Clinical and Echocardiographic Outcomes Following Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement Meta-Analysis and Meta-Regression

被引:53
作者
Mohananey, Divyanshu [1 ]
Jobanputra, Yash [2 ]
Kumar, Arnav [1 ,2 ]
Krishnaswamy, Amar
Mick, Stephanie [3 ]
White, Jonathon M. [2 ]
Kapadia, Samir R. [2 ]
机构
[1] Cleveland Clin, Dept Hosp Med, 9500 Euclid Ave, Cleveland, OH 44195 USA
[2] Cleveland Clin, Dept Cardiovasc Med, Cleveland, OH 44195 USA
[3] Cleveland Clin, Dept Cadiothorac Surg, Cleveland, OH 44195 USA
关键词
aortic valve; meta-analysis; myocardial infarction; permanent pacemaker; transcatheter aortic valve replacement; LEFT-VENTRICULAR FUNCTION; BUNDLE-BRANCH BLOCK; CONDUCTION ABNORMALITIES; ATRIAL-FIBRILLATION; 1-YEAR OUTCOMES; HEART-FAILURE; DUAL-CHAMBER; IMPACT; PREDICTORS; STENOSIS;
D O I
10.1161/CIRCINTERVENTIONS.117.005046
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-Transcatheter aortic valve replacement has become the procedure of choice for inoperable, high-risk, and many intermediate-risk patients with aortic stenosis. Conduction abnormalities are a common finding after transcatheter aortic valve replacement and often result in permanent pacemaker (PPM) implantation. Data pertaining to the clinical impact of PPM implantation are controversial. We used meta-analysis techniques to summarize the effect of PPM implantation on clinical and echocardiographic outcomes after transcatheter aortic valve replacement. Methods and Results-Data were summarized as Mantel-Haenszel relative risk (RR) and 95% confidence intervals (CIs) for dichotomous variables and as standardized mean difference and 95% CI for continuous variables We used the Higgins I-2 statistic to evaluate heterogeneity. We found that patients with and without PPM have similar all-cause mortality (RR, 0.85; 95% CI, 0.70-1.03), cardiovascular mortality (RR, 0.84; 95% CI, 0.59-1.18), myocardial infarction (RR, 0.47; 95% CI, 0.20-1.11), and stroke (RR, 1.26; 95% CI, 0.70-2.26) at 30 days. The groups were also comparable in all-cause mortality (RR, 1.03; 95% CI, 0.92-1.16), cardiovascular mortality (RR, 0.69; 95% CI, 0.39-1.24), myocardial infarction (RR, 0.58; 95% CI, 0.30-1.13), and stroke (RR, 0.70; 95% CI, 0.47-1.04) at 1 year. We observed that the improvement in left ventricular ejection fraction was significantly greater in the patients without PPM (standardized mean difference, 0.22; 95% CI, 0.12-0.32). Conclusions-PPM implantation is not associated with increased risk of all-cause mortality, cardiovascular mortality, stroke, or myocardial infarction both at short-and long-term follow-up. However, PPM is associated with impaired left ventricular ejection fraction recovery post-transcatheter aortic valve replacement.
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页数:33
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