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 and echocardiographic outcomes after SAPIEN 3 transcatheter aortic valve replacement in inoperable, high-risk and intermediate-risk patients with aortic stenosis.
AIMS Based on r and omized trials using first-generation devices , transcatheter aortic valve replacement ( TAVR ) is well established in the treatment of high-risk ( HR ) patients with severe aortic stenosis ( AS ) . To date , there is a paucity of adjudicated , prospect i ve data evaluating outcomes with newer generation devices and in lower risk patients . We report early outcomes of a large , multicentre registry of inoperable , HR , and intermediate-risk ( IR ) patients undergoing treatment with the next-generation SAPIEN 3 transcatheter heart valve ( THV ) .  METHODS AND RESULTS Patients with severe , symptomatic AS ( 583 high surgical risk or inoperable and 1078 IR ) were enrolled in a multicentre , non-r and omized registry at 57 sites in the USA and Canada . All patients received TAVR with the SAPIEN 3 system via transfemoral ( n = 1443 , 86.9 % ) and transapical or transaortic ( n = 218 , 13.1 % ) access routes . The rate of 30-day all-cause mortality was 2.2 % in HR/inoperable patients [ mean Society of Thoracic Surgeons ( STS ) score 8.7 % ] and 1.1 % in IR patients ( mean STS score 5.3 % ) ; cardiovascular mortality was 1.4 and 0.9 % , respectively . In HR/inoperable patients , the 30-day rate of major/disabling stroke was 0.9 % , major bleeding 14.0 % , major vascular complications 5.1 % , and requirement for permanent pacemaker 13.3 % . In IR patients , the 30-day rate of major/disabling stroke was 1.0 % , major bleeding 10.6 % , major vascular complications 6.1 % , and requirement for permanent pacemaker 10.1 % . Mean overall Kansas City Cardiomyopathy Question naire score increased from 47.8 to 67.8 ( HR/inoperable , P < 0.0001 ) and 54.7 to 74.0 ( IR , P < 0.0001 ) . Overall , paravalvular regurgitation at 30 days was none/trace in 55.9 % of patients , mild in 40.7 % , moderate in 3.4 % , and severe in 0.0 % . Mean gradients among patients with paired baseline and 30-day or discharge echocardiograms decreased from 45.8 mmHg at baseline to 11.4 mmHg at 30 days , while aortic valve area increased from 0.69 to 1.67 cm(2 ) . CONCLUSIONS The SAPIEN 3 THV system was associated with low rates of 30-day mortality and major/disabling stroke as well as low rates of moderate or severe paravalvular regurgitation . TRIAL REGISTRATION Clinical Trials.gov # NCT01314313
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 .