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Resident PGY 3
Henry Ford Hospital
Background: Transcatheter Aortic Valve Replacement (TAVR) therapies have increased in the treatment of aortic disease. As TAVR procedures increase, more data is available on complications, such as the development of conduction abnormalities, often requiring pacemaker placement (PMP). A common complication of pacemaker lead placement is the development of tricuspid regurgitation which develops due to pacemaker wire impingement of leaflet function and coaptation.
Methods: Retrospective data was obtained from a major urban Midwestern health center. 796 patients were isolated who underwent TAVR from January 2014 through June 2018. From that sample, 89 patients (11%) underwent PMP following TAVR procedure. From those 89 patients, a sample of 34 patients was isolated that received their pacemaker at 2 years or more prior from the date of data collection. In addition to data from both procedures and patient demographics, echographic data was obtained  prior to TAVR procedure  between TAVR procedure and PMP and  the most recent echocardiogram. Data obtained from the echocardiogram included ejection fraction, degree of tricuspid regurgitation, pulmonary artery pressure, Tricuspid Annular Plane Systolic Excursion (TAPSE), degree of inferior vena cava (IVC) dilation, right ventricular diameter (RVD), right ventricle systolic pressure, right atrium (RA) area and degree of hepatic flow reversal.
Results: Overall there was an increase in the incidence of significant tricuspid regurgitation (defined as above mild) from 29% to 38% following TAVR and PMP. The various changes between echographic parameters were analyzed using the paired t-test and the Wilcoxon signed rank test. The results indicate that a statistically significant change for the RVD from prior to TAVR to after PMP, where the mean RVD increased from 2.9 cm to 3.5 cm (p-value = 0.039). While not statistically significant, it should also be noted that there was an increase in the degree of tricuspid regurgitation and RA area.
Conclusion: There is increasing awareness of the prevalence of tricuspid valve disease. This project serves as a basis to understand the risk of developing tricuspid regurgitation after TAVR procedure. This research can help guide clinicians in future in TAVR patients who have preexisting tricuspid regurgitation and may be evaluated for pacemaker placement. Given recent advances in transcatheter tricuspid valve therapies, more research is required to understand the risk of TAVR procedure and to push therapy and development that may help correct such complications.
Nona, Paul and Wang, Dee Dee, "Pacemaker Following TAVR Associated With Increased Tricuspid Reguritation" (2019). Clinical Research. 46.