Specific recommendations for implantation of each prosthesis , taking into consideration the presence of pre-existent conduction abnormalities and anatomical factors , may be needed to reduce the risk of PPI
Aims The incidence of new-onset conduction abnormalities requiring permanent pacemaker implantation ( PPI ) after transcatheter aortic valve implantation ( TAVI ) with new-generation prostheses remains debated .
This systematic review analyses the incidence of PPI after TAVI  with new-generation devices and evaluates the electrical , anatomical , and procedural factors associated with PPI .
In addition , the incidence of PPI after  TAVI with early generation prostheses was review ed for comparison .
Early Clinical Outcomes After Transcatheter Aortic Valve Replacement Using a Novel Self-Expanding Bioprosthesis in Patients With Severe Aortic Stenosis Who Are Suboptimal for Surgery: Results of the Evolut R U.S. Study.
OBJECTIVES This study sought to evaluate this transcatheter aortic valve ( TAV ) bioprosthesis in patients who are poorly suitable for surgical aortic valve ( AV ) replacement . BACKGROUND A novel self-exp and able TAV bioprosthesis was design ed to provide a low-profile delivery system , conformable annular sealing , and the ability to resheath and reposition during deployment . METHODS The Evolut R U.S. study included 241 patients with severe aortic stenosis who were deemed to be at least high risk for surgery treated at 23 clinical sites in the United States . Clinical outcomes at 30 days were evaluated using Valve Academic Research Consortium-2 criteria . An independent echocardiography laboratory was used to evaluate hemodynamic outcomes . RESULTS Patients were elderly ( 83.3 ± 7.2 years of age ) and had high surgical risk ( Society of Thoracic Surgeons predicted risk of mortality of 7.4 ± 3.4 % ) . The majority of patients ( 89.5 % ) were treated by iliofemoral access . Resheathing or recapturing was performed in 22.6 % of patients ; more than 1 valve was required in 3 patients ( 1.3 % ) . The 30-day outcomes included all-cause mortality ( 2.5 % ) , disabling stroke ( 3.3 % ) , major vascular complications ( 7.5 % ) , life-threatening or disabling bleeding ( 7.1 % ) , and new permanent pacemaker ( 16.4 % ) . AV hemodynamics were markedly improved at 30 days : the mean AV gradient was reduced from 48.2 ± 13.0 mm Hg to 7.8 ± 3.1 mm Hg ( p < 0.001 ) and AV area increased from 0.6 ± 0.2 cm2 to 1.9 ± 0.5 cm2 ( p < 0.001 ) . Moderate residual paravalvular leak was identified in 5.3 % of patients . CONCLUSIONS We conclude that this novel self-exp and ing TAV bioprosthesis is safe and effective for the treatment of patients with severe aortic stenosis who are suboptimal for surgery . ( Medtronic CoreValve Evolut R U.S. Clinical Study ; NCT02207569 )
Specific recommendations for implantation of each prosthesis , taking into consideration the presence of pre-existent conduction abnormalities and anatomical factors , may be needed to reduce the risk of PPI
Aims The incidence of new-onset conduction abnormalities requiring permanent pacemaker implantation ( PPI ) after transcatheter aortic valve implantation ( TAVI ) with new-generation prostheses remains debated .
This systematic review analyses the incidence of PPI after TAVI  with new-generation devices and evaluates the electrical , anatomical , and procedural factors associated with PPI .
In addition , the incidence of PPI after  TAVI with early generation prostheses was review ed for comparison .