Evaluation of Conduction Disorders after Aortic Valve Replacement with Rapid Deployment Bioprostheses

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> The aim of this retrospective, single-center study was to evaluate the occurrence of conduction disorders after rapid deployment aortic bioprosthesis implantation. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> Electrocardiograms of patients undergoing INTUITY (Edwards Lifesciences, Irvine, CA USA) bioprosthesis implantation were collected at admission, during postoperative course, and at discharge. Primary end point was the occurrence of new-onset conduction disorders, defined as complete left bundle branch block, complete right bundle branch block, permanent pacemaker implantation, and worsening of pre-existing rhythm abnormalities. Secondary end points were the assessment of preoperative and postoperative QRS duration and the identification of transitory conduction disorders. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Forty-four patients (July 2015–December 2016) were included in the analysis. Preoperatively, patients with normal conduction and with already existing disorders were 25 (56.8%) and 19 (43.2%), respectively. Primary end point occurred in 14 patients (31.8%). Two patients (4.5%) received pacemaker implantation. In patients with normal preoperative conduction, new abnormalities were found in eight cases (32%): all left bundle branch blocks with one pacemaker implantation. Worsening of pre-existing conduction disorders was found in six patients (31.6%) with one pacemaker implantation. QRS duration increased in 20 patients (45.4%), and average increase was 37 milliseconds. Overall, we observed a significant increase of QRS (96 ± 21 milliseconds vs. 111 ± 28 milliseconds, P &lt; 0.001). Three patients experienced a new-onset temporary left bundle branch block. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> New-onset conduction disorders or worsening of pre-existing rhythm abnormalities occur in one third of patients after rapid deployment aortic bioprosthesis implantation. Although the incidence of postoperative pacemaker implantation before discharge is low, strict follow-up is mandatory to identify a potential need for pacemaker implantation in a timely manner. </jats:p></jats:sec>

Conduction disorders after aortic valve replacement with rapid-deployment bioprostheses: early occurrence and one-year evolution

“…All recovered and improved patients had LBBBs or other left-sided disorders at discharge. This result is in line with our previous study that showed that 6.8% of transient CDs were all LBBB and recovered during hospitalization (5). Furthermore, there are also studies on TAVI that show a recovery of intraventricular conduction over time (14).…”

“…In fact, in TAVI it has been demonstrated that the implantation height of the stent into the LVOT is associated with a higher risk of postoperative CDs and PPI (1). The incidence of PPI after RDB implantation ranges between 5% and 11% (2-4), while postoperative CDs occur in nearly one third of treated patients (5). Despite these results, many published studies end their observation within the hospitalization period, not evaluating how these CDs may change over time.…”

Clinical and Hemodynamic Outcomes of Rapid-Deployment Aortic Bioprostheses

“…6,10,15,21,29 It has been shown that up to one third of patients experience a new onset conduction disorder (mainly left bundle branch block) or a worsening of a pre-existing rhythm alteration following RDB implantation. 30 Patients with pre-existing right bundle-branch block and/or with second-degree atrio-ventricular block are at significantly higher risk for PM implantation. 31 Furthermore, also valve oversizing carries the risk of postoperative conduction disorders 11 and it should never be done.…”

Rhythm disturbances following rapid-deployment aortic valve replacement

“…Likewise, a small sample size study (n = 58) reported 28% of new onset of LBBB in patients who had isolated RDAVR with the Edwards Intuity valve. 9 Regeer and colleagues 10 found 23% new-onset of LBBB with other RDAVR prostheses (Perceval S valve and 3f Enable valve) and 25% with transcatheter aortic valve implantation (TAVI) at hospital discharge. 10 Persistent LBBB with TAVI was reported approximately 9% at long term follow-up 11 and only 2% with conventional AVR, which had been the gold standard treatment for AVR.…”

“…This was consistent with no changes in the frequencies of AV conduction rhythm disturbances: first-degree HB and second-degree HB (Mobitz type 2). D'Onofrio and colleagues 9 reported approximately onethird of new onset of conduction disturbance and significant increase of QRS duration. It should be noted that this study had a small population (n ¼ 58) and only included patients who had isolated RDAVR.…”