Tricuspid regurgitation burden following transcatheter aortic valve replacement requiring early pacemaker implantation

Abstract

Background

Conduction abnormality requiring the implantation of a permanent pacemaker (PPM) is a well-known and clinically important complication of transcatheter aortic valve replacement (TAVR). However, PPM implantation may result in lead-associated tricuspid valve regurgitation (TR). This study sought to determine the incidence and progression of TR following PPM implantation after TAVR.

Methods

This was a retrospective review of all echocardiograms of patients who underwent PPM following TAVR at the Baylor Scott & White hospitals from 2012 to 2021. The primary endpoint was TR progression at 30 days and 1 year. A subanalysis comparing the change in TR progression between small and large TAVR devices was also conducted. Secondary outcomes included all-cause death at 30 days and 1 year.

Results

Out of the 2744 patients who underwent TAVR between April 2012 and August 2021, 177 patients (6.5%) subsequently received a new PPM. There was a statistically significant progression of TR at 1-year follow-up (McNemar’s P value = 0.02). TR progression rates were comparable between the small and large valve groups at 1-year follow-up (4% vs 11%, P = 0.09, respectively).

Conclusion

In this single healthcare system study, we demonstrated a significant progression of TR in patients with PPM post TAVR at 1 year.

Keywords:

• Permanent pacemaker
• transcatheter aortic valve replacement
• tricuspid regurgitation

DISCLOSURE STATEMENT

Disclosures: Michael Mack: Abbott, trial co-PI; Edwards Life Sciences, trial co-PI; Medtronic, trial study chair. All uncompensated. Molly Szerlip: Edwards LifeSciences, proctor, speaker, consultant; Abbott Vascular, advisory board, consultant, proctor; Medtronic, steering committee; Boston Scientific, speaker, consultant. Paul Grayburn: Research grants, Abbott Vascular, Boston Scientific, Cardiovalve, Edwards Lifesciences, Medtronic, Neochord, Restore Medical, 4 C Medical; consultant/advisory board, Abbott Vascular, Edwards Lifesciences, Medtronic, 4 C Medical. Other authors: Nothing to disclose.

The authors report no study-specific funding. They would like to thank Satish and Yasmin Gupta for their unrestricted gift to Baylor Scott & White The Heart Hospital – Plano, for fostering the environment to conduct this research.