Periprocedural Predictors of New-Onset Conduction Abnormalities After Transcatheter Aortic Valve Replacement

Abstract

Pre-existing right bundle branch block (RBBB), firstdegree AVB, self-expandable valves, intraoperative AVB, implantation depth (ID), and the length of the membranous septum (MS) have been identified as predictors of CAs. 10-14 However, the majority of studies have been restricted to earlier-generation prostheses and the definitions of CAs have been limited to new PPM implantation. The present study was therefore designed to delineate the predictive factors of new-onset LBBB and new PPM implantation after TAVR with new-generation valves. Our main objective was to establish correlations between periprocedural imaging and clinical data and CAs.

Computed tomography‐derived membranous septum length as predictor of conduction abnormalities and permanent pacemaker implantation after TAVI: A meta‐analysis of observational studies

“…After excluding duplicates and noneligible studies, 18 studies 4,6,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] met our eligibility criteria (Supporting Information: Figure 1). All the studies were nonrandomized and observational, while four studies were multicentric and five studies included matched populations (Table 1).…”

Determinants and treatments of heart failure after transcatheter aortic valve implantation: moving up a notch

“…Importantly, new‐onset LBBB and PPI were associated with mortality and HF hospitalization. Our prior study consistently showed that new‐onset LBBB and/or PPI led to a two‐fold higher major adverse clinical events at 3 year follow‐up 86 . In a recent meta‐analysis of 50 282 TAVI patients, 7232 patients underwent PPI after TAVI and had an increased mortality rate [hazard ratio: 1.21 (95% confidence interval: 1.14–1.28); P < 0.001] and HF rehospitalization [hazard ratio: 1.30 (95% confidence interval: 1.17–1.45); P < 0.001] 87 .…”

“…The most frequent complications after TAVI are conduction disturbance such as high-degree atrioventricular block leading to new-onset left bundle branch block (LBBB) and permanent pacemaker implantation (PPI). 85,86 A large meta-analysis of 30 studies demonstrated that the incidence of new-onset LBBB ranged from 10.5% to 52.3%, whereas PPI at discharge ranged from 5.9% to 32.0%. 85 Importantly, new-onset LBBB and PPI were associated with mortality and HF hospitalization.…”

“…Our prior study consistently showed that new-onset LBBB and/or PPI led to a two-fold higher major adverse clinical events at 3 year follow-up. 86 In a recent meta-analysis of 50 282 TAVI patients, 7232 patients underwent PPI after TAVI and had an increased mortality rate [hazard ratio: 1.21 (95% confidence interval: 1.14-1.28); P < 0.001] and HF rehospitalization [hazard ratio: 1.30 (95% confidence interval: 1.17-1.45); P < 0.001]. 87 The noxious impact of conduction disturbance and/or PPI on LV reverse remodelling may be caused by the deleterious effect of dyssynchronization induced by new-onset LBBB or pacing.…”

Clinical and Hemodynamic Outcomes in 121 Patients Who Underwent Perceval Sutureless Aortic Valve Implantation ― Early Results From a Single Korean Institution ―

“…Similarly, several studies demonstrated that the MS length and implantation depth were predictors of conduction disturbance in patients treated with TAVI procedures. [19][20][21] When the guiding sutures are used below the annulus 1 mm (new guiding suture technique), the maximum implantation depth will be 4.9 mm (S), 5.2 mm (M), 5.5 mm (L), and 5.8 mm (XL). In this study, only 1 patient (2.5%) required PPI, although no significant association was observed between the new guiding suture technique and PPI.…”