Female sex associated with higher rates of pacemaker implantation when undergoing aortic valve replacement with Rapid Deployment Intuity Valve versus Transcatheter Aortic Valve Replacement

Yatsynovich, Yan

Female sex associated with higher rates of pacemaker implantation when undergoing aortic valve replacement with Rapid Deployment Intuity Valve versus Transcatheter Aortic Valve Replacement

Tuesday, May 21, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Yan Yatsynovich, MD , University at Buffalo The State University of New York, Buffalo, NY

Mohamed Abdel-Aal Ahmed, MD , University at Buffalo The State University of New York, Buffalo, NY

Tharmathai Thammi Ramanan, M.D. , University at Buffalo The State University of New York, Orchard Park, NY

Brian Conway, MD , University at Buffalo The State University of New York, Buffalo, NY

Abhinay Reddy, MD , University at Buffalo The State University of New York, Buffalo, NY

Nikhil Agrawal, MD , State University Of New York At Buffalo, Buffalo, NY

Ashutosh Sharma, MD , University at Buffalo The State University of New York, Buffalo, NY

Rosemary Hansen, DNP , University at Buffalo The State University of New York, Buffalo, NY

Gerald Colern, NP , University at Buffalo The State University of New York, Buffalo, NY

Vijay S. Iyer, M.D., Ph.D., FSCAI , Great Lakes Cardiovascular, East Amherst, NY

Background
Transcatheter Aortic Valve Replacement (TAVR) is a non-inferior alternative to surgery. With recent emergence of balloon expandable surgical aortic valve (Edwards Intuity Valve Rapid Deployment System), we sought to compare the incidence of pacemaker implantation in this population with those that have undergone TAVR.

Methods
We retrospectively evaluated 79 patients who underwent aortic valve replacement with Intuity Rapid Deployment Aortic Valve Replacement (RDAVR) System and 167 patients who underwent TAVR. We compared their clinical, electrocardiographic and procedural variables.

Results
TAVR group had increased co-morbidities as compared to patients who underwent RDAVR including higher rates of MI, CHF, PAD and chronic lung disease (Table 1). TAVR patients had higher NYHA class and were more likely to be in heart failure prior to the procedure. More RDAVR patients were in sinus rhythm as compared to the patients who had TAVR (80% vs. 68%, p = 0.047) with higher rates of baseline LBBB (19% vs. 10%, p = 0.038) (Table 2). The rate of pacemaker implantation in RDAVR cohort was twice as high as the TAVR group (22% vs. 10%, p = 0.012) (Table 3). Females who underwent RDAVR had significantly higher rates pacemaker implantation compared to men (65% vs. 41%, p=0.022). In our study, pre-LBBB or pre-RBBB did not correlate with increased rate of post-procedural pacemaker implantation in either the TAVR or RDAVR groups, regardless of sex.

Conclusions
Despite the increased comorbidities of patients who undergo TAVR, post procedural pacemaker implantation is lower in patients who undergo TAVR, thus making it a worthy alternative, particularly for women.