Conduction Disorders after Surgical Aortic Valve Replacement Using a Rapid Deployment Aortic Valve Prosthesis: Medium-Term Follow-Up

Abstract

Background: We have previously reported that the incidence of postoperative conduction disorders, especially left bundle branch block (LBBB), after implantation of a rapid deployment Intuity™ Elite aortic valve prosthesis (Edwards Lifesciences, Irvine, CA, USA), was significantly increased compared with conventional aortic valve replacement. We were now interested in how these disorders behaved at intermediate follow-up. Methods: All 87 patients who had undergone surgical aortic valve replacement (SAVR) using the rapid deployment Intuity™ Elite prosthesis and were shown to have conduction disorders at the time of hospital discharge were followed up after surgery. These patients’ ECGs were recorded at least 1 year after surgery, and the persistence of the new postoperative conduction disorders was assessed. Results: At hospital discharge, 48.1% of the patients had developed new postoperative conduction disorders, with LBBB being the predominant conduction disturbance (36.5%). At medium-term follow-up (526 days, standard deviation (SD) = 169.6, standard error (SE) = 19.3 days, respectively), 44% of the new LBBB and 50% of the new right bundle branch block (RBBB) had disappeared. There was no new atrio-ventricular block III (AVB III) that occurred. One new pacemaker (PM) was implanted during follow-up because of AVB II Mobitz type II. Conclusions: At medium-term follow-up after the implantation of a rapid deployment Intuity™ Elite aortic valve prosthesis, the number of new postoperative conduction disorders, especially LBBB, has considerably decreased but remains high. The incidence of postoperative AV block III remained stable.

Midterm outcomes of aortic valve replacement using a rapid-deployment valve for aortic stenosis: TRANSFORM trial

“…After commercialization of the INTUITY device, several institutions have shown a lower rate of PPM with increased experience and enhanced technique. 17 , 18 A follow-up study revealed only a single new PPI in 87 patients at risk over the 2 years of monitoring, for a cumulative rate of 10.1%. 18 This is in alignment with the reported 2-year cumulative PPI rates of 9.1% for transcatheter AVR and 7.0% for surgical AVR in the PARTNER 3 study.…”

“… 17 , 18 A follow-up study revealed only a single new PPI in 87 patients at risk over the 2 years of monitoring, for a cumulative rate of 10.1%. 18 This is in alignment with the reported 2-year cumulative PPI rates of 9.1% for transcatheter AVR and 7.0% for surgical AVR in the PARTNER 3 study. 19 …”

Rapid deployment versus its conventional counterpart in aortic valve replacement: comparison of early hemodynamic outcomes

“…Several shortcomings of Intuity valve reported in the previous studies should be recognized. The number of new postoperative conduction disorders, especially left bundle branch block, remains high during follow-up, although the long-term clinical significance was undetermined ( 31 ). There are also concerns that the existence of the subvalvular structure might cause anatomical changes in the aortic-mitral fibrous continuity, thus resulting in the alteration of mitral annular motion ( 32 ).…”