Mackram, Eleid F

ABSTRACT Background Valve‐in‐valve transcatheter aortic valve replacement (ViV‐TAVR) is increasingly used to treat structural valve degeneration. Permanent pacemaker implantation (PPI) following TAVR is associated with increased morbidity and mortality, yet predictors specific to ViV‐TAVR remain poorly defined. Objective To identify clinical and procedural predictors of PPI in patients undergoing ViV‐TAVR. Methods We conducted a retrospective observational study of consecutive ViV‐TAVR cases at the Mayo Clinic from 2012 to 2022. Clinical, ECG, procedural data and fluoroscopic measurements were analyzed, and propensity score matching was used to adjust for confounding. Predictors of PPI were identified using multivariable logistic regression. Results Among 261 patients, 24 (9.2%) underwent PPI. Balloon‐expandable valves were used in 66.7% and self‐expanding valves in 33.3%. Predictors of PPI included Preprocedural bifascicular block (OR 12.15, 95% CI: 2.52–68.89, p = 0.003), greater septal implantation depth (OR 1.29, 95% CI: 1.04–1.65, p = 0.019), and post‐procedural new left (OR 23.56, 95% CI: 4.91–48.52, p = 0.0004) and right bundle branch blocks (OR 24.4, 95% CI: 3.82–30.51, p = 0.001). Aortic regurgitation as the mechanism of prosthetic valve failure was associated with reduced PPI odds (OR 0.28, 95% CI: 0.10–0.76, p = 0.014). Pacing requirement—defined as > 90% ventricular pacing—increased from 25% at 3 months to 56.25% at 12 months. At a median follow‐up of 962.5 days (IQR 481.5–1555.3), adjusted mortality was significantly higher in the PPI group (aOR 9.4, 95% CI: 1.9–60.4, p = 0.028). Conclusion Bifascicular block, greater septal depth, and new bundle branch blocks predict PPI post‐ViV‐TAVR, while aortic regurgitation appears protective. Risk stratification and procedural planning are critical.

Background/Introduction: More than moderate tricuspid regurgitation (TR) at baseline is associated with worse outcome in MitraClip patients. The presence of iatrogenic ASD (iASD) may cause right-sided volume overload and lead to adverse events. However, the real effects of iASD are not well-investigated in these patients who are vulnerable to right-sided volume overload. Methods: Patients with more than moderate TR who underwent a successful MitraClip procedure in the period from June 2014 to September 2020 were identified from the Mayo institutional NCDR database. Follow-up transthoracic echocardiography (TTE) at about 1 year after the procedure was used to determine the presence of iASD, and speckle-tracking strain analysis was done. Patients were grouped according to the presence of iASD (iASD+ group vs. iASD- group) for statistical analysis. Results: A total of 141 consecutive patients were included for the final analysis (iASD+ group n=44 and iASD- group n=97). The mean age was 79.3 ± 8.8 years, and 72.3% were male. Follow-up echocardiography and speckle-tracking strain data did not show a significant difference in either left or right ventricular function in conventional echocardiographic parameters and strain. LA reservoir strain (13.7 ± 6.9 vs 11.5±7.5, P=0.0418) was the only parameter with significant difference among the two groups. Details are summarized in Table 1 . Conclusion: The presence of iASD can decompress the left atrium, but does not affect left or right ventricular strain function in MitraClip patients with more than moderate baseline TR.