Aortic valve replacement is the definitive therapy for severe aortic stenosis (valve area<0.6cm²/m²). Elderly and the associated comorbidity represent an operative risk (estimated with the EuroSCORE). TAVI is an alternative to surgery or balloon valvuloplasty. Two valves were marketed: Edwards and CoreValve. The complications of TAVI are well known and similar for the both. Only the primary pacemaker implantations (PPI) are greater with CoreValves. The objectives are to compare the PPI after a TAVI in the CHU of Clermont Ferrand depending on the type of valve, then to explain this difference.

We used the register FRANCE II to a retrospective analysis of all patients with a TAVI in the CHU of Clermont Ferrand. We only excluded patients who died within 24 hours post procedure and patients who were already a pacemaker. The search for a PPI, age, type of valve, diameter of the valve, surgical approach, presence of bundle branch block (BB), operator dependence and learning curve were analyzed.

From January 2010 to March 2012, 78 were included in this study (66% of CoreValve and 34% of Edwards). Of the 22 PPI (22.9%), 100% complicated a Corevalve (p=0.00034). Age, operator, learning curve, surgical approach and diameter of the valve are not risk factors for PPI, in contrast to the presence of BB (p=0.025).

This study confirms that CoreValves are more complicated PPI than Edwards. The presence of BB is a risk factor for primary implantation. The lack of power of this study does not reveal other risk factors such as the diameter of the valve or the learning curve effect.