Cardiovascular Disease: Cardiovascular Disease |

Incidence and Predictors of Permanent Pacemaker Insertion on Nonagenarians Following Transcatheter Aortic Valve Replacement: A Single Center Experience FREE TO VIEW

Jesus Pino, MD; Kreidieh Omar; Robert Chait; Samineh Sehatbakhsh; Jaehyoung Choi; Marco Nores; Lawrence Lovitz
Author and Funding Information

University of Miami West Palm Beach Campus, West Palm Beach, FL

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):70A. doi:10.1016/j.chest.2016.08.078
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SESSION TITLE: Cardiovascular Disease

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: To determinate the incidence and predictors for permanent pacemaker (PPM) insertion in nonagenarians (Age 90-99) following transcatheter aortic valve replacement (TAVR).

METHODS: This is a retrospective chart review of patients who underwent TAVR in a single cardiovascular center. Patient specific characteristics and outcomes were abstracted by individual chart review. All the electrocardiograms were reviewed by board certified cardiologists.

RESULTS: A total of 363 patients underwent TAVR between 04/2012 and 01/2016. One hundred and sixty patients were female (44%) and 102/363 of the patients were nonagenarians. Thirty out of hundred and two nonagenarians had a PPM prior to the procedure and were exclude from the analysis. The remaining seventy-two patients comprised our study population. The mean age for the studied population was 92 ±2, and their mean STS score was 9.2±5. For nonagenarians, the incidence for new PPM insertion was 33% (24/72) vs 22% (42/189) for patients age younger than 90. OR = 1.7, CI 95% (0.98 - 3.25). For nonagenarians who received a PPM after the procedure, the average baseline QRS was 122 milliseconds vs 101 milliseconds for those nonagenarians who did received a PPM insertion (p-value < 0.05). The presence of prior atrioventricular block was associated with increase of the risk for PPM insertion following TAVR, OR 3.5, CI 95% (1.16-9.96). There were no differences in gender, presence of hypertension OR 1.33, CI 95% (0.36-4.9), Diabetes (OR = 2.11 [0.61-7.3]), COPD (OR=1.05 [0.32—3.44]), baseline creatinine (1.1 ± 0.4 VS 0.9 ± 0.3), baseline DLCO (79% vs 85% [p>0.05]), ejection fraction (56% vs 55%[p>0.05]), preceding balloon aortic valvuloplasty OR: 0.42 (0.083--2.14) or preceding coronary artery bypass grafting OR: 1.3 IC 95% (0.27—6.04). The need for PPM insertion did no affect the 30 day or one year mortality.

CONCLUSIONS: This retrospective cohort study suggests that baseline EKG with QRS >120 miliseconds or evidence of pre-procedure AV block are associated with increase the risk for PPM insertion following TAVR, with a higher incidence on nonagenarians than in patients younger than age 90.

CLINICAL IMPLICATIONS: One out of three nonagenarians will require a PPM insertion following TAVR. This will carry out an additional morbidity on nonagenarians.

DISCLOSURE: The following authors have nothing to disclose: Jesus Pino, Kreidieh Omar, Robert Chait, Samineh Sehatbakhsh, Jaehyoung Choi, Marco Nores, Lawrence Lovitz

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