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 .
Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk: acute and late outcomes of the multicenter Canadian experience.
OBJECTIVES The aim of this study was : 1 ) to evaluate the acute and late outcomes of a transcatheter aortic valve implantation ( TAVI ) program including both the transfemoral ( TF ) and transapical ( TA ) approaches ; and 2 ) to determine the results of TAVI  in patients deemed inoperable because of either porcelain aorta or frailty . BACKGROUND Very few data exist on the results of a comprehensive TAVI program including both TA and TF approaches for the treatment of severe aortic stenosis in patients at very high or prohibitive surgical risk . METHODS Consecutive patients who underwent TAVI with the Edwards valve ( Edwards Lifesciences , Inc. , Irvine , California ) between January 2005 and June 2009 in 6 Canadian centers were included . RESULTS A total of 345 procedures ( TF : 168 , TA : 177 ) were performed in 339 patients . The predicted surgical mortality ( Society of Thoracic Surgeons risk score ) was 9.8 + /- 6.4 % . The procedural success rate was 93.3 % , and 30-day mortality was 10.4 % ( TF : 9.5 % , TA : 11.3 % ) . After a median follow-up of 8 months ( 25th to 75th interquartile range : 3 to 14 months ) the mortality rate was 22.1 % . The predictors of cumulative late mortality were peri-procedural sepsis ( hazard ratio [ HR ] : 3.49 , 95 % confidence interval [ CI ] : 1.48 to 8.28 ) or need for hemodynamic support ( HR : 2.58 , 95 % CI : 1.11 to 6 ) , pulmonary hypertension ( PH ) ( HR : 1.88 , 95 % CI : 1.17 to 3 ) , chronic kidney disease ( CKD ) ( HR : 2.30 , 95 % CI : 1.38 to 3.84 ) , and chronic obstructive pulmonary disease ( COPD ) ( HR : 1.75 , 95 % CI : 1.09 to 2.83 ) . Patients with either porcelain aorta ( 18 % ) or frailty ( 25 % ) exhibited acute outcomes similar to the rest of the study population , and porcelain aorta patients tended to have a better survival rate at 1-year follow-up . CONCLUSIONS A TAVI program including both TF and TA approaches was associated with comparable mortality as predicted by surgical risk calculators for the treatment of patients at very high or prohibitive surgical risk , including porcelain aorta and frail patients . Baseline ( PH , COPD , CKD ) and peri-procedural ( hemodynamic support , sepsis ) factors but not the approach determined worse outcomes
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 .