HENRIQUE BARBOSA RIBEIRO

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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico

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Colaboração internacional: Canadá ×

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  • conferenceObject
    IMPACT OF MORBID OBESITY AND OBESITY PHENOTYPE ON OUTCOMES POST TRANSCATHETER AORTIC VALVE REPLACEMENT
    (2020) MCINERNEY, A.; TIRADO-CONTE, G.; RODES-CABAU, J.; CAMPELO-PARADA, F.; SOTO, J. D. Tafur; BARBANTI, M.; MUNOZ-GARCIA, E.; ARIF, M.; LOPEZ, D.; TOGGWEILER, S.; VEIGA, G.; PYLKO, A.; SEVILLA, T.; COMPAGNONE, M.; REGUEIRO, A.; SERRA, V.; CARNERO, M.; OTEO, J. F.; RIVERO, F.; RIBEIRO, H. Barbosa; GUIMARAES, L.; MATTA, A.; ECHAVARRIA, N. Giraldo; VALVO, R.; MOCCETTI, F.; MUNOZ-GARCIA, A. J.; LOPEZ-PAIS, J.; BLANCO, B. Garcia del; BORGES, D. Carter Campanha; GONZALO, N.; DUMONT, E.; CRISCIONE, E.; DABROWSKI, M.; ALFONSO, F.; HERNANDEZ, J. M. de la Torre; CHEEMA, A. N.; AMAT-SANTOS, I.; SAIA, F.; ESCANED, J.; NOMBELA-FRANCO, L.
  • article 4 Citação(ões) na Scopus
    Late Bleeding Events in Patients Undergoing Percutaneous Coronary Intervention in the Workup Pre-TAVR
    (2023) AVVEDIMENTO, Marisa; CAMPELO-PARADA, Francisco; MUNOZ-GARCIA, Erika; NOMBELA-FRANCO, Luis; FISCHER, Quentin; DONAINT, Pierre; SERRA, Vicenc; VEIGA, Gabriela; GUTIERREZ, Enrique; ESPOSITO, Giovanni; VILALTA, Victoria; ALPERI, Alberto; REGUEIRO, Ander; ASMARATS, Lluis; RIBEIRO, Henrique B.; MATTA, Anthony; MUNOZ-GARCIA, Antonio; TIRADO-CONTE, Gabriela; URENA, Marina; METZ, Damien; RODENAS-ALESINA, Eduard; HERNANDEZ, Jose Maria de la Torre; FERNANDEZ-NOFRERIAS, Eduard; PASCUAL, Isaac; VIDAL-CALES, Pablo; ARZAMENDI, Dabit; CAMPANHA-BORGES, Diego Carter; TRINH, Kim Hoang; COTE, Melanie; FAROUX, Laurent; RODES-CABAU, Josep
    BACKGROUND In patients undergoing percutaneous coronary intervention (PCI) in the work-up pre-transcatheter aortic valve replacement (TAVR), the incidence and clinical impact of late bleeding events (LBEs) remain largely unknown.OBJECTIVES This study sought to determine the incidence, clinical characteristics, associated factors, and outcomes of LBEs in patients undergoing PCI in the work-up pre-TAVR.METHODS This was a multicenter study including 1,457 consecutive patients (mean age 81 +/- 7 years; 41.5% women) who underwent TAVR and survived beyond 30 days. LBEs (>30 days post-TAVR) were defined according to the Valve Academic Research Consortium-2 criteria.RESULTS LBEs occurred in 116 (7.9%) patients after a median follow-up of 23 (IQR: 12-40) months. Late bleeding was minor, major, and life-threatening or disabling in 21 (18.1%), 63 (54.3%), and 32 (27.6%) patients, respectively. Periprocedural (<30 days post-TAVR) major bleeding and the combination of antiplatelet and anticoagulation therapy at discharge were independent factors associated with LBEs (P <= 0.02 for all). LBEs conveyed an increased mortality risk at 4-year follow-up compared with no bleeding (43.9% vs 36.0; P = 0.034). Also, LBE was identified as an independent predictor of all-cause mortality after TAVR (HR: 1.39; 95% CI: 1.05-1.83; P = 0.020).CONCLUSIONS In TAVR candidates with concomitant significant coronary artery disease requiring percutaneous treatment, LBEs after TAVR were frequent and associated with increased mortality. Combining antiplatelet and anticoagulation regimens and the occurrence of periprocedural bleeding determined an increased risk of LBEs. Preventive strategies should be pursued for preventing late bleeding after TAVR, and further studies are needed to provide more solid evidence on the most safe and effective antithrombotic regimen post-TAVR in this challenging group of patients.
  • article 27 Citação(ões) na Scopus
    Valve-in-Valve Challenges: How to Avoid Coronary Obstruction
    (2019) BERNARDI, Fernando L. M.; DVIR, Danny; RODES-CABAU, Josep; RIBEIRO, Henrique B.
    Coronary obstruction is a rare but life-threatening complication in patients undergoing transcatheter aortic valve replacement (TAVR). Aortic valve-in-valve (VIV) procedures to treat failed surgical bioprosthesis is associated with similar to 6-fold higher risk for coronary obstruction in certain situations. The primary mechanism consists in the occlusion of the coronary ostium by the dislodged leaflet from the bioprosthesis after deployment of the transcatheter heart valve (THV), which most commonly occurs during the index procedure, but in up to 1/3 of cases a delayed presentation ensues. The clinical presentation consists of severe hypotension and ECG changes in most of the patients, with very high mortality rates. Therefore, pre-procedural multi-slice computed tomography is crucial for identifying high-risk features, such as low coronary heights, shallow sinuses of Valsalva, and short virtual THV to coronary ostial distance (VTC). Also, some models of surgical bioprosthesis present an increased risk for this dreadful complication. Preemptive protective strategies with coronary wiring, with or without placement of an undeployed stent, could mitigate the risks associated with this complication in high-risk patients, even though studies are lacking. This review aims to take a clinical perspective on the challenges in avoiding this complication during VIV procedures.
  • article 26 Citação(ões) na Scopus
    Myocardial Fibrosis in Classical Low-Flow, Low-Gradient Aortic Stenosis Insights From a Cardiovascular Magnetic Resonance Study
    (2019) ROSA, Vitor E. E.; RIBEIRO, Henrique B.; SAMPAIO, Roney O.; MORAIS, Thamara C.; ROSA, Marcela E. E.; PIRES, Lucas J. T.; VIEIRA, Marcelo L. C.; MATHIAS JR., Wilson; ROCHITTE, Carlos E.; SANTIS, Antonio S. A. L. de; FERNANDES, Joao Ricardo C.; ACCORSI, Tarso A. D.; POMERANTZEFF, Pablo M. A.; RODES-CABAU, Josep; PIBAROT, Philippe; TARASOUTCHI, Flavio
    Background: Few data exist on the degree of interstitial myocardial fibrosis in patients with classical low-flow, low-gradient aortic stenosis (LFLG-AS) and its association with left ventricular flow reserve (FR) on dobutamine stress echocardiography. This study sought to evaluate the diffuse interstitial fibrosis measured by T1 mapping cardiac magnetic resonance technique in LFLG-AS patients with and without FR. Methods: Prospective study including 65 consecutive patients (41 LFLG-AS [mean age, 67.1 +/- 8.4 years; 83% men] and 24 high-gradient aortic stenosis used as controls) undergoing dobutamine stress echocardiography to assess FR and cardiac magnetic resonance to determine the extracellular volume (ECV) fraction of the myocardium, indexed ECV (iECV) to body surface area and late gadolinium enhancement. Results: Interstitial myocardial fibrosis measured by iECV was higher in patients with LFLG-AS with and without FR as compared with high-gradient aortic stenosis (35.25 +/- 9.75 versus 32.93 +/- 11.00 versus 21.19 +/- 6.47 mL/m(2), respectively; P<0.001). However, both ECV and iECV levels were similar between LFLG-AS patients with and without FR (P=0.950 and P=0.701, respectively). Also, FR did not correlate significantly with ECV (r=-0.16, P=0.31) or iECV (r=0.11, P=0.51). Late gadolinium enhancement mass was also similar in patients with versus without FR but lower in high-gradient aortic stenosis (13.3 +/- 10.2 versus 10.5 +/- 7.5 versus 4.8 +/- 5.9 g, respectively; P=0.018). Conclusions: Patients with LFLG-AS have higher ECV, iECV, and late gadolinium enhancement mass compared with high-gradient aortic stenosis. Moreover, among patients with LFLG-AS, the degree of myocardial fibrosis was similar in patients with versus those without FR. These findings suggest that diffuse myocardial fibrosis may not be the main factor responsible for the absence of FR in LFLG-AS patients.
  • article 103 Citação(ões) na Scopus
    Transcatheter Mitral Valve Replacement After Surgical Repair or Replacement Comprehensive Midterm Evaluation of Valve-in-Valve and Valve-in-Ring Implantation From the VIVID Registry
    (2021) SIMONATO, Matheus; WHISENANT, Brian; RIBEIRO, Henrique Barbosa; WEBB, John G.; KORNOWSKI, Ran; GUERRERO, Mayra; WIJEYSUNDERA, Harindra; SONDERGAARD, Lars; BACKER, Ole De; VILLABLANCA, Pedro; RIHAL, Charanjit; ELEID, Mackram; KEMPFERT, Jorg; UNBEHAUN, Axel; ERLEBACH, Magdalena; CASSELMAN, Filip; ADAM, Matti; MONTORFANO, Matteo; ANCONA, Marco; SAIA, Francesco; UBBEN, Timm; MEINCKE, Felix; NAPODANO, Massimo; CODNER, Pablo; SCHOFER, Joachim; PELLETIER, Marc; CHEUNG, Anson; SHUVY, Mony; PALMA, Jose Honorio; GAIA, Diego Felipe; DUNCAN, Alison; HILDICK-SMITH, David; VEULEMANS, Verena; SINNING, Jan-Malte; ARBEL, Yaron; TESTA, Luca; WEGER, Arend de; ELTCHANINOFF, Helene; HEMERY, Thibault; LANDES, Uri; TCHETCHE, Didier; DUMONTEIL, Nicolas; RODES-CABAU, Josep; KIM, Won-Keun; SPARGIAS, Konstantinos; KOURKOVELI, Panagiota; BEN-YEHUDA, Ori; TELES, Rui Campante; BARBANTI, Marco; FIORINA, Claudia; THUKKANI, Arun; MACKENSEN, G. Burkhard; JONES, Noah; PRESBITERO, Patrizia; PETRONIO, Anna Sonia; ALLALI, Abdelhakim; CHAMPAGNAC, Didier; BLEIZIFFER, Sabine; RUDOLPH, Tanja; IADANZA, Alessandro; SALIZZONI, Stefano; AGRIFOGLIO, Marco; NOMBELA-FRANCO, Luis; BONAROS, Nikolaos; KASS, Malek; BRUSCHI, Giuseppe; AMABILE, Nicolas; CHHATRIWALLA, Adnan; MESSINA, Antonio; HIRJI, Sameer A.; ANDREAS, Martin; WELSH, Robert; SCHOELS, Wolfgang; HELLIG, Farrel; WINDECKER, Stephan; STORTECKY, Stefan; MAISANO, Francesco; STONE, Gregg W.; DVIR, Danny
    Background: Mitral valve-in-valve (ViV) and valve-in-ring (ViR) are alternatives to surgical reoperation in patients with recurrent mitral valve failure after previous surgical valve repair or replacement. Our aim was to perform a large-scale analysis examining midterm outcomes after mitral ViV and ViR. Methods: Patients undergoing mitral ViV and ViR were enrolled in the Valve-in-Valve International Data Registry. Cases were performed between March 2006 and March 2020. Clinical endpoints are reported according to the Mitral Valve Academic Research Consortium (MVARC) definitions. Significant residual mitral stenosis (MS) was defined as mean gradient >= 10 mm Hg and significant residual mitral regurgitation (MR) as >= moderate. Results: A total of 1079 patients (857 ViV, 222 ViR; mean age 73.5 +/- 12.5 years; 40.8% male) from 90 centers were included. Median STS-PROM score 8.6%; median clinical follow-up 492 days (interquartile range, 76-996); median echocardiographic follow-up for patients that survived 1 year was 772.5 days (interquartile range, 510-1211.75). Four-year Kaplan-Meier survival rate was 62.5% in ViV versus 49.5% for ViR (P<0.001). Mean gradient across the mitral valve postprocedure was 5.7 +/- 2.8 mm Hg (>= 5 mm Hg; 61.4% of patients). Significant residual MS occurred in 8.2% of the ViV and 12.0% of the ViR patients (P=0.09). Significant residual MR was more common in ViR patients (16.6% versus 3.1%; P<0.001) and was associated with lower survival at 4 years (35.1% versus 61.6%; P=0.02). The rates of Mitral Valve Academic Research Consortium-defined device success were low for both procedures (39.4% total; 32.0% ViR versus 41.3% ViV; P=0.01), mostly related to having postprocedural mean gradient >= 5 mm Hg. Correlates for residual MS were smaller true internal diameter, younger age, and larger body mass index. The only correlate for residual MR was ViR. Significant residual MS (subhazard ratio, 4.67; 95% CI, 1.74-12.56; P=0.002) and significant residual MR (subhazard ratio, 7.88; 95% CI, 2.88-21.53; P<0.001) were both independently associated with repeat mitral valve replacement. Conclusions: Significant residual MS and/or MR were not infrequent after mitral ViV and ViR procedures and were both associated with a need for repeat valve replacement. Strategies to improve postprocedural hemodynamics in mitral ViV and ViR should be further explored.
  • article 19 Citação(ões) na Scopus
    Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Complex Coronary Artery Disease
    (2021) ALPERI, Alberto; MOHAMMADI, Siamak; CAMPELO-PARADA, Francisco; MUNOZ-GARCIA, Erika; NOMBELA-FRANCO, Luis; FAROUX, Laurent; VEIGA, Gabriela; SERRA, Vicenc; FISCHER, Quentin; PASCUAL, Isaac; ASMARATS, Luis; GUTIERREZ, Enrique; REGUEIRO, Ander; VILALTA, Victoria; RIBEIRO, Henrique B.; MATTA, Anthony; MUNOZ-GARCIA, Antonio; ARMIJO, German; METZ, Damien; HERNANDEZ, Jose M. de la Torre; RODENAS-ALESINA, Eduard; URENA, Marina; MORIS, Cesar; ARZAMENDI, Dabit; PEREZ-FUENTES, Pedro; FERNANDEZ-NOFRERIAS, Eduard; CAMPANHA-BORGES, Diego Carter; MESNIER, Jules; VOISINE, Pierre; DUMONT, Eric; KALAVROUZIOTIS, Dimitri; RODES-CABAU, Josep
    OBJECTIVES The aim of this study was to compare, in a cohort of patients with complex coronary artery disease (CAD) and severe aortic stenosis (AS), the clinical outcomes associated with transfemoral transcatheter aortic valve replacement (TAVR) (plus percutaneous coronary intervention [PCI]) versus surgical aortic valve replacement (SAVR) (plus coronary artery bypass grafting [CABG]). BACKGROUND Patients with complex CAD were excluded from the main randomized trials comparing TAVR with SAVR, and no data exist comparing TAVR + PCI vs SAVR + CABG in such patients. METHODS A multicenter study was conducted including consecutive patients with severe AS and complex CAD (SYN-TAX [Synergy Between PCI with Taxus and Cardiac Surgery] score >22 or unprotected left main disease). A 1:1 propensity-matched analysis was performed to account for unbalanced covariates. The rates of major adverse cardiac and cere-brovascular events (MACCE), including all-cause mortality, nonprocedural myocardial infarction, need for new coronary revascularization, and stroke, were evaluated. RESULTS A total of 800 patients (598 undergoing SAVR + CABG and 202 undergoing transfemoral TAVR + PCI) were included, and after propensity matching, a total of 156 pairs of patients were generated. After a median follow-up period of 3 years (interquartile range: 1-6 years), there were no significant differences between groups for MACCE (HR for transfemoral TAVR vs SAVR: 1.33; 95% CI: 0.89-1.98), all-cause mortality (HR: 1.25; 95% CI: 0.81-1.94), myocardial infarction (HR: 1.16; 95% CI: 0.41-3.27), and stroke (HR: 0.42; 95% CI: 0.13-1.32), but there was a higher rate of new coronary revascularization in the TAVR + PCI group (HR: 5.38; 95% CI: 1.73-16.7). CONCLUSIONS In patients with severe AS and complex CAD, TAVR + PCI and SAVR + CABG were associated with similar rates of MACCE after a median follow-up period of 3 years, but TAVR + PCI recipients exhibited a higher risk for repeat coronary revascularization. Future trials are warranted. (J Am Coll Cardiol Intv 2021;14:2490-2499) (c) 2021 by the American College of Cardiology Foundation.
  • article
    Novel strategies in aortic valve-in-valve therapy including bioprosthetic valve fracture and BASILICA
    (2018) DVIR, Danny; KHAN, Jaffar; KORNOWSKI, Ran; KOMATSU, Ikki; CHHATRIWALLA, Adnan; MACKENSEN, G. Burkhard; SIMONATO, Matheus; RIBEIRO, Henrique; WOOD, David; LEIPSIC, Jonathon; WEBB, John; MYLOTTE, Darren
    An ageing population and increased utilisation of tissue valves in younger patients imply that the number of patients receiving transcatheter aortic valve implantation within failed bioprostheses will continue to increase. There are two major adverse events associated with aortic valve-in-valve procedures that may temper the enthusiasm for these appealing interventions. Residual stenosis is the ""Achilles' heel"" of aortic valve-in-valve, while coronary obstruction is an uncommon but life-threatening adverse event. Prevention of these adverse events is essential. Emerging tools and techniques enable operators to manipulate existing devices and to implant new ones inside them safely. Considering the available evidence, it seems that bioprosthetic valve ring fracture and bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) may enable some solution. Until we have prosthetic valves that are both very durable and non-thrombogenic, we can expect that techniques and tools chosen to treat failed bioprosthetic valves effectively will continue to be designed and utilised.
  • article 57 Citação(ões) na Scopus
    Renin-Angiotensin System Inhibition Following Transcatheter Aortic Valve Replacement
    (2019) RODRIGUEZ-GABELLA, Tania; CATALA, Pablo; MUNOZ-GARCIA, Antonio J.; NOMBELA-FRANCO, Luis; VALLE, Raquel Del; GUTIERREZ, Enrique; REGUEIRO, Ander; JIMENEZ-DIAZ, Victor A.; RIBEIRO, Henrique B.; RIVERO, Fernando; FERNANDEZ-DIAZ, Jose Antonio; PIBAROT, Philippe; ALONSO-BRIALES, Juan H.; TIRADO-CONTE, Gabriela; MORIS, Cesar; HOYO, Felipe Diez Del; JIMENEZ-BRITEZ, Gustavo; ZADERENKO, Nicolas; ALFONSO, Fernando; GOMEZ, Itziar; CARRASCO-MORALEJA, Manuel; RODES-CABAU, Josep; CALVAR, J. Alberto San Roman; AMAT-SANTOS, Ignacio J.
    BACKGROUND Several studies have demonstrated the benefits of transcatheter aortic valve replacement (TAVR) in patients with aortic stenosis, but the presence of persistent fibrosis and myocardial hypertrophy has been related to worse prognosis. OBJECTIVES The aim of this study was to explore the potential benefits of renin-angiotensin system (RAS) inhibitors on left ventricular remodeling and major clinical outcomes following successful transcatheter aortic valve replacement (TAVR). METHODS Patients from 10 institutions with severe aortic stenosis who underwent TAVR between August 2007 and August 2017 were included. All baseline data were prospectively recorded, and pre-specified follow-up was performed. Doses and types of RAS inhibitors at discharge were recorded, and matched comparison according to their prescription at discharge was performed. RESULTS A total of 2,785 patients were included. Patients treated with RAS inhibitors (n = 1,622) presented similar surgical risk scores but a higher rate of all cardiovascular risk factors, coronary disease, and myocardial infarction. After adjustment for these baseline differences, reduction of left ventricular volumes and hypertrophy was greater and cardiovascular mortality at 3-year follow-up was lower (odds ratio: 0.59; 95% confidence interval: 0.41 to 0.87; p = 0.007) in patients treated with RAS inhibitors. Moreover, RAS inhibitors demonstrated a global cardiovascular protective effect with significantly lower rates of new-onset atrial fibrillation, cerebrovascular events, and readmissions. CONCLUSIONS Post-TAVR RAS inhibitors are associated with lower cardiac mortality at 3-year follow-up and offer a global cardiovascular protective effect that might be partially explained by a positive left ventricular remodeling. An ongoing randomized trial will help confirm these hypothesis-generating findings. (Renin-Angiotensin System Blockade Benefits in Clinical Evolution and Ventricular Remodeling After Transcatheter Aortic Valve Implantation [RASTAVI]; NCT03201185) (C) 2019 by the American College of Cardiology Foundation.
  • article 2 Citação(ões) na Scopus
    Usefulness of the B-Type Natriuretic Peptides in Low Ejection Fraction, Low-Flow, Low-Gradient Aortic Stenosis Results from the TOPAS Multicenter Prospective Cohort Study
    (2021) ANNABI, Mohamed-Salah; ZHANG, Bin; BERGLER-KLEIN, Jutta; DAHOU, Abdellaziz; BURWASH, Ian G.; GUZZETTI, Ezequiel; ONG, Geraldine; TASTET, Lionel; ORWAT, Stefan; BAUMGARTNER, Helmut; BARTKO, Philipp E.; KOSCHUTNIK, Matthias; MASCHERBAUER, Julia; MUNDIGLER, Gerald; CAVALCANTE, Joao; RIBEIRO, Henrique B.; RODES-CABAU, Josep; PIBAROT, Philippe; CLAVEL, Marie-Annick
    Background: Patients with low left ventricular ejection fraction (LVEF), low-flow, low-gradient (i.e. classical low flow [CLF]) aortic stenosis (AS) have a dismal short-term outcome without aortic valve replacement (AVR) but high operative mortality. We hypothesized that brain natriuretic peptides (BNP/NT-proBNP) can risk stratify patients with CLF AS and may assist in clinical decision-making. Methods: Patients with aortic valve area <= 1.2 cm(2), mean transvalvular gradient <40 mmHg, and left ventricular ejection fraction <50%, were prospectively recruited. BNP and/or NT-proBNP were measured at baseline. Results: Among 234 patients (77 [68-83] years, 76% male), BNP > 550 pg/ml or NT-proBNP > 1,600 pg/ml (85% and 93% sensitivity, respectively, to correctly classify 1-year death) strongly predicted all-cause mortality (adjusted HR = 2.53 [1.68-3.81], p < 0.001) outperforming flow reserve and baseline LVEF (all likelihood ratio p <= 0.02). For both natriuretic peptides, spline curve analysis showed gradual increase in mortality with higher biomarkers levels, which was blunted by AVR. In a head-to-head comparison (n = 104), NT-proBNP appeared to have superior incremental prognostic value than BNP (likelihood-ratio p p = 0.07). Baseline NT-proBNP >= 1,600 pg/ml or BNP >= 550 pg/ml, identified: i) a high-risk cohort with a dismal outcome under conservative management, but a markedly better survival associated with early AVR (adjusted HR = 0.41 [0.25-0.65], p < 0.001); and ii) a low-risk cohort with an excellent 1-year survival (94 +/- 4%) with conservative management or deferred AVR. Conclusion: In patients with CLF AS, BNP/NT-proBNP have the potential to identify high-risk patients who may benefit from early AVR.
  • article 20 Citação(ões) na Scopus
    Permanent Pacemaker Implantation Following Valve-in-Valve Transcatheter Aortic Valve Replacement
    (2021) ALPERI, Alberto; RODES-CABAU, Josep; SIMONATO, Matheus; TCHETCHE, Didier; CHARBONNIER, Gaetan; RIBEIRO, Henrique B.; LATIB, Azeem; MONTORFANO, Matteo; BARBANTI, Marco; BLEIZIFFER, Sabine; REDFORS, Bjorn; ABDEL-WAHAB, Mohamed; ALLALI, Abdelhakim; BRUSCHI, Giuseppe; NAPODANO, Massimo; AGRIFOGLIO, Marco; PETRONIO, Anna Sonia; GIANNINI, Cristina; CHAN, Albert; KORNOWSKI, Ran; PRAVDA, Nili Schamroth; ADAM, Matti; IADANZA, Alessandro; NOBLE, Stephane; CHATFIELD, Andrew; ERLEBACH, Magdalena; KEMPFERT, Joerg; UBBEN, Timm; WIJEYSUNDERA, Harindra; SEIFFERT, Moritz; PILGRIM, Thomas; KIM, Won-Keun; TESTA, Luca; HILDICK-SMITH, David; NERLA, Roberto; FIORINA, Claudia; BRINKMANN, Christina; CONZELMANN, Lars; CHAMPAGNAC, Didier; SAIA, Francesco; NISSEN, Henrik; AMRANE, Hafid; WHISENANT, Brian; SHAMEKHI, Jasmin; SONDERGAARD, Lars; WEBB, John G.; DVIR, Danny
    BACKGROUND Permanent pacemaker implantation (PPI) remains one of the main drawbacks of transcatheter aortic valve replacement (TAVR), but scarce data exist on PPI after valve-in-valve (ViV) TAVR, particularly with the use of newer-generation transcatheter heart valves (THVs). OBJECTIVES The goal of this study was to determine the incidence, factors associated with, and clinical impact of PPI in a large series of ViV-TAVR procedures. METHODS Data were obtained from the multicenter VIVID Registry and included the main baseline and procedural characteristics, in-hospital and late (median follow-up: 13 months [interquartile range: 3 to 41 months]) outcomes analyzed according to the need of periprocedural PPI. All THVs except CoreValve, Cribier-Edwards, Sapien, and Sapien XT were considered to be new-generation THVs. RESULTS A total of 1,987 patients without prior PPI undergoing ViV-TAVR from 2007 to 2020 were included. Of these, 128 patients (6.4%) had PPI after TAVR, with a significant decrease in the incidence of PPI with the use of new-generation THVs (4.7% vs. 7.4%; p = 0.017), mainly related to a reduced PPI rate with the Evolut R/Pro versus CoreValve (3.7% vs. 9.0%; p = 0.002). There were no significant differences in PPI rates between newer-generation balloon-and self expanding THVs (6.1% vs. 3.9%; p = 0.18). In the multivariable analysis, older age (odds ratio [OR]: 1.05 for each increase of 1 year; 95% confidence interval [CI]: 1.02 to 1.07; p = 0.001), larger THV size (OR: 1.10; 95% CI: 1.01 to 1.20; p = 0.02), and previous right bundle branch block (OR: 2.04; 95% CI: 1.00 to 4.17; p = 0.05) were associated with an increased risk of PPI. There were no differences in 30-day mortality between the PPI (4.7%) and no-PPI (2.7%) groups (p = 0.19), but PPI patients exhibited a trend toward higher mortality risk at follow-up (hazard ratio: 1.39; 95% CI: 1.02 to 1.91; p = 0.04; p = 0.08 after adjusting for age differences between groups). CONCLUSIONS In a contemporary large series of ViV-TAVR patients, the rate of periprocedural PPI was relatively low, and its incidence decreased with the use of new-generation THV systems. PPI following ViV-TAVR was associated with a trend toward increased mortality at follow-up. (J Am Coll Cardiol 2021;77:2263 & ndash;73) (c) 2021 by the American College of Cardiology Foundation.