Small balloon strategy associated with low pacemaker implantation rate after self-expanding transcatheter valve implantation

BACKGROUND: This study aims to investigate whether small balloon aortic valvuloplasty(BAV) reduces the need for permanent pacemaker implantation (PPMI) after transcatheter aortic valveimplantation (TAVI).METHODS: This was a retrospective analysis using data from our local TAVI database. SmallBAV was defined as a small balloon size (=18 mm) pre-dilatation. Normal BAV was defined as aballoon size >18 mm. The primary endpoint was the incidence of new PPMI.RESULTS: Of 99 consecutive TAVI patients, five patients were excluded due to pre-existingpermanent pacemaker. Patients in the small BAV group (n=57) had a signifi cantly lower PPMI ratecompared with the normal BAV group (n=37) (3.5% vs. 18.9%, P=0.026). Moderate or severe aorticvalve regurgitation post-procedure was similar between the small BAV and normal BAV groups (5.3%vs. 8.1%, P=0.480);likewise, the mean aortic gradient post-procedure did not differ significantly(11.5±5.2 mmHg vs. 12.2±7.3 mmHg, 1 mmHg=0.133 kPa, P=0.580) between the groups. Devicesuccess rates were also similar (94.7% vs. 91.8%, P=0.680). In multivariable analysis, small BAV(P=0.027), the ratio of prosthesis diameter to annulus diameter (P=0.048), and mean aortic gradientby echo in the basement (P=0.021) were independent predictors of PPMI.CONCLUSIONS: The small BAV strategy is associated with a low rate of permanentpacemaker implantation after transcatheter self-expanding valve implantation in this single-centerobservational study.

Trends in the prevalence of heart diseases over a ten-year period from single-center observations based on a large echocardiographic database

There is a paucity of data regarding trends in the incidence of heart disease in China during recent years. Using a large echocardiography database in our center, we analyzed trends in the prevalence of several common heart diseases from Dec. 2003. This study retrospectively analyzed the echocardiographic database in our Department from 2003 to 2012. A total of 385 682 cases were included in the study. The prevalence of rheumatic heart disease decreased over the 10-year period, from 4.04% in 2003 to 3.06% in 2012 （P〈0.01）. Infective endocarditis also decreased, from a mean prevalence of 0.37% in July 2003 to 0.27% in Dec. 2008 （P〈0.001）. The prevalence of hy- pertrophic cardiomyopathy, which includes 20% apical hypertrophic cardiomyopathy and 20% hypertrophic obstructive cardiomyopathy, was about 1.8%. The prevalence of the three most common adult congenital heart diseases （CHDs） decreased by about 10% from July 2003 to Dec. 2008 （all P〈0.001）. The prevalence of moderate pulmonary arterial hypertension （PAH） or left ventricular systolic dysfunction （LVSD） decreased during the 10-year period （P〈0.001）, but there was no change in the prevalence of severe PAH or LVSD （P〉0.05）. The present study indirectly demonstrates that the prevalence of several common heart diseases in China has declined in recent years.