TAVR) is an alternative to surgery in patients with severe aortic stenosis who are at increased risk for death from surgery; less is known about TAVR in low-risk patients.

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Author and article information

Contributors

Andrea Zito

Giuseppe Princi

Marco Lombardi:

ORCID: https://orcid.org/0000-0002-4045-2859

Domenico D’Amario

Rocco Vergallo:

ORCID: https://orcid.org/0000-0001-5577-081X

Cristina Aurigemma:

ORCID: https://orcid.org/0000-0001-6391-422X

Enrico Romagnoli:

ORCID: https://orcid.org/0000-0003-1611-7708

Gemma Pelargonio

Piergiorgio Bruno

Carlo Trani:

ORCID: https://orcid.org/0000-0001-9777-013X

Francesco Burzotta:

ORCID: https://orcid.org/0000-0002-6569-9401

Filippo Crea:

ORCID: https://orcid.org/0000-0002-9482-411X

Journal

Journal ID (nlm-ta): Europace

Journal ID (iso-abbrev): Europace

Journal ID (publisher-id): europace

Title: Europace

Publisher: Oxford University Press

ISSN (Print): 1099-5129

ISSN (Electronic): 1532-2092

Publication date Collection: July 2022

Publication date (Electronic): 09 February 2022

Publication date PMC-release: 09 February 2022

Volume: 24

Issue: 7

Pages: 1127-1136

Affiliations

Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore , L.go A. Gemelli 1, 00168 Rome, Italy