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Ventricular Conduction Defects After Transcatheter Aortic Valve Implantation: A Single‐Institute Analysis
Author(s) -
Kawaguchi Akira T.,
D'Allessandro Cosimo,
Collet Jean Philippe,
Cluzel Philippe,
Makri Ralouka,
Leprince Pascal
Publication year - 2015
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/aor.12393
Subject(s) - medicine , cardiology , left bundle branch block , right bundle branch block , stenosis , hemodynamics , heart block , bundle branch block , heart failure , electrocardiography
Patients with aortic stenosis tend to develop ventricular conduction problems, which are known adverse events following transcatheter aortic valve implantation ( TAVI ). Changes in ventricular conduction status after TAVI were analyzed in 195 consecutive patients from a single institute registered in FRANCE 2 between F ebruary 2010 and J une 2012. Among the 195 patients, 29 had a prior pacemaker implantation (+ PM ) and 6 had acute catastrophic hemodynamics that made a full electrocardiogram ( ECG ) unavailable. Among the remaining 160, PM was newly required in 28 (17.5%, PM +) but not in 132 ( PM −), which included 21 (13.1%) who developed new left bundle branch block ( BBB ), 12 (7.5%) had right BBB , and 99 (61.9%) had no change. While PM requirement had no correlation with preoperative factors, there was significant association with the development of right BBB with E dwards S apien/ XT ( P = 0.003), and new left BBB ( P = 0.012) and complete heart block requiring PM with CoreValve (22.6% vs. E dwards S apien/ XT , 7.4%, P = 0.016). Whereas postoperative survival regarding PM status (+ PM , PM +, PM –), vascular access, valve size or type showed no difference, delayed heart block ( n = 12, Day 2 or later) was associated with poor survival ( P = 0.038) compared with the remaining PM + patients with earlier onset ( n = 16, Day 0 or 1). As a result, PM + patients ( n = 28) had significantly longer intensive care unit ( ICU ) stay and hospitalization than PM − or + PM patients. The results suggest that ventricular conduction problems requiring PM occurred more frequently after TAVI (17.5%) than with usual surgical replacement. Nonetheless, conduction problems failed to influence postoperative survival for up to 3 years on average with use of PM , but therefore did increase medical costs.