Development of advanced conduction disturbances following balloon‐expandable transcatheter aortic valve replacement leads to poorer clinical outcomes

Autor: Patrick A. DeValeria, Luis R. Scott, Louis A. Lanza, John P. Sweeney, Pedro Maranzano, Hasan Ashraf, Floyd David Fortuin, Gary Ramsay, Lorna Patrick
Rok vydání: 2020
Předmět:
Zdroj: Journal of Arrhythmia
Journal of Arrhythmia, Vol 36, Iss 4, Pp 755-761 (2020)
ISSN: 1883-2148
1880-4276
DOI: 10.1002/joa3.12383
Popis: Background Transcatheter aortic valve replacement (TAVR) is a reliable method of treating patients with severe aortic stenosis, but is associated with postprocedure conduction defects. Objective The purpose of this study was to compare clinical outcomes in patients who developed advanced conduction defects post‐TAVR to those who did not. Methods We conducted a retrospective chart review of 243 patients who underwent balloon‐expandable TAVR with the Edwards Sapien valve to determine the incidence of advanced conduction defects in our cohort. We compared clinical outcomes including overall mortality, improvement in symptomatology, and improvement in left ventricular ejection fraction. Results Among the 243 patients included in the study, 9.1% (22/243) required permanent pacemaker (PPM); 19.8% (48/243) developed left bundle branch block (LBBB), and 71.2% (173/243) did not develop any permanent advanced conduction defects. Overall 1‐year mortality was similar across all three groups. There was significant improvement in New York Heart Association functional capacity of all groups post‐TAVR, but this was much less in the PPM group (45.5% vs 68.8%, P = .04). Postprocedure from TAVR, patients with LBBB or PM were less likely to have improvement in their ejection fraction (net loss of −0.7% for LBBB and −5.7% for PPM compared to a net gain of 2.3% for no‐LBBB/PM (P = .02). Conclusion Patients who develop LBBB or require PM post‐TAVR with Edwards Sapien valves are less likely to improve New York Heart Association functional capacity and more likely to have no improvement or deterioration of their pre‐TAVR left ventricular ejection fraction.
Patients who develop left bundle branch block (LBBB) post‐transcatheter aortic valve replacement (TAVR) or require permanent pacemaker (PPM) with RV pacing are less likely to have improvement of New York Heart Association functional capacity and in their post‐TAVR ejection fraction as measured by echocardiography. Right bundle branch block is an independent risk factor for PPM implantation post‐TAVR. Patients who developed a LBBB or require a PM should have more vigilant observation and follow up.
Databáze: OpenAIRE
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