Complete Heart Block Following Replacement of the Aortic Valve

Gannon, Paul G.; Sellers, Robert D.; Kanjuh, Vladimir; Edwards, Jesse E.; Lillehei, C. Walton

doi:10.1161/01.cir.33.4s1.i-152

Cited by 23 publications

(13 citation statements)

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“…All but two of these patients were on anticoagulants Causes of late deaths in this series encompassed a wide spectrum. As in other series, 8,17,20 the number of sudden deaths and deaths due to persistent congestive heart failure and myocardial infarction was relatively high. Twelve patients died suddenly, and eight died in unremitting congestive failure.…”

Section: Resultssupporting

confidence: 64%

Survival After Starr-Edwards Aortic Valve Replacement

et al. 1971

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SUMMARYA series of 507 patients who underwent Starr-Edwards aortic valve replacement is reported. Four hundred fifty-five of these patients were adequately followed an average of 36 months. Of this number, 339 patients (75%) are alive, and 116 (25%) have died. There was an operative mortality of 10.8% and a late mortality of 13.4%. Patients with mixed aortic stenosis and regurgitation had a significantly lower cumulative mortality than patients with pure stenosis or regurgitation. Complications related to the valvular prosthesis itself were frequent. Although the great majority were minor, prosthetic complications caused a significant number of deaths and considerable morbidity. Myocardial disease was the other signfficant limiting factor in survival. Preoperative cardiac index and functional classification were valuable in predicting long-term survival, but age at time of surgery and type of preoperative symptoms were of lesser prognostic value.

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Section: Resultssupporting

confidence: 64%

Survival After Starr-Edwards Aortic Valve Replacement

et al. 1971

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“…A difference in rates of pacing has also been noted between stented and nonstented surgical prostheses, with higher rates in stented prostheses, 18 as well as with preexisting aortic regurgitation, previous myocardial infarction, and preimplantation RBBB. 22,23 Preimplantation RBBB was confirmed as a significant correlate in our logistic regression.…”

Section: Discussionmentioning

confidence: 98%

Permanent Pacemaker Insertion After CoreValve Transcatheter Aortic Valve Implantation

Khawaja¹,

Rajani²,

Cook³

et al. 2011

Circulation

294

159

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Background-Permanent pacemaker (PPM) requirement is a recognized complication of transcatheter aortic valve implantation. We assessed the UK incidence of permanent pacing within 30 days of CoreValve implantation and formulated an anatomic and electrophysiological model. Methods and Results-Data from 270 patients at 10 centers in the United Kingdom were examined. Twenty-five patients (8%) had preexisting PPMs; 2 patients had incomplete data. The remaining 243 were 81.3Ϯ6.7 years of age; 50.6% were male. QRS duration increased from 105Ϯ23 to 135Ϯ29 milliseconds (PϽ0.01). Left bundle-branch block incidence was 13% at baseline and 61% after the procedure (PϽ0.001). Eighty-one patients (33.3%) required a PPM within 30 days.Rates of pacing according to preexisting ECG abnormalities were as follows: right bundle-branch block, 65.2%; left bundle-branch block, 43.75%; normal QRS, 27.6%. Among patients who required PPM implantation, the median time to insertion was 4.0 days (interquartile range, 2.0 to 7.75 days). Multivariable analysis revealed that periprocedural atrioventricular block (odds ratio, 6.29; 95% confidence interval, 3.55 to 11.15), balloon predilatation (odds ratio, 2.68; 95% confidence interval, 2.00 to 3.47), use of the larger (29 mm) CoreValve prosthesis (odds ratio, 2.50; 95% confidence interval, 1.22 to 5.11), interventricular septum diameter (odds ratio, 1.18; 95% confidence interval, 1.10 to 3.06), and prolonged QRS duration (odds ratio, 3.45; 95% confidence interval, 1.61 to 7.40) were independently associated with the need for PPM. Conclusion-One third of patients undergoing a CoreValve transcatheter aortic valve implantation procedure require a PPM within 30 days. Periprocedural atrioventricular block, balloon predilatation, use of the larger CoreValve prosthesis, increased interventricular septum diameter and prolonged QRS duration were associated with the need for PPM. (Circulation. 2011;123:951-960.)Key Words: aortic stenosis Ⅲ electrocardiography Ⅲ pacemakers Ⅲ transcatheter aortic valve Ⅲ transcatheter aortic valve implantation A ortic stenosis (AS) is the most common valvular disease in Europe, 1,2 and age is a significant factor in its natural history. 2 Severe AS occurs in 2% to 4% of adults Ͼ65 years of age. 3,4 Current guidelines recommend aortic valve replacement (AVR) surgery for these patients when they become symptomatic or develop impaired left ventricular systolic function with an ejection fraction Ͻ50%. 5,6 However, the aging population generates greater numbers of patients with severe AS and significant comorbidities, 3 prohibitively raising their perioperative risks for surgical AVR. Since the first successful implant in 2002,7 transcatheter aortic valve implantation (TAVI) has become an increasingly common technology in this cohort. The initial surveillance has been encouraging with respect to procedural success, improvement in quality of life, and short-term and medium-term mortality. 8 -10 Clinical Perspective on p 960Aortic valvular disease is itself associated with cond...

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“…The origin of the atrioventricular disorder may be the known age-associated aortic valve disease, mechanical factors (high pressure in the left ventricle), histological abnormalities in the conduction system, etc. Clinicopathologic study demonstrated that there is an area particularly at risk near the His bundle region comprised of non-coronary cusp and its portion adjacent to the right coronary artery [14].…”

Section: Discussionmentioning

confidence: 99%