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DOI: 10.1055/s-0042-1742361
Outcomes in Patients with Left Bundle Branch Block after Rapid Deployment Aortic Valve Replacement
Funding This study was supported by a research grant from Edwards Lifesciences (grant HVT-I18-411).![](https://www.thieme-connect.de/media/thoracic/202307/lookinside/thumbnails/10-1055-s-0042-1742361_216350oc-1.jpg)
Abstract
Objectives Increased rates of postoperative left bundle branch block (LBBB) and permanent pacemaker implantation (PPI) frequently occur after implantation of rapid deployment valves. The impact of LBBB on follow-up outcomes remains controversial. So far, no data regarding long-term outcomes exist.
Aim The aim of this study was to analyze the impact of LBBB on postoperative outcomes after rapid deployment aortic valve replacement (RDAVR).
Methods A total of 620 consecutive patients without preexisting LBBB or PPI who underwent rapid deployment AVR between March 2012 and September 2019 were included. New-onset LBBB was defined as any new LBBB that persisted at hospital discharge. The median follow-up time for clinical data was 1.7 years post-RDAVR.
Results At discharge, new-onset LBBB was seen in 109 patients (17.5%). There were no differences between the LBBB groups and no-LBBB groups regarding baseline characteristics. At a median follow-up of 1.7 years, no difference was found between LBBB groups and no-LBBB groups concerning all-cause mortality (12.8 vs. 11.7%; hazard ratio [HR]: 1.08; 95% confidence interval [CI]: 0.74–1.53; p = 0.54). Nevertheless, new-onset LBBB was associated with significant higher pacemaker implantation rates at follow-up (10.1 vs. 6.3%; HR: 3.58; 95% CI: 1.89–6.81 p < 0.001).
Conclusion After a median follow-up of 1.7 years, new-onset LBBB was not associated with increased mortality. Nevertheless, higher pacemaker implantation rates were observed in patients with new-onset LBBB after RDAVR.
Clinical Registration Number
The clinical registration number is DRKS 00012950.
IRB Approval
IRB approval was obtained on October 15, 2015—Reg. Nr.: 15–5359.
Freedom of Investigation
The authors confirm that they had full freedom of investigation, full control of the design of the study, methods used, outcome parameters and results, analysis of data, and production of the written report.
Authors' Contribution
M.S. and D.U. contributed to study design, data analysis, interpretation, and writing of the manuscript. Both equally contributed to this work. P.H. contributed to data collection. H.N. contributed to data analysis and V.M. contributed to literature search. M.B. and J.S. contributed to data interpretation and review of the manuscript.
* These authors contributed equally to this study.
Publication History
Received: 18 July 2021
Accepted: 26 November 2021
Article published online:
02 February 2022
© 2022. Thieme. All rights reserved.
Georg Thieme Verlag KG
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References
- 1 Schlömicher M, Bechtel M, Useini D. et al. Single-center outcomes with rapid deployment aortic valve replacement. Thorac Cardiovasc Surg 2021; 69 (05) 405-411
- 2 Schlömicher M, Bechtel M, Taghiyev Z. et al. Intermediate outcomes after rapid deployment aortic valve replacement in multiple valve surgery. Thorac Cardiovasc Surg 2020; 68 (07) 595-601
- 3 Bechtel M, Schlömicher M, Moustafine V, Strauch JT. Rapid deployment aortic valve replacement in the setting of concomitant mitral valve procedures. Eur J Cardiothorac Surg 2017; 51 (04) 792-793
- 4 Schlömicher M, Taghiyev Z, AlJabery Y. et al. Rapid deployment aortic valve replacement in a minimal access setting: intermediate clinical and echocardiographic outcomes. Eur J Cardiothorac Surg 2018; 54 (02) 354-360
- 5 Schlömicher M, Haldenwang PL, Moustafine V, Bechtel M, Strauch JT. Minimal access rapid deployment aortic valve replacement: initial single-center experience and 12-month outcomes. J Thorac Cardiovasc Surg 2015; 149 (02) 434-440
- 6 Andreas M, Coti I, Rosenhek R. et al. Intermediate-term outcome of 500 consecutive rapid-deployment surgical aortic valve procedures†. Eur J Cardiothorac Surg 2019; 55 (03) 527-533
- 7 Herry M, Laghlam D, Touboul O. et al. Pacemaker implantation after aortic valve replacement: rapid-deployment Intuity® compared to conventional bioprostheses. Eur J Cardiothorac Surg 2020; 58 (02) 335-342
- 8 Romano MA, Koeckert M, Mumtaz MA. et al; TRANSFORM Trial Investigators. Permanent pacemaker implantation after rapid deployment aortic valve replacement. Ann Thorac Surg 2018; 106 (03) 685-690
- 9 Erdogan HB, Kayalar N, Ardal H. et al. Risk factors for requirement of permanent pacemaker implantation after aortic valve replacement. J Card Surg 2006; 21 (03) 211-215 , discussion 216–217
- 10 Koplan BA, Stevenson WG, Epstein LM, Aranki SF, Maisel WH. Development and validation of a simple risk score to predict the need for permanent pacing after cardiac valve surgery. J Am Coll Cardiol 2003; 41 (05) 795-801
- 11 Coti I, Schukro C, Drevinja F, Haberl T, Kaider A, Kocher A. et al. Conduction disturbances following surgical aortic valve replacement with a rapid-deployment bioprosthesis. J Thorac Cardiovasc Surg 2021; 162 (03) 803-811
- 12 Chamandi C, Barbanti M, Munoz-Garcia A. et al. Long-term outcomes in patients with new-onset persistent left bundle branch block following TAVR. JACC Cardiovasc Interv 2019; 12 (12) 1175-1184
- 13 Auffret V, Puri R, Urena M. et al. Conduction disturbances after transcatheter aortic valve replacement: current status and future perspectives. Circulation 2017; 136 (11) 1049-1069
- 14 van der Boon RM, Nuis R-J, Van Mieghem NM. et al. New conduction abnormalities after TAVI–frequency and causes. Nat Rev Cardiol 2012; 9 (08) 454-463
- 15 van Rosendael PJ, Delgado V, Bax JJ. Pacemaker implantation rate after transcatheter aortic valve implantation with early and new-generation devices: a systematic review. Eur Heart J 2018; 39 (21) 2003-2013
- 16 Houthuizen P, Van Garsse LAFM, Poels TT. et al. Left bundle-branch block induced by transcatheter aortic valve implantation increases risk of death. Circulation 2012; 126 (06) 720-728
- 17 Houthuizen P, van der Boon RMA, Urena M. et al. Occurrence, fate and consequences of ventricular conduction abnormalities after transcatheter aortic valve implantation. EuroIntervention 2014; 9 (10) 1142-1150
- 18 Brignole M, Auricchio A, Baron-Esquivias G. et al; ESC Committee for Practice Guidelines (CPG), Document Reviewers. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J 2013; 34 (29) 2281-2329
- 19 Kappetein AP, Head SJ, Généreux P. et al; Valve Academic Research Consortium-2. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. J Thorac Cardiovasc Surg 2013; 145 (01) 6-23
- 20 Schymik G, Tzamalis P, Bramlage P. et al. Clinical impact of a new left bundle branch block following TAVI implantation: 1-year results of the TAVIK cohort. Clin Res Cardiol 2015; 104 (04) 351-362
- 21 Carrabba N, Valenti R, Migliorini A. et al. Impact on left ventricular function and remodeling and on 1-year outcome in patients with left bundle branch block after transcatheter aortic valve implantation. Am J Cardiol 2015; 116 (01) 125-131
- 22 Franzoni I, Latib A, Maisano F. et al. Comparison of incidence and predictors of left bundle branch block after transcatheter aortic valve implantation using the CoreValve versus the Edwards valve. Am J Cardiol 2013; 112 (04) 554-559
- 23 Urena M, Rodés-Cabau J. Managing heart block after transcatheter aortic valve implantation: from monitoring to device selection and pacemaker indications. EuroIntervention 2015; 11 (Suppl W): W101-5
- 24 Rodés-Cabau J, Urena M, Nombela-Franco L. et al. Arrhythmic burden as determined by ambulatory continuous cardiac monitoring in patients with new-onset persistent left bundle branch block following transcatheter aortic valve replacement: the MARE Study. JACC Cardiovasc Interv 2018; 11 (15) 1495-1505
- 25 Toggweiler S, Stortecky S, Holy E. et al. The electrocardiogram after transcatheter aortic valve replacement determines the risk for post-procedural high-degree AV block and the need for telemetry monitoring. JACC Cardiovasc Interv 2016; 9 (12) 1269-1276
- 26 Kocher AA, Laufer G, Haverich A. et al. One-year outcomes of the Surgical Treatment of Aortic Stenosis With a Next Generation Surgical Aortic Valve (TRITON) trial: a prospective multicenter study of rapid-deployment aortic valve replacement with the EDWARDS INTUITY Valve System. J Thorac Cardiovasc Surg 2013; 145 (01) 110-115 , discussion 115–116
- 27 Barnhart GR, Accola KD, Grossi EA. et al; TRANSFORM Trial Investigators. TRANSFORM (Multicenter Experience With Rapid Deployment Edwards INTUITY Valve System for Aortic Valve Replacement) US clinical trial: performance of a rapid deployment aortic valve. J Thorac Cardiovasc Surg 2017; 153 (02) 241-251.e2