OR03-5
Valve-in-Valve Transcatheter Aortic Valve Replacement: Incidence, Predictors, and Clinical Implications of Permanent Pacemaker Implantation – A Mayo Clinic Study (2012-2022)
Karol Quelal Analuisa, MD, Mayo Clinic, Rochester, MN, Rochester, MN
Karol Quelal Analuisa, MD1, Namrata Arya2, Teodora Donisan, MD2, David Harmon, MD1, Abhishek Deshmukh, MD1 and Mackram F. Eleid, M.D., FSCAI3, (1)Mayo Clinic, Rochester, MN, Rochester, MN, (2)Mayo Clinic College of Medicine and Science, Rochester, MN, (3)Mayo Clinic Health System Rochester, Rochester, MN
Keywords: TAVI/TAVR/Aortic Valve
Background
Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) is an alternative to repeat surgery for malfunctioning bioprosthetic aortic valves. ViV-TAVR can have higher rates of prosthesis-patient mismatch and coronary obstruction compared to native valve TAVR. T
Limited data exists for ViV-TAVR patients requiring permanent pacemaker implantation (PPI). This study aims to assess PPI occurrence, related factors, and clinical consequences in ViV-TAVR procedures conducted at the Mayo Clinic between 2012 - 2022.
Methods
We retrospectively analyzed ViV-TAVR recipients using t-tests and chi-square tests for continuous and categorical variables. Adjusted odds ratios (aOR) were calculated to identify PPI-related factors, with significance set at p < 0.05. Results
We included 237 patients without prior PPI who underwent ViV TAVR from 2012 to 2022. Of these, 77.6% were male, with a mean age of 77.2 years, and 10.1% had PPI.
PPI rates were comparable between newer balloon-expandable and self-expandable valves (12.4% vs. 9.4%, p = 0.5). Mean valve diameters were statistically similar in both groups (24.5 mm vs. 24.4 mm, p = 0.4). However, the depth of the TAVR implantation beneath the prosthesis ring was greater in the PPI group (6.3 vs. 4.4 mm, p = 0.015).
Multivariable logistic regression identified postprocedural ECG factors linked to higher PPI likelihood: LBBB (OR 21.3, 95% CI 4.5–99.6, p < 0.001), RBBB (OR 27.1, 95% CI 4.7–40.4, p < 0.001), and bi-fascicular block (OR 15.2, 95% CI 1.9–28.4, p = 0.01). Preprocedural ECG bi-fascicular block predicted PPI (OR 13.2, 95% CI 3.7 – 47.7, p < 0.001). Aortic stenosis (OR 4.8, CI 95% 1.8 – 13.2, p = 0.002) and combined aortic regurgitation/stenosis (OR 6.9, CI 95% 1.4 – 20.5, p = 0.035) were the TAVR procedural indications associated with PPI. Although PPI appeared to increase mortality during follow-up (OR 1.66, CI 95% 0.7 – 3.9, p = 0.249) after adjusting for age and sex, this was not statistically significant.
Conclusions
In our study, the incidence of PPI in ViV-TAVR was 10%. Deeper ViV TAVR implantation was associated with PPI. Baseline ECG features such as bi-fascicular block and postprocedural ECG findings like LBBB, RBBB, and bi-fascicular block were linked to a higher probability of PPI.