Publications (2)6.94 Total impact
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Article: Incidence and predictors of permanent pacemaker implantation following transcatheter aortic valve implantation: Analysis from the German transcatheter aortic valve interventions registry.
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ABSTRACT: Objectives: To determine predictors of permanent pacemaker (PPM) implantation up to 30 days after transcatheter aortic valve implantation (TAVI) in a prospective multicenter registry. Background: Conduction disorders requiring PPM implantation are one of the most common complications seen after TAVI. Knowledge about possible predictors may help to decrease the rate of PPM implantations. Methods In total, 1.347 consecutive patients who underwent TAVI in 22 centers were prospectively enrolled in the German Transcatheter Aortic Valve Interventions Registry. Both Medtronic CoreValve™ and Edwards Sapien™ valves were implanted. Patients with pre-procedurally implanted PPM or implantable cardioverter defibrillator were excluded from the analysis (n=199). Regression analysis of baseline and procedure characteristics of the remaining 1.147 patients was performed. Results: Procedural success was achieved in 97.4 % of the cases. The rate for PPM after TAVI was 33.7 %. The absence of prior valve surgery, the use of Medtronic CoreValve™ prosthesis and the presence of a porcelain aorta were identified as independent predictors for PPM after TAVI. Mortality at 30 days did not differ between patients with or without PPM necessity (6.0 % vs. 8.1 % respectively; HR 0.72; CI (0.45-1.16); p= 0.17). Conclusions: PPM is a common post-procedure requirement after TAVI. The absence of prior valve surgery, the implantation of Medtronic CoreValve™ prosthesis and the presence of a porcelain aorta were independently associated with PPM after TAVI. © 2013 Wiley Periodicals, Inc.Catheterization and Cardiovascular Interventions 03/2013; · 2.29 Impact Factor -
Article: The impact of peripheral arterial disease on early outcome after transcatheter aortic valve implantation: results from the German Transcatheter Aortic Valve Interventions Registry.
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ABSTRACT: A significant proportion of patients undergoing transcatheter aortic valve implantation (TAVI) have concomitant peripheral arterial disease (PAD), which plays a crucial role in the preinterventional selection process of determining an optimal vascular access site. The aim of our study was to determine the impact of PAD on clinical outcome after TAVI in a real-world setting. A total of 1,315 patients (mean logistic European System for Cardiac Operative Risk Evaluation 20.6% ± 13.7%) underwent TAVI in 27 centers and were included in the prospective German TAVI Registry. Of the 1,315 patients with TAVI, 330 (25.1%) had PAD. These patients had a higher logistic European System for Cardiac Operative Risk Evaluation score (27.7% ± 16.0% vs 18.3% ± 12.0%, P < .0001), mainly attributed to more frequent and severe comorbidities. Compared with patients without PAD, patients with PAD had a higher rate of vascular complications (28.5% vs 20.7%, P < .01), dialysis-dependent renal failure (11.2% vs 5.4%, P < .001), myocardial infarction (1.2% vs 0.3%, P < .05), and, subsequently, 30-day mortality (12.7% vs 6.9%, P < .001). Choosing a surgical approach, for example, transapical access, did not reduce the periprocedural risk associated with PAD; in-hospital mortality was 15.7% for surgical and 10.5% for percutaneous patients with TAVI having PAD (P < .001). In a multivariate regression analysis, PAD was an independent predictor of 30-day mortality (hazard ratio 1.8, 95% CI 1.2-2.7, P = .004) after TAVI. In this real-world TAVI Registry, PAD was an independent predictor of mortality in patients with percutaneous and surgical TAVI, including vascular complications. Assessment of PAD should play a crucial role in the preinterventional selection process, regardless of the access strategy.American heart journal 07/2012; 164(1):102-10.e1. · 4.65 Impact Factor
