title: Unravelling the (arte)fact of increased pacemaker rate with the Edwards SAPIEN 3 valve.
abstract: OBJECTIVE
  Early data on the Edwards SAPIEN 3 valve (S3-THV) have shown low rates of paravalvular leaks and vascular complications but relatively high 30-day permanent pacemaker implantation (PPMI) rates. No direct comparisons on clinical outcomes including PPMI rates are available for the S3-THV and the Edwards SAPIEN XT (XT-THV). We aimed to compare the 30-day PPMI rates in patients treated with the two prostheses and to assess the interplay among valve type, depth of implantation and PPMI rate.
  
  
  RESULTS
  Two hundred and nine patients treated by TAVI were considered. The S3-THV was associated with higher PPMI rates compared to the XT-THV, both overall and in subgroups matched for several predictors of PPMI. However, in the S3-THV group, 30-day PPMI was strictly associated with deep valve implantation, and PPMI risk of high-implanted S3-THVs was similar to that of the overall XT-THV matched group. No cases of significant paravalvular leak were observed in the S3-THV group.
  
  
  CONCLUSIONS
  The S3-THV was associated with a higher incidence of PPMI compared to the XT-THV. In the S3-THV group, pacemaker implantation was strictly associated with deep valve implantation. An implantation technique involving higher initial placement of the central marker (from 0 to 3 mm above the base of the aortic cusps) and, as a consequence, higher final valve depth might help in preventing post-TAVI PPMI with the S3-THV, without affecting the risk of paravalvular leak.
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padua, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.forename: Marco
authors.initials: M
authors.lastname: Mojoli
authors.forename: Paola
authors.initials: P
authors.lastname: Purita
authors.forename: Massimo
authors.initials: M
authors.lastname: Napodano
authors.forename: Augusto
authors.initials: A
authors.lastname: D'Onofrio
authors.forename: Annachiara
authors.initials: A
authors.lastname: Frigo
authors.forename: Elisa
authors.initials: E
authors.lastname: Covolo
authors.forename: Michela
authors.initials: M
authors.lastname: Facchin
authors.forename: Giambattista
authors.initials: G
authors.lastname: Isabella
authors.forename: Gino
authors.initials: G
authors.lastname: Gerosa
authors.forename: Sabino
authors.initials: S
authors.lastname: Iliceto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy*; D006328:Cardiac Catheterization / Q000379:methods; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012306:Risk; D012720:Severity of Illness Index; D016896:Treatment Outcome