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 .
Multicenter evaluation of a next-generation balloon-expandable transcatheter aortic valve.
BACKGROUND The SAPIEN 3 ( Edwards Lifesciences Inc. , Irvine , California ) transcatheter valve incorporates features design ed to address the well-known deficiencies of transcatheter aortic valve replacement ( TAVR ) . An ultra-low-profile delivery system facilitates safe , controlled , and accurate implantation and an external seal minimizes paravalvular regurgitation . OBJECTIVES The study evaluated whether TAVR with this third-generation valve would be a viable alternative to high- or intermediate-risk surgery for severe aortic stenosis . METHODS The prospect i ve study enrolled 150 patients at 16 sites in Europe and Canada .  Clinical and echocardiographic outcomes were assessed at baseline , post-procedure , and 30 days . New sizing recommendations were developed during the course of the study . RESULTS Patients were 83.6 ± 5.0 years of age , with multiple comorbidities reflected by a Society of Thoracic Surgeons score of 7.4 ± 4.5 % and logistic EuroSCORE of 21.6 ± 12.3 % . A transfemoral approach was chosen in 64.0 % and alternative access ( transapical/direct aortic ) in the remainder . At 30 days , paravalvular regurgitation was none to mild in 96.4 % and moderate in 3.5 % . No patient had severe regurgitation . Transfemoral implantation was associated with low mortality ( 2.1 % ) , no disabling stroke ( 0.0 % ) , and fully percutaneous access and closure in 95.8 % . Nontransfemoral alternative access was associated with higher rates of mortality ( 11.6 % ) and stroke ( 5.6 % ) . CONCLUSIONS This third-generation device addresses major deficiencies of earlier valves in terms of ease of use , accuracy of positioning , and paravalvular sealing . The rates of mortality and stroke with transfemoral access are among the lowest reported and support further evaluation as an alternative to open surgery in intermediate-risk patients . ( Safety and Performance Study of the Edwards SAPIEN 3 Transcatheter Heart Valve [ SAPIEN3 ] ; NCT01808287 )
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 .