Predictors of Permanent Pacemaker Implantation in Patients With Raphe-Type Bicuspid Aortic Valve Stenosis Undergoing TAVR.

Mangieri, A.; Gitto, M.; Tarantini, G.; Kim, WK.; Fabris, T.; de Biase, C.; Bellamoli, M.; Montarello, N.; Costa, G.; Alfadhel, M.; Koren, O.; Fezzi, S.; Bellini, B.; Massussi, M.; Scotti, A.; Bai, L.; Mazzapicchi, A.; Giacomin, E.; Gorla, R.; Hug, K.; Briguori, C.; Bettari, L.; Messina, A.; Boiago, M.; Renker, M.; Gomez, MG.; Fraccaro, C.; De Rosa, ML.; Zito, A.; Trani, C.; Laterra, G.; Pellegrini, D.; Ielasi, A.; Orbach, A.; Landes, U.; Rheude, T.; Testa, L.; Santos, IA.; Saia, F.; Favero, L.; Chen, M.; Adamo, M.; Latib, A.; Petronio, AS.; Montorfano, M.; Makkar, RR.; Mylotte, D.; Blackman, DJ.; Burzotta, F.; Barbanti, M.; De Backer, O.; Tchetche, D.; Maffeo, D.; Buono, A.

Predictors of Permanent Pacemaker Implantation in Patients With Raphe-Type Bicuspid Aortic Valve Stenosis Undergoing TAVR.

All Authors

Mangieri, A.

Gitto, M.

Tarantini, G.

Kim, WK.

Fabris, T.

de Biase, C.

Bellamoli, M.

Montarello, N.

Costa, G.

Alfadhel, M.

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LTHT Author

Alfadhel, Mesfer
Blackman, Daniel

LTHT Department

Cardio-Respiratory
Cardiology

Publication Date

2026

Item Type

Journal Article
Multicenter Study
Observational Study

Abstract

There are limited data regarding predictors and impact of permanent pacemaker implantation (PPI) among patients with raphe-type bicuspid aortic valve (BAV) stenosis undergoing transcatheter aortic valve replacement (TAVR). The aim is to evaluate the incidence, predictors and clinical impact of PPI among patient with raphe-type BAV treated with TAVR. The AD-HOC is an international registry enrolling patients with raphe-type BAV stenosis undergoing TAVR. We investigated the incidence of PPI; clinical, anatomical and procedural predictors of PPI were assessed. The impact of PPI on overall survival and on the Valve Academic Research Consortium-3 (VARC-3) clinical efficacy endpoint, defined as freedom from death, heart failure (HF) hospitalizations or TIA/stroke, was evaluated. Among the 912 patients, PPI after TAVR was required in 141 cases (15.5%). The VARC-3 technical success and device success endpoints were met in 94.7% and 85.2% of patients with no differences between those with and without PPI. Independent predictors of PPI included peripheral vascular disease (OR: 2.05, 95% CI: 1.09-3.87, p = 0.026), chronic kidney disease (OR: 1.53, 95% CI: 1.04-2.26), right bundle branch block (RBBB - OR: 5.88, 05% CI: 3.33-10.38), R-L raphe localization (OR: 2.51, 95% CI: 1.24, 5.10) and use of Evolut R/Pro/Pro+ (OR: 1.68, 95% CI: 1.18-2.68, p = 0.006). At follow-up, VARC-3 clinical efficacy endpoint was similar (log-rank p = 0.579). In conclusions, PPI following TAVR in BAV is relatively common but without impact on mid-term clinical outcome. Beyond preprocedural RBBB and the use of Evolut valves, PPI had unique anatomical predictors within this population, such as the R-L raphe localization. The AD-HOC is an observational, international, multicenter registry enrolling patients with raphe-type 1 BAV stenosis undergoing TAVR at 24 Institutions from 2016 to 2023. Among the 912 included patients, new PPI was required in 141 cases (15.5%). The VARC-3 technical success and device success endpoints were met in 94.7% and 85.2% of patients, respectively, with no differences between those with and without PPI. At multivariable logistic regression analysis, independent predictors of PPI after TAVR included peripheral vascular disease, chronic kidney disease, preprocedural RBBB, the R-L raphe localization and the use of Evolut R/Pro/Pro+ valves. No differences were noticed between PPI and no-PPI recipients in terms of the VARC-3 efficacy endpoint at the 3-year follow-up.