Reference Citation Analysis: Find an Article, Find a Category, Find a Journal, Find a Scholar

For:	[Subscribe] [Scholar Register]

Number

Cited by Other Article(s)

Wedin JO, Näslund V, Rodin S, Simonson OE, Flachskampf FA, James SK, Ståhle E, Grinnemo KH. Conduction Disturbances and Outcome After Surgical Aortic Valve Replacement in Patients With Bicuspid and Tricuspid Aortic Stenosis. Circulation 2025;151:288-298. [PMID: 39440421 PMCID: PMC11789612 DOI: 10.1161/circulationaha.124.070753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 10/01/2024] [Indexed: 10/25/2024]

Abstract

BACKGROUND

This study aimed to compare the incidence and prognostic implications of new-onset conduction disturbances after surgical aortic valve replacement (SAVR) in patients with bicuspid aortic valve (BAV) aortic stenosis (AS) versus patients with tricuspid aortic valve (TAV) AS (ie, BAV-AS and TAV-AS, respectively). Additionally, the study included stratification of BAV patients according to subtype.

METHODS

In this cohort study, the incidence of postoperative third-degree atrioventricular (AV) block with subsequent permanent pacemaker requirement and new-onset left bundle-branch block (LBBB) was investigated in 1147 consecutive patients without preoperative conduction disorder who underwent isolated SAVR (with or without ascending aortic surgery) between January 1, 2005, and December 31, 2022. The groups were stratified by aortic valve morphology (BAV, n=589; TAV, n=558). The outcomes of interests were new-onset third-degree AV block or new-onset LBBB during the index hospitalization. The impact of new-onset postoperative conduction disturbances on survival was investigated in BAV-AS and TAV-AS patients during a median follow-up of 8.2 years. BAV morphology was further categorized according to the Sievers and Schmidtke classification system (possible in 307 BAV-AS patients) to explore association between BAV subtypes and new-onset conduction disturbances after SAVR.

RESULTS

The overall incidence of third-degree AV block and new-onset LBBB after SAVR was 4.5% and 7.8%, respectively. BAV-AS patients had a higher incidence of both new-onset third-degree AV block (6.5% versus 2.5%; P=0.001) and new-onset LBBB (9.7% versus 5.7%; P=0.013) compared with TAV-AS patients. New-onset LBBB was associated with an increased all-cause mortality during follow-up (adjusted hazard ratio, 1.60 [95% CI, 1.12-2.30]; P=0.011), whereas new-onset third-degree AV block was not associated with worse prognosis. Subgroup analysis of the BAV cohort revealed that BAV-AS patients with fusion of the right- and non-coronary cusps had the highest risk of new-onset third-degree AV block (adjusted odds ratio [aOR], 8.33 [95% CI, 3.31-20.97]; P<0.001, with TAV as reference group) and new-onset LBBB (aOR, 4.03 [95% CI, 1.84-8.82]; P<0.001, with TAV as reference group), whereas no significant association was observed for the other BAV subtypes.

CONCLUSIONS

New-onset LBBB after SAVR is associated with increased all-cause mortality during follow-up, and is more frequent complication in BAV AS patients compared with TAV-AS patients. BAV-AS patients with fusion of the right- and non-coronary cusps have an increased risk for conduction disturbances after SAVR. This should be taken into consideration when managing these patients.

Collapse

Affiliation(s)

Johan O. Wedin Cardio-Thoracic Translational Medicine Lab (J.O.W., S.R., O.E.S., E.S., K-H.G.), Uppsala University, Sweden Departments of Surgical Sciences (J.O.W., S.R., O.E.S., E.S., K-H.G.), Uppsala University, Sweden Departments of Cardiothoracic Surgery and Anesthesiology (J.O.W., V.N. S.R., O.E.S., E.S., K-H.G.), Uppsala University Hospital, Sweden
Viktor Näslund Departments of Cardiothoracic Surgery and Anesthesiology (J.O.W., V.N. S.R., O.E.S., E.S., K-H.G.), Uppsala University Hospital, Sweden
Sergey Rodin Cardio-Thoracic Translational Medicine Lab (J.O.W., S.R., O.E.S., E.S., K-H.G.), Uppsala University, Sweden Departments of Surgical Sciences (J.O.W., S.R., O.E.S., E.S., K-H.G.), Uppsala University, Sweden Departments of Cardiothoracic Surgery and Anesthesiology (J.O.W., V.N. S.R., O.E.S., E.S., K-H.G.), Uppsala University Hospital, Sweden
Oscar E. Simonson Cardio-Thoracic Translational Medicine Lab (J.O.W., S.R., O.E.S., E.S., K-H.G.), Uppsala University, Sweden Departments of Surgical Sciences (J.O.W., S.R., O.E.S., E.S., K-H.G.), Uppsala University, Sweden Departments of Cardiothoracic Surgery and Anesthesiology (J.O.W., V.N. S.R., O.E.S., E.S., K-H.G.), Uppsala University Hospital, Sweden
Frank A. Flachskampf Medical Sciences (F.A.F., S.K.J.), Uppsala University, Sweden Clinical Physiology and Cardiology (F.A.F., S.K.J.), Uppsala University Hospital, Sweden
Stefan K. James Medical Sciences (F.A.F., S.K.J.), Uppsala University, Sweden Clinical Physiology and Cardiology (F.A.F., S.K.J.), Uppsala University Hospital, Sweden Uppsala Clinical Research Center, Sweden. (S.K.J.)
Elisabeth Ståhle Cardio-Thoracic Translational Medicine Lab (J.O.W., S.R., O.E.S., E.S., K-H.G.), Uppsala University, Sweden Departments of Surgical Sciences (J.O.W., S.R., O.E.S., E.S., K-H.G.), Uppsala University, Sweden Departments of Cardiothoracic Surgery and Anesthesiology (J.O.W., V.N. S.R., O.E.S., E.S., K-H.G.), Uppsala University Hospital, Sweden
Karl-Henrik Grinnemo Cardio-Thoracic Translational Medicine Lab (J.O.W., S.R., O.E.S., E.S., K-H.G.), Uppsala University, Sweden Departments of Surgical Sciences (J.O.W., S.R., O.E.S., E.S., K-H.G.), Uppsala University, Sweden Departments of Cardiothoracic Surgery and Anesthesiology (J.O.W., V.N. S.R., O.E.S., E.S., K-H.G.), Uppsala University Hospital, Sweden

Collapse

Echivard M, Vaxelaire N, Pibarot P, Lamiral Z, Freysz L, Popovic B, Monzo L, Baudry G, Phamisith E, Maureira JP, Girerd N. Factors associated with heart failure events in patients with new-onset persistent left bundle branch block at discharge after transcatheter aortic valve replacement. Heart Rhythm 2025:S1547-5271(25)00105-5. [PMID: 39894134 DOI: 10.1016/j.hrthm.2025.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Revised: 01/15/2025] [Accepted: 01/27/2025] [Indexed: 02/04/2025]

Abstract

BACKGROUND

New-onset persistent left bundle branch block (NOP-LBBB) at discharge after transcatheter aortic valve replacement (TAVR) is frequent, but its association with death and hospitalization for heart failure (HHF) remains unclear.

OBJECTIVE

We aimed to assess the association of LBBB persistence or resolution after discharge and of permanent pacemaker (PPM) implantation before discharge with these outcomes.

METHODS

We analyzed consecutive patients undergoing TAVR at Nancy University Hospital from 2009 to 2021 with NOP-LBBB at discharge and available 1-year follow-up. We assessed the association of LBBB persistence (LBBB+) or resolution (LBBB-) at 3 months and in-hospital PPM implantation (PPM+) or absence (PPM-) with the 1-year risk of the composite outcome of mortality or HHF.

RESULTS

Of 1646 TAVR patients, 287 (17.4%) had NOP-LBBB, with complete follow-up data available for 234 patients. Of them, 73 patients (31.2%) required in-hospital PPM implantation, 142 patients (60.7%) experienced LBBB persistence at 3-month follow-up, and 45 (19.2%) had both. The 1-year mortality or HHF rate was 6.3% (PPM-/LBBB-), 10.7% (PPM+/LBBB-), 20.6% (PPM-/LBBB+), and 22.2% (PPM+/LBBB+). LBBB persistence was significantly associated with the composite outcome irrespective of PPM implantation (adjusted hazard ratio [aHR] compared with PPM-/LBBB-: aHR for PPM-/LBBB+, 4.91 [1.64-14.64; P = .004]; aHR for PPM+/LBBB+, 4.58 [1.43-14.68; P = .010]), whereas PPM implantation with LBBB- was not (P = .29). This association was mainly driven by HHF (aHR for PPM-/LBBB+, 8.36 [1.90-36.83; P = .005]; aHR for PPM+/LBBB+, 8.36 [1.80-38.89; P = .007]).

CONCLUSION

The persistence of LBBB beyond discharge, rather than in-hospital PPM implantation, was associated with a higher risk of 1-year mortality or HHF in patients with NOP-LBBB at discharge after TAVR. Assessing postdischarge LBBB persistence may improve prognostic accuracy.

Collapse

Bendandi F, Taglieri N, Ciurlanti L, Mazzapicchi A, Foroni M, Lombardi L, Palermo F, Filice F, Ghetti G, Bruno AG, Orzalkiewicz M, Costa G, Frittitta V, Comis A, Sammartino S, Calì MC, Dipietro E, Rosa LL, Tamburino C, Palmerini T, Barbanti M, Saia F. Development and validation of the D-PACE scoring system to predict delayed high-grade conduction disturbances after transcatheter aortic valve implantation. EUROINTERVENTION 2025;21:e119-e129. [PMID: 39570035 PMCID: PMC11727695 DOI: 10.4244/eij-d-24-00850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2024] [Accepted: 10/21/2024] [Indexed: 11/22/2024]

Affiliation(s)

Francesco Bendandi Cardiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna Policlinico S. Orsola, Bologna, Italy Cardiology Unit, Ospedale Umberto I, Lugo, Italy
Nevio Taglieri Cardiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna Policlinico S. Orsola, Bologna, Italy
Leonardo Ciurlanti Cardiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna Policlinico S. Orsola, Bologna, Italy
Alessandro Mazzapicchi Cardiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna Policlinico S. Orsola, Bologna, Italy
Marco Foroni Cardiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna Policlinico S. Orsola, Bologna, Italy
Laura Lombardi Cardiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna Policlinico S. Orsola, Bologna, Italy
Francesco Palermo Cardiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna Policlinico S. Orsola, Bologna, Italy
Francesco Filice Cardiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna Policlinico S. Orsola, Bologna, Italy
Gabriele Ghetti Cardiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna Policlinico S. Orsola, Bologna, Italy
Antonio Giulio Bruno Cardiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna Policlinico S. Orsola, Bologna, Italy
Mateusz Orzalkiewicz Cardiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna Policlinico S. Orsola, Bologna, Italy
Giuliano Costa Cardiology Unit, Azienda Ospedaliero Universitaria di Catania Policlinico G. Rodolico - S. Marco, Catania, Italy
Valentina Frittitta Cardiology Unit, Azienda Ospedaliero Universitaria di Catania Policlinico G. Rodolico - S. Marco, Catania, Italy
Alessandro Comis Cardiology Unit, Azienda Ospedaliero Universitaria di Catania Policlinico G. Rodolico - S. Marco, Catania, Italy
Sofia Sammartino Cardiology Unit, Azienda Ospedaliero Universitaria di Catania Policlinico G. Rodolico - S. Marco, Catania, Italy
Maria Chiara Calì Cardiology Unit, Azienda Ospedaliero Universitaria di Catania Policlinico G. Rodolico - S. Marco, Catania, Italy
Elena Dipietro Cardiology Unit, Azienda Ospedaliero Universitaria di Catania Policlinico G. Rodolico - S. Marco, Catania, Italy
Luigi La Rosa Cardiology Unit, Azienda Ospedaliero Universitaria di Catania Policlinico G. Rodolico - S. Marco, Catania, Italy
Corrado Tamburino Cardiology Unit, Azienda Ospedaliero Universitaria di Catania Policlinico G. Rodolico - S. Marco, Catania, Italy
Tullio Palmerini Cardiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna Policlinico S. Orsola, Bologna, Italy
Marco Barbanti Cardiology Unit, Azienda Ospedaliero Universitaria di Catania Policlinico G. Rodolico - S. Marco, Catania, Italy Università degli Studi di Enna Kore, Enna, Italy
Francesco Saia Cardiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna Policlinico S. Orsola, Bologna, Italy

Collapse

Kroon HG, Hokken T, van Wiechen M, Ooms JFW, van Gils L, Kardys I, Daemen J, De Jaegere PPT, Nuis RJ, Van Mieghem NM. Conduction dynamics over time after transcatheter aortic valve replacement: An expert review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2025;70:92-102. [PMID: 39299841 DOI: 10.1016/j.carrev.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 07/27/2024] [Accepted: 08/13/2024] [Indexed: 09/22/2024]

Feroze R, Kang P, Dallan LAP, Akula N, Galo J, Yoon SH, Ukaigwe A, Filby SJ, Baeza C, Pelletier M, Rushing G, Rajagopalan S, Al-Kindi S, Rashid I, Attizzani GF. Elevated myocardial extracellular volume fraction is associated with the development of conduction pathway defects following transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2024;104:1119-1128. [PMID: 38952304 DOI: 10.1002/ccd.31136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 05/27/2024] [Accepted: 06/16/2024] [Indexed: 07/03/2024]

Abstract

BACKGROUND

Transcatheter aortic valve replacement (TAVR) has become an established method of aortic stenosis treatment but suffers from the risk of heart block and pacemaker requirement. Risk stratification for patients who may develop heart block remains imperfect. Simultaneously, myocardial fibrosis as measured by cardiac magnetic resonance imaging (CMR) has been demonstrated as a prognostic indicator of ventricular recovery and mortality following TAVR. However, the association of CMR-based measures of myocardial fibrosis with post-TAVR conduction disturbances has not yet been explored.

AIMS

We evaluated whether myocardial fibrosis, as measured by late gadolinium enhancement and extracellular volume (ECV) from CMR would be associated with new conduction abnormalities following TAVR.

METHODS

One hundred seventy patients who underwent CMR within 2 months before TAVR were retrospectively reviewed. Septal late gadolinium enhancement (LGE) and ECV measurements were made as surrogates for replacement and interstitial fibrosis respectively. New conduction abnormalities were defined by the presence of transient or permanent atrioventricular block, new bundle branch blocks, and need for permanent pacemaker. Association of myocardial fibrosis and new conduction derangements were tested using receiver operator curve (ROC) and regression analysis in patients with and without pre-existing conduction issues.

RESULTS

Forty-six (27.1%) patients developed post-TAVR conduction deficits. ECV was significantly higher among patients who experienced new conduction defects (26.2 ± 3.45% vs. 24.7% ± 4.15%, p value: 0.020). A greater fraction of patients that had new conduction defects had an elevated ECV of ≥26% (54.3% vs. 36.3%, p value: 0.026). ECV ≥ 26% was independently associated with the development of new conduction defects (odds ratio [OR]: 2.364, p value: 0.030). ROC analysis revealed a significant association of ECV with new conduction defects with an area under the receiver operating characteristic curve (AUC) of 0.632 (95% confidence interval: 0.555-0.705, p value: 0.005). The combination of prior right bundle branch block (RBBB) and ECV revealed a greater AUC of 0.779 (0.709-0.839, p value: <0.001) than RBBB alone (Delong p value: 0.049). No association of LGE/ECV with new conduction defects was observed among patients with pre-existing conduction disease. Among patients without baseline conduction disease, ECV was independently associated with the development of new conduction deficits (OR: 3.685, p value: 0.008).

CONCLUSION

The present study explored the association of myocardial fibrosis, as measured by LGE and ECV with conduction deficits post-TAVR. Our results demonstrate an association of ECV, and thereby interstitial myocardial fibrosis, with new conduction derangement post-TAVR and introduce ECV as a potentially new risk stratification tool to identify patients at higher risk for needing post-TAVR surveillance and/or permanent pacemaker.

Collapse

Affiliation(s)

Rafey Feroze Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
Puneet Kang Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
Luis Augusto Palma Dallan Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
Navya Akula Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
Jason Galo Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
Sung-Han Yoon Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
Anene Ukaigwe Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
Steven J Filby Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
Cristian Baeza Division of Cardiovascular Surgery, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
Marc Pelletier Division of Cardiovascular Surgery, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
Gregory Rushing Division of Cardiovascular Surgery, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
Sanjay Rajagopalan Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
Sadeer Al-Kindi Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
Imran Rashid Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
Guilherme F Attizzani Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA

Collapse

Chen BY, Huang TF, Jiang XD, Ding XY, Zhou XF. Predictors and clinical outcomes of permanent pacemaker implantation after transcatheter aortic valve implantation. BMC Cardiovasc Disord 2024;24:448. [PMID: 39182065 PMCID: PMC11344446 DOI: 10.1186/s12872-024-04101-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 08/07/2024] [Indexed: 08/27/2024] Open

Kikuchi S, Minamimoto Y, Matsushita K, Cho T, Terasaka K, Hanajima Y, Nakahashi H, Gohbara M, Kimura Y, Yasuda S, Okada K, Matsuzawa Y, Iwahashi N, Kosuge M, Ebina T, Morel O, Ohlmann P, Uchida K, Hibi K. Impact of New-Onset Right Bundle-Branch Block After Transcatheter Aortic Valve Replacement on Permanent Pacemaker Implantation. J Am Heart Assoc 2024;13:e032777. [PMID: 38639357 PMCID: PMC11179913 DOI: 10.1161/jaha.123.032777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/15/2024] [Indexed: 04/20/2024]

Affiliation(s)

Shinnosuke Kikuchi Division of CardiologyYokohama City University Medical CenterYokohamaJapan
Yugo Minamimoto Division of CardiologyYokohama City University Medical CenterYokohamaJapan
Kensuke Matsushita Division of CardiologyYokohama City University Medical CenterYokohamaJapan
Tomoki Cho Cardiovascular CenterYokohama City University Medical CenterYokohamaJapan
Kengo Terasaka Division of CardiologyYokohama City University Medical CenterYokohamaJapan
Yohei Hanajima Division of CardiologyYokohama City University Medical CenterYokohamaJapan
Hidefumi Nakahashi Division of CardiologyYokohama City University Medical CenterYokohamaJapan
Masaomi Gohbara Division of CardiologyYokohama City University Medical CenterYokohamaJapan
Yuichiro Kimura Division of CardiologyYokohama City University Medical CenterYokohamaJapan
Shota Yasuda Cardiovascular CenterYokohama City University Medical CenterYokohamaJapan
Kozo Okada Division of CardiologyYokohama City University Medical CenterYokohamaJapan
Yasushi Matsuzawa Division of CardiologyYokohama City University Medical CenterYokohamaJapan
Noriaki Iwahashi Division of CardiologyYokohama City University Medical CenterYokohamaJapan
Masami Kosuge Division of CardiologyYokohama City University Medical CenterYokohamaJapan
Toshiaki Ebina Division of CardiologyYokohama City University Medical CenterYokohamaJapan
Olivier Morel Université de Strasbourg, Pôle d’Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier UniversitaireStrasbourgFrance
Patrick Ohlmann Université de Strasbourg, Pôle d’Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier UniversitaireStrasbourgFrance
Keiji Uchida Cardiovascular CenterYokohama City University Medical CenterYokohamaJapan
Kiyoshi Hibi Division of CardiologyYokohama City University Medical CenterYokohamaJapan Department of CardiologyYokohama City University Graduate School of MedicineYokohamaJapan

Collapse

Yu Q, Fu Q, Xia Y, Wu Y. Predictors, clinical impact, and management strategies for conduction abnormalities after transcatheter aortic valve replacement: an updated review. Front Cardiovasc Med 2024;11:1370244. [PMID: 38650916 PMCID: PMC11033487 DOI: 10.3389/fcvm.2024.1370244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 03/27/2024] [Indexed: 04/25/2024] Open

Chamoun N, Jdaidani J, Iskandarani DZ, Ghalayini S, Zgheib A, Khoury A, Alam S, Rebeiz AG, Ghazzal Z, Sawaya F. Short-Term Clinical Outcomes of Transcatheter Aortic Valve Replacement in a Developing Country. Cureus 2024;16:e58334. [PMID: 38752027 PMCID: PMC11095913 DOI: 10.7759/cureus.58334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 05/18/2024] Open

Abstract

INTRODUCTION

Transcatheter aortic valve replacement (TAVR) is an effective alternative to surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis in all surgical risk groups. Reports of clinical outcomes post-TAVR in developing countries are scarce. We aimed to address the clinical outcomes and safety profile of TAVR in a developing country.

METHODS

We conducted a single-center, retrospective study on patients undergoing TAVR at the American University of Beirut Medical Center (AUBMC) from January 2016 to April 2023. We included a total of 399 patients. Our primary endpoint was to assess the rate of TAVR in-hospital and 30-day mortality, neurologic events, and new permanent pacemaker implantation (PPI) in patients, stratified by the Society of Thoracic Surgeons (STS) risk of mortality score.

RESULTS

Survival rates were 98.7% (394) at discharge vs. 97.5% (389) at 30 days post-procedure. The technical success rate was 95% (379) at the end of the procedure. Device success and early safety rates were 93.5% (373) and 83% (331), respectively at 30 days post-procedure. The all-cause mortality rate increased from 1.3% (5) at discharge to 2.5% (10) at 30-day intervals. The rate of ischemic stroke was 1.3% (five) at discharge and increased to 2% (eight) at 30 days post-procedure. PPI was needed in 5.8% (23) of patients at discharge with an increase to 7% (28) at one-month interval. Overall, the rates of TAVR outcomes among the three risk groups were comparable including neurologic events, valve-related complications, bleeding problems, vascular and access-related complications, and myocardial infarction.

CONCLUSION

This study at AUBMC highlights the successful implementation of the TAVR program in a developing country, showcasing its efficacy and safety within 30 days post-operation, despite challenges such as financial constraints and limited access to specialized training. Larger cohorts and longer follow-up periods are needed to accurately represent clinical outcomes in developing countries.

Collapse

Tan NY, Adedinsewo D, El Sabbagh A, Ahmed AFS, Morales-Lara AC, Wieczorek M, Madhavan M, Mulpuru SK, Deshmukh AJ, Asirvatham SJ, Eleid MF, Friedman PA, Cha YM, Killu AM. Incidence and Outcomes of New-Onset Right Bundle Branch Block Following Transcatheter Aortic Valve Replacement. Circ Arrhythm Electrophysiol 2024;17:e012377. [PMID: 38288627 PMCID: PMC11166259 DOI: 10.1161/circep.123.012377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 01/02/2024] [Indexed: 02/22/2024]

Abstract

BACKGROUND

The incidence and prognosis of right bundle branch block (RBBB) following transcatheter aortic valve replacement (TAVR) are unknown. Hence, we sought to characterize the incidence of post-TAVR RBBB and determine associated risks of permanent pacemaker (PPM) implantation and mortality.

METHODS

All patients 18 years and above without preexisting RBBB or PPM who underwent TAVR at US Mayo Clinic sites and Mayo Clinic Health Systems from June 2010 to May 2021 were evaluated. Post-TAVR RBBB was defined as new-onset RBBB in the postimplantation period. The risks of PPM implantation (within 90 days) and mortality following TAVR were compared for patients with and without post-TAVR RBBB using Kaplan-Meier analysis and Cox proportional hazards modeling. The risks of PPM implantation (within 90 days) and mortality following TAVR were compared for patients with and without post-TAVR RBBB using Kaplan-Meier analysis and Cox proportional hazards modeling.

RESULTS

Of 1992 patients, 15 (0.75%) experienced new RBBB post-TAVR. There was a higher degree of valve oversizing among patients with new RBBB post-TAVR versus those without (17.9% versus 10.0%; P=0.034). Ten patients (66.7%) with post-TAVR RBBB experienced high-grade atrioventricular block and underwent PPM implantation (median 1 day; Q1, 0.2 and Q3, 4), compared with 268/1977 (13.6%) without RBBB. Following propensity score adjustment for covariates (age, sex, balloon-expandable valve, annulus diameter, and valve oversizing), post-TAVR RBBB was significantly associated with PPM implantation (hazard ratio, 8.36 [95% CI, 4.19-16.7]; P<0.001). No statistically significant increase in mortality was seen with post-TAVR RBBB (hazard ratio, 0.83 [95% CI, 0.33-2.11]; P=0.69), adjusting for age and sex.

CONCLUSIONS

Although infrequent, post-TAVR RBBB was associated with elevated PPM implantation risk. The mechanisms for its development and its clinical prognosis require further study.

Collapse

Burke GM, Popma JJ, Chang JD. Heart Failure after Transcatheter Aortic Valve Implantation: Application of the Most Impactful Strain Imaging Techniques. CASE (PHILADELPHIA, PA.) 2024;8:4-10. [PMID: 38264618 PMCID: PMC10801808 DOI: 10.1016/j.case.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]

Stephan T, Krohn-Grimberghe M, von Lindeiner genannt von Wildau A, Buck C, Baumhardt M, Mörike J, Gonska B, Rottbauer W, Buckert D. Cusp-overlap view reduces conduction disturbances and permanent pacemaker implantation after transcatheter aortic valve replacement even with balloon-expandable and mechanically-expandable heart valves. Front Cardiovasc Med 2023;10:1269833. [PMID: 38107259 PMCID: PMC10722163 DOI: 10.3389/fcvm.2023.1269833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/30/2023] [Indexed: 12/19/2023] Open

Abstract

Background

Conduction disturbances demanding permanent pacemaker implantation (PPI) remain a common complication after transcatheter aortic valve replacement (TAVR). Optimization of the implantation depth (ID) by introducing the cusp-overlap projection (COP) technique led to a reduced rate of PPI when self-expanding valves were used.

Objectives

The aim of the present study was to determine if using the novel COP view is applicable for all types of TAVR prosthesis and results in a higher ID and reduced incidence of new conduction disturbances and PPI.

Methods

In this prospective case-control study 586 consecutive patients undergoing TAVR with either balloon-expandable Edwards SAPIEN S3 (n = 280; 47.8%), or mechanically expandable Boston LOTUS Edge heart valve prostheses (n = 306; 52.2%) were included. ID as well as rates of periprocedural PPI and left bundle branch block (LBBB) were compared between the conventional three-cusp coplanar (TCC) projection and the COP view for implantation.

Results

Of 586 patients, 282 (48.1%) underwent TAVR using COP, whereas in 304 patients (51.9%) the TCC view was applied. Using COP a significantly higher ID was achieved in Edwards SAPIEN S3 TAVR procedures (ID mean difference -1.0 mm, 95%-CI -1.9 to -0.1 mm; P = 0.029), whereas the final platform position did not differ significantly between both techniques when a Boston LOTUS Edge valve was used (ID mean difference -0.1 mm, 95%-CI -1.1 to +0.9 mm; P = 0.890). In Edwards SAPIEN S3 valves, higher ID was associated with a numerically lower post-procedural PPI incidence (4.9% vs. 7.3%; P = 0.464). Moreover, ID was significantly deeper in patients requiring PPI post TAVR compared to those without PPI [8.7 mm (6.8-10.6 mm) vs. 6.5 mm (6.1-7.0 mm); P = 0.005]. In Boston LOTUS Edge devices, COP view significantly decreased the incidence of LBBB post procedure (28.1% vs. 47.9%; P < 0.001), while PPI rates were similar in both groups (21.6% vs. 25.7%; P = 0.396).

Conclusion

The present study demonstrates the safety, efficacy and reproducibility of the cusp-overlap view even in balloon-expandable and mechanically-expandable TAVR procedures. Application of COP leads to significantly less LBBB in repositionable Boston LOTUS Edge valves and a numerically lower PPI rate in Edwards SAPIEN S3 valves post TAVR compared to the standard TCC projection. The results should encourage to apply the COP view more widely in clinical practice.

Collapse

Park S, Kang DY, Ahn JM, Kim DH, Park DW, Park SJ, Kang JW, Yang DH, Lee SA, Koo HJ. Impact of new-onset arrhythmia on cardiac reverse remodeling following transcatheter aortic valve replacement: computed tomography-derived left ventricular and atrial strains. Eur Radiol 2023;33:8454-8463. [PMID: 37368107 DOI: 10.1007/s00330-023-09836-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/03/2023] [Accepted: 04/10/2023] [Indexed: 06/28/2023]

Abstract

OBJECTIVE

Patients who undergo transcatheter aortic valve replacement (TAVR) are at risk for new-onset arrhythmia (NOA) that may require permanent pacemaker (PPM) implantation, resulting in decreased cardiac function. We aimed to investigate the factors that are associated with NOA after TAVR and to compare pre- and post-TAVR cardiac functions between patients with and without NOA using CT-derived strain analyses.

METHODS

We included consecutive patients who underwent pre- and post-TAVR cardiac CT scans six months after TAVR. New-onset left bundle branch block, atrioventricular block, and atrial fibrillation/flutter lasting over 30 days after the procedure and/or the need for PPM diagnosed within 1 year after TAVR were regarded as NOA. Implant depth and left heart function and strains were analyzed using multi-phase CT images and compared between patients with and without NOA.

RESULTS

Of 211 patients (41.7% men; median 81 years), 52 (24.6%) presented with NOA after TAVR, and 24 (11.4%) implanted PPM. Implant depth was significantly deeper in the NOA group than in the non-NOA group (- 6.7 ± 2.4 vs. - 5.6 ± 2.6 mm; p = 0.009). Left ventricular global longitudinal strain (LV GLS) and left atrial (LA) reservoir strain were significantly improved only in the non-NOA group (LV GLS, - 15.5 ± 4.0 to - 17.3 ± 2.9%; p < 0.001; LA reservoir strain, 22.3 ± 8.9 to 26.5 ± 7.6%; p < 0.001). The mean percent change of the LV GLS and LA reservoir strains was evident in the non-NOA group (p = 0.019 and p = 0.035, respectively).

CONCLUSIONS

A quarter of patients presented with NOA after TAVR. Deep implant depth on post-TAVR CT scans was associated with NOA. Patients with NOA after TAVR had impaired LV reserve remodeling assessed by CT-derived strains.

CLINICAL RELEVANCE STATEMENT

New-onset arrhythmia (NOA) following transcatheter aortic valve replacement (TAVR) impairs cardiac reverse remodeling. CT-derived strain analysis reveals that patients with NOA do not show improvement in left heart function and strains, highlighting the importance of managing NOA for optimal outcomes.

KEY POINTS

• New-onset arrhythmia following transcatheter aortic valve replacement (TAVR) is a concern that interferes with cardiac reverse remodeling. • Comparison of pre-and post-TAVR CT-derived left heart strain provides insight into the impaired cardiac reverse remodeling in patients with new-onset arrhythmia following TAVR. • The expected reverse remodeling was not observed in patients with new-onset arrhythmia following TAVR, given that CT-derived left heart function and strains did not improve.

Collapse

Lemarchand L, Boulmier D, Leurent G, Bedossa M, Sharobeem S, Bakhti A, Le Breton H, Auffret V. Conductive disturbances in the transcatheter aortic valve implantation setting: An appraisal of current knowledge and unmet needs. Arch Cardiovasc Dis 2023;116:419-425. [PMID: 37328391 DOI: 10.1016/j.acvd.2023.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 06/18/2023]

Li Y, Lei R, Zhou J, Wang J, Zhang H. Lower incidence of new-onset severe conduction disturbances after transcatheter aortic valve implantation with bicuspid aortic valve in patients with no baseline conduction abnormality: a cross-sectional investigation in a single center in China. Front Cardiovasc Med 2023;10:1176984. [PMID: 37441707 PMCID: PMC10333533 DOI: 10.3389/fcvm.2023.1176984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/09/2023] [Indexed: 07/15/2023] Open

Agasthi P, Ashraf H, Pujari SH, Girardo M, Tseng A, Mookadam F, Venepally N, Buras MR, Abraham B, Khetarpal BK, Allam M, MD SKM, Eleid MF, Greason KL, Beohar N, Sweeney J, Fortuin D, Holmes DRJ, Arsanjani R. Prediction of permanent pacemaker implantation after transcatheter aortic valve replacement: The role of machine learning. World J Cardiol 2023;15:95-105. [PMID: 37033682 PMCID: PMC10074998 DOI: 10.4330/wjc.v15.i3.95] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/04/2023] [Accepted: 03/01/2023] [Indexed: 03/21/2023] Open

Sammour YM, Lak H, Chahine J, Abushouk A, Chawla S, Kadri A, Alkhalaileh F, Kumar S, Ghimire B, Svensson L, Popovic Z, Tarakji K, Wazni O, Reed GW, Yun J, Puri R, Krishnaswamy A, Kapadia SR. Clinical and echocardiographic outcomes with new-onset left bundle branch block after SAPIEN-3 transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2023;101:187-196. [PMID: 36378620 DOI: 10.1002/ccd.30488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 10/13/2022] [Accepted: 10/30/2022] [Indexed: 11/17/2022]

Abstract

BACKGROUND

New-onset left bundle branch block (LBBB) can develop after transcatheter aortic valve replacement (TAVR) resulting in worse outcomes.

AIMS

Describe clinical and echocardiographic outcomes with new-onset LBBB after TAVR.

METHODS

We included consecutive patients who underwent transfemoral-TAVR with SAPIEN-3 (S3) valve between April 2015 and December 2018. Exclusion criteria included pre-existing LBBB, right BBB, left anterior hemiblock, left posterior hemiblock, wide QRS ≥ 120ms, prior permanent pacemaker (PPM), and nontransfemoral access.

RESULTS

Among 612 patients, 11.4% developed new-onset LBBB upon discharge. The length of stay was longer with new-onset LBBB compared with no LBBB [3 (2-5) days versus 2 (1-3) days; p < 0.001]. New-onset LBBB was associated with higher rates of 30-day PPM requirement (18.6% vs. 5.4%; p < 0.001) and 1-year heart failure hospitalizations (10.7% vs. 4.4%; p = 0.033). There was no difference in 3-year mortality between both groups (30.9% vs. 30.6%; p = 0.829). Further, new-onset LBBB was associated with lower left ventricular ejection fraction (LVEF) at both 30 days (55.9 ± 11.4% vs. 59.3 ± 9%; p = 0.026) and 1 year (55 ± 12% vs. 60.1 ± 8.9%; p = 0.002). These changes were still present when we stratified patients according to baseline LVEF (≥50% or <50%). New-onset LBBBs were associated with a higher 1-year LV end-diastolic volume index (51.4 ± 18.6 vs. 46.4 ± 15.1 ml/m² ; p = 0.036), and LV end-systolic volume index (23.2 ± 14.1 vs. 18.9 ± 9.7 ml/m² ; p = 0.009). Compared with resolved new-onset LBBB, persistent new-onset LBBB was associated with worse LVEF and higher PPM at 1 year.

CONCLUSIONS

New-onset LBBB after S3 TAVR was associated with higher PPM requirement, worse LVEF, higher LV volumes, and increased heart failure hospitalizations, with no difference in mortality.

Collapse

Affiliation(s)

Yasser M Sammour Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Hassan Lak Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Johnny Chahine Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Abdelrahman Abushouk Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Sanchit Chawla Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Amer Kadri Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Feras Alkhalaileh Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Sachin Kumar Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Bindesh Ghimire Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Lars Svensson Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Zoran Popovic Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Khaldoun Tarakji Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Oussama Wazni Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Grant W Reed Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
James Yun Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Rishi Puri Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Amar Krishnaswamy Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Samir R Kapadia Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA

Collapse

Ananwattanasuk T, Atreya AR, Teerawongsakul P, Ghannam M, Lathkar-Pradhan S, Latchamsetty R, Jame S, Patel HJ, Grossman PM, Oral H, Jongnarangsin K. Outcomes in patients with electrocardiographic left ventricular dyssynchrony following transcatheter aortic valve replacement. Heart Rhythm 2023;20:22-28. [PMID: 35948202 DOI: 10.1016/j.hrthm.2022.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 01/10/2023]

Abstract

BACKGROUND

Left bundle branch block (LBBB) and atrioventricular (AV) conduction abnormalities requiring permanent pacemaker (PPM) implantation occur frequently following transcatheter aortic valve replacement (TAVR). The resultant left ventricular (LV) dyssynchrony may be associated with adverse clinical events.

OBJECTIVES

The purpose of this study was to assess the adverse outcomes associated with LV dyssynchrony due to high-burden right ventricular (RV) pacing or permanent LBBB following TAVR in patients with preserved left ventricular ejection fraction (LVEF).

METHODS

Consecutive TAVR patients at the University of Michigan from January 2012 to June 2017 were included. Pre-existing cardiac implantable electronic device, previous LBBB, LVEF <50%, or follow-up period <1 year were excluded. The primary outcome was all-cause mortality. Secondary outcomes included cardiomyopathy (defined as LVEF ≤45%), a composite endpoint of cardiomyopathy or all-cause mortality, and the change in LVEF at 1-year follow-up.

RESULTS

A total of 362 patients were analyzed (mean age 77 years). LV dyssynchrony group (n = 91 [25.1%]) included 56 permanent LBBB patients, 12 permanent LBBB patients with PPM, and 23 non-LBBB patients with PPM and high-burden RV pacing. Remaining patients served as control (n = 271 [74.9%]). After adjusted analysis, LV dyssynchrony had significantly higher all-cause mortality (adjusted hazard ratio [HR] 2.16; 95% confidence interval [CI] 1.07-4.37) and cardiomyopathy (adjusted HR 14.80; 95% CI 6.31-14.69). The LV dyssynchrony group had mean LVEF decline of 10.5% ± 10.2% compared to a small increase (0.5% ± 7.7%) in control.

CONCLUSION

Among TAVR patients with preserved LVEF and normal AV conduction, development of postprocedural LV dyssynchrony secondary to high-burden RV pacing or permanent LBBB was associated with significantly higher risk of death and cardiomyopathy at 1-year follow-up.

Collapse

Vilalta V, Cediel G, Mohammadi S, López H, Kalavrouziotis D, Resta H, Dumont E, Voisine P, Philippon F, Escabia C, Borrellas A, Alperi A, Fernandez-Nofrerias E, Carrillo X, Panagides V, Bayes-Genis A, Rodés-Cabau J. New-onset persistent left bundle branch block following sutureless aortic valve replacement. Heart 2022;109:143-150. [PMID: 35842233 DOI: 10.1136/heartjnl-2022-321191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/30/2022] [Indexed: 02/04/2023] Open

Affiliation(s)

Victoria Vilalta Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
Germán Cediel Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
Siamak Mohammadi Department of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
Helena López Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
Dimitri Kalavrouziotis Department of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
Helena Resta Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
Eric Dumont Department of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
Pierre Voisine Department of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
François Philippon Department of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
Claudia Escabia Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
Andrea Borrellas Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
Alberto Alperi Department of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
Eduard Fernandez-Nofrerias Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
Xavier Carrillo Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
Vassili Panagides Department of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
Antoni Bayes-Genis Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
Josep Rodés-Cabau Department of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada

Collapse

Jalava MP, Savontaus M, Ahvenvaara T, Laakso T, Virtanen M, Niemelä M, Tauriainen T, Maaranen P, Husso A, Kinnunen E, Dahlbacka S, Jaakkola J, Rosato S, D’Errigo P, Laine M, Mäkikallio T, Raivio P, Eskola M, Valtola A, Juvonen T, Biancari F, Airaksinen J, Anttila V. Transcatheter and surgical aortic valve replacement in patients with left ventricular dysfunction. J Cardiothorac Surg 2022;17:322. [PMID: 36529781 PMCID: PMC9759878 DOI: 10.1186/s13019-022-02061-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open

Affiliation(s)

Maina P. Jalava grid.410552.70000 0004 0628 215XHeart Centre, Turku University Hospital and University of Turku, P. O. Box 52, 20521 Turku, Finland
Mikko Savontaus grid.410552.70000 0004 0628 215XHeart Centre, Turku University Hospital and University of Turku, P. O. Box 52, 20521 Turku, Finland
Tuomas Ahvenvaara grid.412326.00000 0004 4685 4917Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland
Teemu Laakso grid.15485.3d0000 0000 9950 5666Heart Center, Helsinki University Hospital, Helsinki, Finland
Marko Virtanen grid.502801.e0000 0001 2314 6254Heart Hospital, Tampere University Hospital and University of Tampere, Tampere, Finland
Matti Niemelä grid.412326.00000 0004 4685 4917Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
Tuomas Tauriainen grid.412326.00000 0004 4685 4917Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland
Pasi Maaranen grid.502801.e0000 0001 2314 6254Heart Hospital, Tampere University Hospital and University of Tampere, Tampere, Finland
Annastiina Husso grid.410705.70000 0004 0628 207XHeart Center, Kuopio University Hospital, Kuopio, Finland
Eve Kinnunen grid.15485.3d0000 0000 9950 5666Heart Center, Helsinki University Hospital, Helsinki, Finland
Sebastian Dahlbacka grid.15485.3d0000 0000 9950 5666Heart Center, Helsinki University Hospital, Helsinki, Finland
Jussi Jaakkola grid.410552.70000 0004 0628 215XHeart Centre, Turku University Hospital and University of Turku, P. O. Box 52, 20521 Turku, Finland
Stefano Rosato grid.416651.10000 0000 9120 6856National Centre of Global Health, Istituto Superiore di Sanità, Rome, Italy
Paola D’Errigo grid.416651.10000 0000 9120 6856National Centre of Global Health, Istituto Superiore di Sanità, Rome, Italy
Mika Laine grid.15485.3d0000 0000 9950 5666Heart Center, Helsinki University Hospital, Helsinki, Finland
Timo Mäkikallio grid.412326.00000 0004 4685 4917Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
Peter Raivio grid.15485.3d0000 0000 9950 5666Heart Center, Helsinki University Hospital, Helsinki, Finland
Markku Eskola grid.502801.e0000 0001 2314 6254Heart Hospital, Tampere University Hospital and University of Tampere, Tampere, Finland
Antti Valtola grid.410705.70000 0004 0628 207XHeart Center, Kuopio University Hospital, Kuopio, Finland
Tatu Juvonen grid.412326.00000 0004 4685 4917Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland ,3grid.15485.3d0000 0000 9950 5666Heart Center, Helsinki University Hospital, Helsinki, Finland
Fausto Biancari Clinica Montevergine, GVM Care and Research, Mercogliano, Italy
Juhani Airaksinen grid.410552.70000 0004 0628 215XHeart Centre, Turku University Hospital and University of Turku, P. O. Box 52, 20521 Turku, Finland
Vesa Anttila grid.410552.70000 0004 0628 215XHeart Centre, Turku University Hospital and University of Turku, P. O. Box 52, 20521 Turku, Finland

Collapse

Monizzi G, Olivares P, Makmur G, Fabbiocchi F, Grancini L, Mastrangelo A, Ferrari C, Galli S, Montorsi P, Bartorelli AL. Conduction disorders after transcatheter aortic valve implantation: A comparison between SAPIEN 3 and SAPIEN 3 Ultra balloon-expandable valves. Front Cardiovasc Med 2022;9:922696. [DOI: 10.3389/fcvm.2022.922696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open

Dolci G, Singh GK, Wang X, van der Kley F, de Weger A, Bootsma M, Ajmone Marsan N, Bax JJ, Delgado V. Effects of Left Bundle Branch Block and Pacemaker Implantation on Left Ventricular Systolic Function After Transcatheter Aortic Valve Implantation. Am J Cardiol 2022;179:64-69. [PMID: 35843731 DOI: 10.1016/j.amjcard.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/30/2022] [Accepted: 06/06/2022] [Indexed: 11/01/2022]

Tsushima T, Main A, Al-Kindi SG, Dallan LAP, Wheat HL, Baeza CR, Pelletier MP, Arruda MS, Mackall JA, Thal SG, Ohno Y, Lee KH, Siqueira DA, Kaneko T, Harloff MT, Costa G, Barbanti M, Attizzani GF. Risk Stratification of New Persistent Left Bundle Branch Block After Transcatheter Aortic Valve Implantation. Am J Cardiol 2022;175:80-87. [PMID: 35597627 DOI: 10.1016/j.amjcard.2022.03.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/21/2022] [Accepted: 03/28/2022] [Indexed: 11/15/2022]

Affiliation(s)

Takahiro Tsushima Department of Medicine, Division of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
Anthony Main Department of Medicine, Division of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
Sadeer G Al-Kindi Department of Medicine, Division of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
Luis Augusto Palma Dallan Department of Medicine, Division of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
Heather L Wheat Department of Medicine, Division of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
Cristian R Baeza Department of Surgery, Division of Cardiac Surgery, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
Marc P Pelletier Department of Surgery, Division of Cardiac Surgery, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
Mauricio S Arruda Department of Medicine, Division of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
Judith A Mackall Department of Medicine, Division of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
Sergio G Thal Department of Medicine, Division of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
Yohei Ohno Department of Cardiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
Kyong-Hee Lee Department of Cardiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
Dimytri A Siqueira Department of Cardiology, Instituto Dante Pazzanese de Cardiologia - Fundação Adib Jatene, Sao Paulo, Brazil
Tsuyoshi Kaneko Department of Surgery, Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
Morgan T Harloff Department of Surgery, Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
Giuliano Costa Division of Cardiology, Policlinico "G. Rodolico-San Marco," University of Catania, Catania, Italy
Marco Barbanti Division of Cardiology, Policlinico "G. Rodolico-San Marco," University of Catania, Catania, Italy
Guilherme F Attizzani Department of Medicine, Division of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio.

Collapse

Dowling C, Gooley R, McCormick L, Rashid HN, Dargan J, Khan F, Firoozi S, Brecker SJ. Patient-Specific Computer Simulation to Predict Conduction Disturbance With Current-Generation Self-Expanding Transcatheter Heart Valves. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022;6:100010. [PMID: 37274548 PMCID: PMC10236875 DOI: 10.1016/j.shj.2022.100010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/19/2022] [Accepted: 02/02/2022] [Indexed: 10/18/2022]

Abstract

Background

Patient-specific computer simulation may predict the development of conduction disturbance following transcatheter aortic valve replacement (TAVR). Validation of the computer simulations with current-generation devices has not been undertaken.

Methods

A retrospective study was performed on patients who had undergone TAVR with a current-generation self-expanding transcatheter heart valve (THV). Preprocedural computed tomography imaging was used to create finite element models of the aortic root. Procedural contrast angiography was reviewed, and finite element analysis performed using a matching THV device size and implantation depth. A region of interest corresponding to the atrioventricular bundle and proximal left bundle branch was identified. The percentage of this area (contact pressure index [CPI]) and maximum contact pressure (CPMax) exerted by THV were recorded. Postprocedural electrocardiograms were reviewed, and major conduction disturbance was defined as the development of persistent left bundle branch block or high-degree atrioventricular block.

Results

A total of 80 patients were included in the study. THVs were 23- to 29-mm Evolut PRO (n = 53) and 34-mm Evolut R (n = 27). Major conduction disturbance occurred in 27 patients (33.8%). CPI (28.3 ± 15.8 vs. 15.6 ± 11.2%; p < 0.001) and CPMax (0.51 ± 0.20 vs. 0.36 ± 0.24 MPa; p = 0.008) were higher in patients who developed major conduction disturbance. CPI (area under the receiver operating characteristic curve [AUC], 0.74; 95% CI, 0.63-0.86; p < 0.001) and CPMax (AUC, 0.69; 95% CI, 0.57-0.81; p = 0.006) demonstrated a discriminatory power to predict the development of major conduction disturbance.

Conclusions

Patient-specific computer simulation may identify patients at risk for conduction disturbance after TAVR with current-generation self-expanding THVs.

Collapse

Wang J, Liu S, Han X, Chen Y, Chen H, Wan Z, Song B. Prognostic Outcome of New-Onset Left Bundle Branch Block After Transcatheter Aortic Valve Replacement in Patients With Aortic Stenosis: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022;9:842929. [PMID: 35463780 PMCID: PMC9024042 DOI: 10.3389/fcvm.2022.842929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/03/2022] [Indexed: 11/13/2022] Open

Abstract BackgroundLeft bundle branch block (LBBB) is a common complication of the transcatheter aortic valve replacement (TAVR), and its impact on prognosis is controversial.MethodsA comprehensive electronic search was conducted in databases (PubMed, Embase, Cochrane Library, and The Web of Science), from the date of database establishment till March 2021, to screen for studies on new-onset LBBB after TAVR. We next performed a meta-analysis to evaluate the effect of new-onset LBBB after TAVR on patient prognosis, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.ResultsA total of 17 studies, including 9205 patients, were eligible for our analysis. Patients with new-onset LBBB had elevated all-cause mortality risk verses patients without new-onset LBBB, during all follow ups. The relevant data are as follows: 30-day (RR:1.71; 95%CI:1.27–2.29; P < 0.001), 1-year (RR:1.31; 95%CI:1.12–1.52; P < 0.001), and 2-year (RR:1.31; 95%CI:1.09–1.56; P = 0.003) follow ups. Likewise, new-onset LBBB patients also experienced increased cardiovascular mortality, compared to non-new-onset LBBB patients, but only in the 1-year follow up (RR:1.49; 95%CI:1.23–1.82; P < 0.001). Hospitalization for heart failure was dramatically elevated in patients with new-onset LBBB verses non-new-onset LBBB, in all follow ups. The relevant data are as follows: 30-day (RR:1.56; 95%CI:1.13–2.12; P = 0.007), 1-year (RR:1.35; 95%CI:1.08–1.68; P = 0.007), and 2-year (RR:1.49; 95%CI:1.21–1.84; P < 0.001). Similarly, new-onset LBBB patients had higher PPI risk than non-new-onset LBBB patients, in all follow ups. The relevant data are as follows: 30-day (RR:3.05; 95%CI:1.49–6.22; P = 0.002), 1-year (RR:2.15; 95%CI:1.52–3.03; P < 0.001), and 2-year (RR:2.52; 95%CI:1.68–3.78; P < 0.001).ConclusionPatients with new-onset LBBB have worse prognosis after TAVR than those without new-onset LBBB. Recognition of the adverse effects of post-TAVR new-onset LBBB can lead to the development of new strategies that enhance clinical outcomes.Systematic Trial Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=197224, identifier: 19722. Collapse

Isogai T, Dykun I, Agrawal A, Shekhar S, Tarakji KG, Wazni OM, Kalra A, Krishnaswamy A, Reed GW, Kapadia SR, Puri R. Early Resolution of New-Onset Left Bundle Branch Block After Transcatheter Aortic Valve Implantation With the SAPIEN 3 Valve. Am J Cardiol 2022;168:117-127. [PMID: 35045936 DOI: 10.1016/j.amjcard.2021.12.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/05/2021] [Accepted: 12/07/2021] [Indexed: 11/29/2022]

Mitsis A, Eftychiou C, Christophides T, Sakellaropoulos S, Avraamides P. The conjunction conundrum in Transcatheter Aortic Valve Implantation. Curr Probl Cardiol 2022;48:101130. [PMID: 35114293 DOI: 10.1016/j.cpcardiol.2022.101130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022]

Santos-Martinez S, Halim J, Castro-Mejía A, De Marco F, Trani C, Martin P, Infusino F, Ancona M, Moreno R, den Heijer P, Nombela-Franco L, Bedogni F, Sardella G, Montorfano M, Revilla-Orodea A, Delgado-Arana JR, Barrero A, Gómez-Salvador I, IJsselmuiden AJJ, Redondo A, Gutiérrez H, Serrador A, Serruys PW, Román JAS, Amat-Santos IJ. Myval versus alternative balloon- and self-expandable transcatheter heart valves: A central core lab analysis of conduction disturbances. Int J Cardiol 2022;351:25-31. [PMID: 34979152 DOI: 10.1016/j.ijcard.2021.12.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 12/29/2022]

Abstract

BACKGROUND

Several studies have compared surface electrocardiographic changes following different self-expandable (SE) (Evolut (Medtronic, USA); Acurate (Boston Scientific, USA); Portico (Abbott, USA); and Allegra (NVT, Germany)) and balloon-expandable (BE) Sapien-3 (Edwards Lifesciences, USA) transcatheter heart valves. We aimed to compare these prosthesis with the novel Myval BE prosthesis (Meril Life, India).

METHODS

Academic European registry of consecutive patients with severe aortic stenosis who received any of the 6 aforementioned valves. Baseline, post-procedural, and discharge 12‑leads electrocardiograms (ECG) were centrally analyzed and compared.

RESULTS

A total of 1131 patients were included: 135 Myval (11.9%), 290 Sapien-3 (25.6%), 298 Evolut (26.3%), 180 Acurate (15.9%), 125 Portico (11.1%), and 103 Allegra (9.1%). There were no baseline differences in intraventricular conduction disturbances rate. Compared to the novel BE Myval, there were similar procedural and in-hospital outcomes. Similar rates of early new permanent pacemaker implant (PPI) were observed amongst Myval (7.4%), Sapien-3 (13.4%), and Acurate (9.1%), but Evolut, Portico, and Allegra presented significantly higher rates (18.5%, p = 0.003; 29.5% p < 0.001 and 22%, p = 0.001, respectively). Central analysis of ECGs, unraveled significant prolongation of the PR segment with Evolut, Portico and Allegra whereas Evolut, Acurate, and Portico showed significant QRS widening compared to Myval. However, at discharge no differences in PR segment duration were observed while, Evolut, and Portico- but not Acurate, Allegra or Sapien-3 - still presented significant widening of QRS segment compared to Myval.

CONCLUSIONS

After blinded central ECG analysis, the novel Myval balloon-expandable prosthesis was associated with a low rate of early conduction disturbances.

Collapse

Thuraisingam A, Newcomb AE. Rhythm disturbances following rapid-deployment aortic valve replacement. JTCVS Tech 2021;10:219-226. [PMID: 34984381 PMCID: PMC8691943 DOI: 10.1016/j.xjtc.2021.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/03/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022] Open

Abstract

Objectives

There have been reports of postoperative conduction disturbances after rapid-deployment aortic valve replacement. Our objective was to assess electrocardiogram changes in patients undergoing this procedure and review the literature on this topic.

Methods

In this retrospective case series, clinical data were extracted from patient records at St Vincent's Hospital Melbourne and the Australia New Zealand Society of Cardiac and Thoracic Surgeons database. Electrocardiogram data were obtained at baseline and postoperatively on day 5 and at week 6 and reviewed for rhythm disturbances and intracardiac conduction problems. Pacemaker status was also recorded.

Results

From 2013 to 2017, 100 consecutive patients underwent rapid-deployment aortic valve replacement with 1 valve type at our institution. Three patients were excluded because of paced rhythm preoperatively, leaving 97 patients (mean age 74.7 ± 8.12 years; 56.7% male) for analysis. Some 18.6% of patients developed new left bundle branch block at 5 days postoperatively and only 4.1% of patients found with persistent left bundle branch block at 6-week follow-up compared with preoperatively. No significant changes were observed in the frequencies of atrial fibrillation, first-degree heart block, and right bundle branch block. However, there was evidence of increases in paced rhythm and subsequent need for a permanent pacemaker. A total of 14 patients (14.4%) had a permanent pacemaker implanted at an average of 11.1 ± 2.9 days postoperatively.

Conclusions

Rhythm disturbances and conduction abnormalities are noted with the rapid-deployment aortic valves used at our institution, but appear comparable to other rapid-deployment aortic valve replacement bioprostheses. These abnormalities may be related to the effect of the sub-annular stent frame of the valve system and implantation technique.

Collapse

Nakashima M, Jilaihawi H. Conduction Disturbances and Pacing in Transcatheter Aortic Valve Replacement. Interv Cardiol Clin 2021;10:455-463. [PMID: 34593109 DOI: 10.1016/j.iccl.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]

Increased Rate of New-onset Left Bundle Branch Block in Patients With Bicuspid Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation (From a National Registry). Am J Cardiol 2021;156:101-107. [PMID: 34344509 DOI: 10.1016/j.amjcard.2021.06.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/21/2021] [Accepted: 06/25/2021] [Indexed: 11/27/2022]

Abstract

There is a growing interest in transcutaneous aortic valve implantation (TAVI) therapy among patients with bicuspid severe aortic stenosis (BAV). Conduction disturbances remain a frequent complication of TAVI, and new-onset permanent LBBB (NOP-LBBB) post-TAVI may be a marker of worse outcomes. We aimed to evaluate the rate of NOP-LBBB following TAVI among patients with BAV as compared to tricuspid severe aortic stenosis (TAV). Patients enrolled in the multicenter (5 centers) Bicuspid AS TAVI Registry were reviewed and compared with patients with TAV. Patients with previous aortic valve replacement, other valve morphologies and those with preprocedural LBBB or pacemaker were excluded. NOP-LBBB was defined as LBBB first detected and persisting 30-days following TAVI. A total of 387 patients (66 with BAV, 321 with TAV), age 80.3 ± 7.3, 47% females were analyzed. The device success rates were 95% in both groups without any conversions to surgery. The rate of NOP-LBBB was significantly higher among patients with BAV versus TAV (29.2% vs 16.9%, p = 0.02). However, the rate of post procedural pacemaker implantation was similar (14.8% vs 12.5%; respectively, p = 0.62). In BAV and TAV groups, 1-year mortality (6.1% vs 7.2%; respectively, p = 0.75) and stroke rates (6.1% vs 3.5%; respectively, p = 0.30) were not significantly different. Multivariate analysis identified BAV as an independent predictor of NOP-LBBB (AdjOR = 2.7, 95%CI 1.3 to 5.4). Furthermore, BAV subtypes with raphe (type 1) were identified as independent predictors of NOP-LBBB (AdjOR = 3.2, 95%CI: 1.5 to 6.7). In conclusion, patients with BAV undergoing TAVI have greater risk for developing NOP-LBBB compared with patients with TAV and the presence of raphe was associated with increased risk of NOP-LBBB. The prognostic significance for this finding warrants further evaluation in future studies.

Collapse

Aymond JD, Benn F, Williams CM, Bernard ML, Hiltbold AE, Khatib S, Polin GM, Rogers PA, Tafur Soto JD, Ramee SR, Parrino PE, Falterman JB, Al-Khatib SM, Morin DP. Epidemiology, evaluation, and management of conduction disturbances after transcatheter aortic valve replacement. Prog Cardiovasc Dis 2021;66:37-45. [PMID: 34332660 DOI: 10.1016/j.pcad.2021.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]

Ko TY, Kao HL, Liu YJ, Yeh CF, Huang CC, Chen YH, Hung CS, Chan CY, Lin LC, Chen YS, Lin MS. Impact of conduction disturbances on left ventricular mass regression and geometry change following transcatheter aortic valve replacement. Sci Rep 2021;11:16778. [PMID: 34408241 PMCID: PMC8373860 DOI: 10.1038/s41598-021-96297-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 08/09/2021] [Indexed: 11/23/2022] Open

Three-year outcome after transcatheter aortic valve implantation: Comparison of a restrictive versus a liberal strategy for pacemaker implantation. Heart Rhythm 2021;18:2040-2047. [PMID: 34400310 DOI: 10.1016/j.hrthm.2021.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 12/29/2022]

Sammour Y, Krishnaswamy A, Kumar A, Puri R, Tarakji KG, Bazarbashi N, Harb S, Griffin B, Svensson L, Wazni O, Kapadia SR. Incidence, Predictors, and Implications of Permanent Pacemaker Requirement After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2021;14:115-134. [PMID: 33478630 DOI: 10.1016/j.jcin.2020.09.063] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/04/2020] [Accepted: 09/29/2020] [Indexed: 12/29/2022]

Gul EE, Kabadi RA, Padala SK, Sanchez Somonte P, Kron J, Shepard RK, Koneru JN, Kalahasty G, Terricabras M, Tsang B, Khaykin Y, Wulffhart Z, Pantano A, Ellenbogen KA, Verma A. Safety and feasibility of left bundle branch area pacing following valvular interventions: Multicenter study. J Cardiovasc Electrophysiol 2021;32:2515-2521. [PMID: 34245466 DOI: 10.1111/jce.15153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/27/2021] [Accepted: 06/29/2021] [Indexed: 12/24/2022]

Occurrence and Persistency of Conduction Disturbances during Transcatheter Aortic Valve Implantation. ACTA ACUST UNITED AC 2021;57:medicina57070695. [PMID: 34356976 PMCID: PMC8303948 DOI: 10.3390/medicina57070695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 11/17/2022]

Abstract

Background and Objectives: Conduction disturbances such as left bundle branch block (LBBB) and complete atrio-ventricular block (cAVB) are relatively frequent complications following trans-catheter aortic valve implantation (TAVI). We investigated the dynamics of these conduction blocks to further understand luxating factors and predictors for their persistency. Materials and Methods: We prospectively included 157 consecutive patients who underwent a TAVI procedure. Electrocardiograms (ECGs) were obtained at specific time points during the TAVI procedure and at follow-up until at least six months post-procedure. Results: Of the 106 patients with a narrow QRS complex (nQRS) before TAVI, ~70% developed LBBB; 28 (26.4%) being classified as super-transient (ST-LBBB), 20 (18.9%) as transient (T-LBBB) and 24 (22.6%) as persistent (P-LBBB). Risk of LBBB was higher for self-expandable (SE) than for balloon-expandable (BE) prostheses and increased with larger implant depth. During the TAVI procedure conduction disturbances showed a dynamic behavior, as illustrated by alternating kinds of blocks in 18 cases. Most LBBBs developed during balloon aortic valvuloplasty (BAV) and at positioning and deployment of the TAVI prosthesis. The incidence of LBBB was not significantly different between patients who did and did not undergo BAV prior to TAVI implantation (65.3% and 74.2%, respectively (p = 0.494)). Progression to cAVB was most frequent for patients with preexisting conduction abnormalities (5/34) patients) and in patients showing ST-LBBB (6/28). Conclusions: During the TAVI procedure, conduction disturbances showed a dynamic behavior with alternating types of block in 18 cases. After a dynamic period of often alternating types of block, most BBBs are reversible while one third persist. Patients with ST-LBBB are most prone to progressing into cAVB. The observation that the incidence of developing LBBB after TAVI is similar with and without BAV suggests that a subgroup of patients has a substrate to develop LBBB regardless of the procedure.

Collapse

Impact of Bundle Branch Block on Permanent Pacemaker Implantation after Transcatheter Aortic Valve Implantation: A Meta-Analysis. J Clin Med 2021;10:jcm10122719. [PMID: 34205478 PMCID: PMC8235153 DOI: 10.3390/jcm10122719] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 12/30/2022] Open

Ricco JB, Castagnet H, Christiaens L, Palazzo P, Lamy M, Mergy J, Corbi P, Neau JP. Predictors of Early Stroke or Death in Patients Undergoing Transcatheter Aortic Valve Implantation. J Stroke Cerebrovasc Dis 2021;30:105912. [PMID: 34130105 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/05/2021] [Accepted: 05/23/2021] [Indexed: 10/21/2022] Open

Abstract

BACKGROUND/OBJECTIVE

While postoperative stroke is a known complication of Transcatheter Aortic Valve Implantation (TAVI), predictors of early stroke occurrence have not been specifically reviewed. The objective of this study was to estimate the predictors and incidence of stroke during the first 30 days post-TAVI.

METHODS

A cohort of 506 consecutive patients having undergone TAVI between January 2017 and June 2019 was extracted from a prospective database. Preoperative, intraoperative and postoperative characteristics were analyzed by univariate analysis followed by logistic regression to find predictors of the occurrence of stroke or death within the first 30 days after the procedure.

RESULTS

Incidence of stroke within 30 days post-TAVI was 4.9%, [CI 95% 3.3-7.2], i.e., 25 strokes. Four out of the 25 patients (16%) with a stroke died within 30 days post-TAVI. After logistic regression analysis, the predictors of early stroke related to TAVI were: CHA2Ds2VASc score ≥ 5 (odds ratio [OR] 2.62; 95% CI: 1.06-6.49; p = .037), supra-aortic access vs. femoral access (OR: 9.00, 95%CI: 2.95-27.44; p = .001) and introduction post-TAVI of a single vs. two or three antithrombotic agents (OR: 5.13; CI 95%: 1.99 to 13.19; p = .001). Over the 30-day period, bleeding occurred in 28 patients (5.5%), in 25 of whom, it was associated with femoral or iliac artery access injury. Anti-thrombotic regimen was not associated with bleeding; two patients out of 48 (4.1%) bled with a single anti-thrombotic regimen vs. 26 patients out of 458 (5.6%) with a dual or triple anti-thrombotic regimen (p = 0.94). The overall 30-day mortality rate was 3.9%, [95% CI 2.5-6.0]. Patients with a single post-TAVI antithrombotic agent (OR: 44.07 [CI 95% 13.45-144.39]; p < .0001) and patients with previous coronary artery bypass surgery or coronary artery stenting (OR: 6.16, [CI 95% 1.99-21.29]; p = .002) were at significantly higher risk of death within the 30-day period.

CONCLUSION

In this large-scale single-center retrospective study, a single post-TAVI antithrombotic regimen independently predicted occurrence of early stroke or death. Dual or triple antithrombotic regimen was not associated with a higher risk of bleeding and should be considered as an option in patients undergoing TAVI.

Collapse

Poels TT, Stassen R, Kats S, Veenstra L, van Ommen V, Kietselaer B, Houthuizen P, Maessen JG, Prinzen FW. Effective Distance between Aortic Valve and Conduction System Is an Independent Predictor of Persistent Left Bundle Branch Block during Transcatheter Aortic Valve Implantation. ACTA ACUST UNITED AC 2021;57:medicina57050476. [PMID: 34064932 PMCID: PMC8150689 DOI: 10.3390/medicina57050476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 01/05/2023]

Généreux P, Piazza N, Alu MC, Nazif T, Hahn RT, Pibarot P, Bax JJ, Leipsic JA, Blanke P, Blackstone EH, Finn MT, Kapadia S, Linke A, Mack MJ, Makkar R, Mehran R, Popma JJ, Reardon M, Rodes-Cabau J, Van Mieghem NM, Webb JG, Cohen DJ, Leon MB. Valve Academic Research Consortium 3: updated endpoint definitions for aortic valve clinical research. Eur Heart J 2021;42:1825-1857. [DOI: 10.1093/eurheartj/ehaa799] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/22/2020] [Accepted: 09/24/2020] [Indexed: 12/17/2022] Open

Abstract Abstract Aims The Valve Academic Research Consortium (VARC), founded in 2010, was intended to (i) identify appropriate clinical endpoints and (ii) standardize definitions of these endpoints for transcatheter and surgical aortic valve clinical trials. Rapid evolution of the field, including the emergence of new complications, expanding clinical indications, and novel therapy strategies have mandated further refinement and expansion of these definitions to ensure clinical relevance. This document provides an update of the most appropriate clinical endpoint definitions to be used in the conduct of transcatheter and surgical aortic valve clinical research. Methods and results Several years after the publication of the VARC-2 manuscript, an in-person meeting was held involving over 50 independent clinical experts representing several professional societies, academic research organizations, the US Food and Drug Administration (FDA), and industry representatives to (i) evaluate utilization of VARC endpoint definitions in clinical research, (ii) discuss the scope of this focused update, and (iii) review and revise specific clinical endpoint definitions. A writing committee of independent experts was convened and subsequently met to further address outstanding issues. There were ongoing discussions with FDA and many experts to develop a new classification schema for bioprosthetic valve dysfunction and failure. Overall, this multi-disciplinary process has resulted in important recommendations for data reporting, clinical research methods, and updated endpoint definitions. New definitions or modifications of existing definitions are being proposed for repeat hospitalizations, access site-related complications, bleeding events, conduction disturbances, cardiac structural complications, and bioprosthetic valve dysfunction and failure (including valve leaflet thickening and thrombosis). A more granular 5-class grading scheme for paravalvular regurgitation (PVR) is being proposed to help refine the assessment of PVR. Finally, more specific recommendations on quality-of-life assessments have been included, which have been targeted to specific clinical study designs. Conclusions Acknowledging the dynamic and evolving nature of less-invasive aortic valve therapies, further refinements of clinical research processes are required. The adoption of these updated and newly proposed VARC-3 endpoints and definitions will ensure homogenous event reporting, accurate adjudication, and appropriate comparisons of clinical research studies involving devices and new therapeutic strategies. Collapse

Affiliation(s)


Philippe Généreux Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA
Nicolo Piazza McGill University Health Centre, Montreal, QC, Canada
Maria C Alu Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, NY, USA
Tamim Nazif Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, NY, USA
Rebecca T Hahn Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, NY, USA
Philippe Pibarot Quebec Heart & Lung Institute, Laval University, Quebec, QC, Canada
Jeroen J Bax Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Jonathon A Leipsic Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
Philipp Blanke Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
Eugene H Blackstone Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic and Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, OH, USA
Matthew T Finn Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, NY, USA
Samir Kapadia Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
Axel Linke Herzzentrum Dresden, Dresden, Germany
Michael J Mack Baylor Scott & White Heart Hospital Plano, Plano, TX, USA
Raj Makkar Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
Roxana Mehran The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
Jeffrey J Popma Beth Israel Deaconess Medical Center, Boston, MA, USA
Michael Reardon Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
Josep Rodes-Cabau Quebec Heart & Lung Institute, Laval University, Quebec, QC, Canada
Nicolas M Van Mieghem Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
John G Webb Department of Cardiology, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
David J Cohen University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
Martin B Leon Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, NY, USA

Collapse

Généreux P, Piazza N, Alu MC, Nazif T, Hahn RT, Pibarot P, Bax JJ, Leipsic JA, Blanke P, Blackstone EH, Finn MT, Kapadia S, Linke A, Mack MJ, Makkar R, Mehran R, Popma JJ, Reardon M, Rodes-Cabau J, Van Mieghem NM, Webb JG, Cohen DJ, Leon MB. Valve Academic Research Consortium 3: Updated Endpoint Definitions for Aortic Valve Clinical Research. J Am Coll Cardiol 2021;77:2717-2746. [PMID: 33888385 DOI: 10.1016/j.jacc.2021.02.038] [Citation(s) in RCA: 596] [Impact Index Per Article: 149.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]

Abstract

AIMS

The Valve Academic Research Consortium (VARC), founded in 2010, was intended to (i) identify appropriate clinical endpoints and (ii) standardize definitions of these endpoints for transcatheter and surgical aortic valve clinical trials. Rapid evolution of the field, including the emergence of new complications, expanding clinical indications, and novel therapy strategies have mandated further refinement and expansion of these definitions to ensure clinical relevance. This document provides an update of the most appropriate clinical endpoint definitions to be used in the conduct of transcatheter and surgical aortic valve clinical research.

METHODS AND RESULTS

Several years after the publication of the VARC-2 manuscript, an in-person meeting was held involving over 50 independent clinical experts representing several professional societies, academic research organizations, the US Food and Drug Administration (FDA), and industry representatives to (i) evaluate utilization of VARC endpoint definitions in clinical research, (ii) discuss the scope of this focused update, and (iii) review and revise specific clinical endpoint definitions. A writing committee of independent experts was convened and subsequently met to further address outstanding issues. There were ongoing discussions with FDA and many experts to develop a new classification schema for bioprosthetic valve dysfunction and failure. Overall, this multi-disciplinary process has resulted in important recommendations for data reporting, clinical research methods, and updated endpoint definitions. New definitions or modifications of existing definitions are being proposed for repeat hospitalizations, access site-related complications, bleeding events, conduction disturbances, cardiac structural complications, and bioprosthetic valve dysfunction and failure (including valve leaflet thickening and thrombosis). A more granular 5-class grading scheme for paravalvular regurgitation (PVR) is being proposed to help refine the assessment of PVR. Finally, more specific recommendations on quality-of-life assessments have been included, which have been targeted to specific clinical study designs.

CONCLUSIONS

Acknowledging the dynamic and evolving nature of less-invasive aortic valve therapies, further refinements of clinical research processes are required. The adoption of these updated and newly proposed VARC-3 endpoints and definitions will ensure homogenous event reporting, accurate adjudication, and appropriate comparisons of clinical research studies involving devices and new therapeutic strategies.

Collapse

Affiliation(s)


Philippe Généreux Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA
Nicolo Piazza McGill University Health Centre, Montreal, Quebec, Canada
Maria C Alu Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, New York, USA
Tamim Nazif Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, New York, USA
Rebecca T Hahn Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, New York, USA
Philippe Pibarot Quebec Heart & Lung Institute, Laval University, Quebec, Quebec, Canada
Jeroen J Bax Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Jonathon A Leipsic Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
Philipp Blanke Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
Eugene H Blackstone Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic and Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
Matthew T Finn Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, New York, USA
Samir Kapadia Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
Axel Linke Herzzentrum Dresden, Dresden, Germany
Michael J Mack Baylor Scott & White Heart Hospital Plano, Plano, Texas, USA
Raj Makkar Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
Roxana Mehran The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Jeffrey J Popma Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
Michael Reardon Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
Josep Rodes-Cabau Quebec Heart & Lung Institute, Laval University, Quebec, Quebec, Canada
Nicolas M Van Mieghem Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
John G Webb Department of Cardiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
David J Cohen University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
Martin B Leon Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, New York, USA.

Collapse

Sandhu A, Tzou WS. A Disruptive Technology: Determining Need for Permanent Pacing After TAVR. Curr Cardiol Rep 2021;23:53. [PMID: 33871728 DOI: 10.1007/s11886-021-01481-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 12/01/2022]

Oh JK, Lee SH, Lee SA, Kang DY, Lee S, Kim HJ, Ahn JM, Kim JB, Park DW, Song JM, Choo SJ, Kang DH, Song JK, Park SJ, Kim DH. Prognostic impact of left ventricular mass regression after transcatheter aortic valve replacement in patients with left ventricular hypertrophy. Int J Cardiol 2021;332:60-66. [PMID: 33781852 DOI: 10.1016/j.ijcard.2021.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/23/2021] [Accepted: 03/22/2021] [Indexed: 11/30/2022]

Affiliation(s)

Jin Kyung Oh Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
Sun Hack Lee Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
Seung-Ah Lee Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Do-Yoon Kang Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Sahmin Lee Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Ho Jin Kim Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Jung-Min Ahn Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Joon Bum Kim Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Duk-Woo Park Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Jong-Min Song Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Suk Jung Choo Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Duk-Hyun Kang Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Jae-Kwan Song Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Seung-Jung Park Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Dae-Hee Kim Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Collapse

Impact of Interventricular membranous septum length on pacemaker need with different Transcatheter aortic valve implantation systems. Int J Cardiol 2021;333:152-158. [PMID: 33675890 DOI: 10.1016/j.ijcard.2021.02.080] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/02/2021] [Accepted: 02/26/2021] [Indexed: 11/23/2022]

Abstract

Background The need for new permanent pacemaker implantation (PPI) after Transcatheter Aortic Valve Implantation (TAVI) remains a critical issue. Membranous Septum (MS) length is associated with PPI after TAVI. The aim of this study was to identify different MS thresholds for the contemporary THV-platforms. Methods This retrospective, case-control study enrolled all patients who underwent a successful TAVI procedure with contemporary THV-platforms in the Erasmus University Medical Center between January 2016 and March 2020. The follow-up period for new PPI was 30 days. MS-length was determined by Computed Tomography. Results The study consisted 653 TAVI patients with median age 80.6 years (IQR 74.7-84.8). New PPI occurred in 120 patients (18.4%). Patients with new PPI had a shorter MS-length (2.9 mm (IQR 2.3-4.3) vs. 4.2 mm (IQR 2.9-5.7), p < 0.001). MS-length < 3 mm identified a high-risk phenotype with 30.3% PPI-rate (OR 6.5 [95%CI 2.9-14.9]), MS-length 3-6 mm an intermediate-risk phenotype with 15.4% PPI-rate (OR 2.7 [95%CI 1.2-6.2]) and MS > 6 mm a low-risk phenotype with a 6.3% PPI-rate (reference). For the Lotus valve, there was no significant difference in PPI-rates between the high-risk (45.8%, OR 3.5 [95%CI 0.8-15.1]) and low-risk group (20%). By multivariate analysis MS-length, Agatston-score, use of Lotus valve, and ECG with first-degree AV block, RBBB or bifascular block were independent predictors for new PPI. Conclusion MS-length was an independent predictor for new PPI post-TAVI. Three phenotypes were found based on MS-length. MS < 3 mm was universally associated with a high risk for new PPI (>30%). MS > 6 mm represented a low-risk phenotype with PPI-rate < 10%. PPI-rate varied per THV type in the intermediate phenotype. PPI-rate with Lotus was high regardless of MS-length.

Collapse

Stankowski T, Mangner N, Linke A, Aboul-Hassan SS, Gąsior T, Muehle A, Herwig V, Harnath A, Salem M, Szłapka M, Grimmig O, Just S, Fritzsche D, Perek B. Cardiac conduction abnormalities in patients with degenerated bioprostheses undergoing transcatheter aortic valve-in-valve implantations and their impact on long-term outcomes. Int J Cardiol 2021;330:16-22. [PMID: 33592238 DOI: 10.1016/j.ijcard.2021.02.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 12/12/2022]

Abstract

BACKGROUND

The relationship between preoperative cardiac conduction abnormalities (CCA) and long-term outcomes after transcatheter aortic valve-in-valve implantation (TAVI-VIV) remains unclear. The aim of the study was to evaluate the effects of preoperative CCA on mortality and morbidity after TAVI-VIV and to estimate the impact of new-onset CCA on postoperative outcomes.

METHODS

Between 2011 and 2020, 201 patients with degenerated aortic bioprostheses were qualified for TAVI-VIV procedures in two German heart centers. Cases with previously implanted permanent rhythm-controlling devices were excluded (n = 53). A total of 148 subjects met the eligibility criteria and were divided into 2 study groups according to the presence of preexisting CCA (CCA (n = 84) and non-CCA (n = 64), respectively). Early and late mortality and morbidity were evaluated. Follow-up functional status was assessed according to New York Heart Association (NYHA) classification.

RESULTS

There were no procedural deaths. TAVI-VIV related new-onset CCAs were observed in 35.8% patients. The 30-day permanent pacemaker implantation rate was 1.6% in non-CCA vs 9.5% in CCA group (p = 0.045). Preexisting right bundle-branch block (OR:5.01; 95%CI, 1.05-23.84) and first-degree atrioventricular block (OR:4.55; 95%CI, 1.10-18.73) were independent predictors of new pacemaker implantation. One-year and five-year probability of survival were comparable in CCA and non-CCA groups: 90.3% vs 91.8% and 68.2% vs 74.3%, respectively. Surviving patients with preexisting and new-onset CCA had a worse functional status according to NYHA classification at follow-up.

CONCLUSION

Preexisting and new-onset postoperative CCAs did not affect early and late mortality after TAVI-VIV procedures, however, they may have a negative impact on late functional status.

Collapse

Chen S, Chau KH, Nazif TM. The incidence and impact of cardiac conduction disturbances after transcatheter aortic valve replacement. Ann Cardiothorac Surg 2020;9:452-467. [PMID: 33312903 PMCID: PMC7724062 DOI: 10.21037/acs-2020-av-23] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/21/2020] [Indexed: 12/29/2022]

Sá MPBO, Simonato M, Van den Eynde J, Cavalcanti LRP, Roever L, Bisleri G, Dokollari A, Dvir D, Zhigalov K, Ruhparwar A, Weymann A. Asymptomatic severe aortic stenosis, bicuspid aortic valves and moderate aortic stenosis in heart failure: New indications for transcatheter aortic valve implantation. Trends Cardiovasc Med 2020;31:435-445. [PMID: 33065313 DOI: 10.1016/j.tcm.2020.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 11/15/2022]

Ashraf H, Fortuin FD, Sweeney J, DeValeria PA, Lanza LA, Ramsay G, Maranzano P, Patrick L, Scott LR. Development of advanced conduction disturbances following balloon-expandable transcatheter aortic valve replacement leads to poorer clinical outcomes. J Arrhythm 2020;36:755-761. [PMID: 32782650 PMCID: PMC7411204 DOI: 10.1002/joa3.12383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 12/31/2022] Open

Manuel AM, Almeida J, Guerreiro C, Dias T, Barbosa A, Teixeira P, Ribeiro J, Dias A, Caeiro D, Fonseca M, Teixeira M, Oliveira M, Gonçalves H, Primo J, Rodrigues A, Gama V, Braga P, Fontes-Carvalho R. The effects of transcatheter aortic valve implantation on cardiac electrical properties. Rev Port Cardiol 2020;39:431-440. [DOI: 10.1016/j.repc.2020.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 12/31/2019] [Accepted: 02/22/2020] [Indexed: 11/26/2022] Open