Key result
Early temporary pacemaker removal and hospital discharge after TAVI were feasible in patients with conduction disturbances, with low TPM reinsertion and 30-day PPM rates.
Why the study?
External validations of expert panel recommendations for conduction disturbance management after TAVI with the Sapien 3 valve are limited.
Does early temporary pacemaker removal and hospital discharge after TAVI with the Sapien 3 valve increase the risk of TPM reinsertion or permanent pacemaker implantation compared to expert panel recommendations?
Cohort (n=808)
No
Does early temporary pacemaker removal and hospital discharge after TAVI with the Sapien 3 valve increase the risk of TPM reinsertion or permanent pacemaker implantation compared to expert panel recommendations?
Answers are grounded in this paper and cite their sources.
Early temporary pacemaker removal and hospital discharge after TAVI appear safe and feasible, suggesting that more conservative expert panel recommendations may be safely streamlined for certain patients.
Background: In the absence of randomized data, an expert panel recently proposed an algorithm for conduction disturbance management in transcatheter aortic valve implantation (TAVI) recipients. However, external validations of its recommendations are limited. Methods: We retrospectively identified 808 patients without a pre-existing pacing device who underwent transfemoral TAVI with the Sapien 3 valve at our institution in 2018-2019. Patients were grouped based on pre-existing conduction disturbance and immediate post-TAVI electrocardiogram. Timing of temporary pacemaker (TPM) removal and hospital discharge were compared with those of the expert panel recommendations to evaluate the associated risk of TPM reinsertion and permanent pacemaker (PPM) implantation. Results: In most group 1 patients (no electrocardiogram changes without pre-existing right bundle branch block), the timing of TPM removal and discharge were concordant with those of the expert panel recommendations, with low TPM reinsertion (0.8%) and postdischarge PPM (0.8%) rates. In the majority of group 5 patients (procedural high-degree/complete atrioventricular block), TPM was maintained, followed by PPM implantation, compatible with the expert panel recommendations. In contrast, in groups 2-4 (pre-existing/new conduction disturbances), earlier TPM removal than recommended by the expert panel (mostly, immediately after procedure) was feasible in 97.5%-100% of patients, with a low TPM reinsertion rate (0.0%-1.8%); earlier discharge was also feasible in 50.0%-65.5%, with a low 30-day postdischarge PPM rate (0.0%-2.8%) and no 30-day death. Conclusions: Early TPM removal and discharge after TAVI appear safe and feasible in the majority of cases. These data may provide a framework for an early, streamlined hospital discharge plan for TAVI recipients, optimizing both cost savings and patient safety.
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Isogai et al. (2022) conducted a cohort in Transcatheter aortic valve implantation (TAVI) (n=808). Early temporary pacemaker (TPM) removal and hospital discharge vs. Expert panel recommendations was evaluated on TPM reinsertion and permanent pacemaker (PPM) implantation. Early temporary pacemaker removal and hospital discharge after TAVI were feasible in patients with conduction disturbances, with low TPM reinsertion and 30-day PPM rates.
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