It seems that as experience in the transcatheter aortic valve implantation (TAVI) procedure is gained, strategies are being adopted to reduce the need for permanent pacing. Furthermore, information being garnered from national registries provides a useful insight into the adoption of this new technology.
Last week saw the PCR London Valves 2012 conference and one of the most striking reports to come out of the event came from the discussion on the association between (TAVI), specifically with Medtronic’s CoreValve device, and pacemaker implantation.
Heartwire reports that new data—including results from registries in Latin America, Asia, and parts of Europe—suggest that rates of pacemaker implantation following transcatheter aortic-valve implantation (TAVI) with the CoreValve device may be falling, although large intercountry differences still exist. The report can be found here.
The “pacemaker issue” has been one of the major unresolved questions for the CoreValve. Because it self-expands, this can seemingly lead to conduction disturbances following implantation, necessitating use of a pacemaker in around 25% of patients who receive it (although one study has shown that pacemaker implantation doesn’t affect the clinical outcome of TAVI).
Doctors at last week’s event said that economic circumstances and reimbursement policies might have some impact on pacemaker use, in that some countries may not be able to afford to fit them willy-nilly, and others may do it just to be “on the safe side.”
But they believe there are clinical strategies that can be employed to reduce pacemaker implantation with the CoreValve. These include avoiding predilation wherever possible, placing the valve a few milimeters higher, and waiting until about 10 days after the TAVI procedure before deciding whether a pacemaker is warranted or not, as is the practice following surgical aortic-valve replacement (SAVR).
The article provides an illuminating insight into TAVI in the real world, especially useful for the American physician population currently restricted in its access to the procedure.