Conduction Disorders after Rapid Deployment Aortic Valve Replacement Compared to Conventional Aortic Valve Replacement

Abstract

Objectives We evaluated and compared early postprocedural and midterm incidence and evolution of atrioventricular and intraventricular conduction disorders following rapid deployment aortic valve replacement (RDAVR) and conventional aortic valve replacement (AVR).

Materials and Methods One hundred and forty-seven patients who underwent isolated rapid deployment AVR between 2017 and 2021 as well as 128 patients after conventional biological AVR in the same period were included in this study. ECGs recorded at baseline, discharge, and 12 months were retrospectively analyzed. Intrinsic rhythm, PQ interval, QRS duration, and atrioventricular and intraventricular conduction were evaluated and compared between both groups.

Results Patients in both groups had comparable Society of Thoracic surgeons risc (STS) scores (2.9 ± 1.6 vs. 3.1 ± 2.2, p = 0.32) and comparable baseline characteristics. The mean age was 73.4 ± 5.7 years in the RDAVR group and 74.2 ± 5.9 years in the AVR group, respectively. At baseline, the mean QRS width was 95.7 ± 25.5 ms in the RDAVR group, and 97.3 ± 23.5 ms in the AVR group, respectively (p = 0.590). At discharge, the mean QRS width in the RDAVR group was significantly increased with 117.4 ± 28.6 ms and a mean ΔQRS width of 21.7 ± 26.3 ms (p < 0.001) compared with baseline. No significant changes in QRS width were found in the AVR group with a mean value of 101.2 ± 24.1 ms and a mean ΔQRS width of 3.9 ± 23.9 ms at discharge (p = 0.193). The left bundle branch block (LBBB) was increased in the RDAVR group after 12 months (19.3% vs. 5.1%, p < 0.001). Permanent pacemaker implantation (PPI) rates were significantly higher in the RDAVR group after 12 months (hazard ratio (HR): 4.68; 95% CI: 2.23–7.43, p < 0.001). Mortality did not differ between both groups after 12 months (HR: 1.09; 95% CI: 0.46–1.83, p = 0.835)

Conclusion Patients after RDAVR showed significantly higher rates of LBBB and PPI after 12 months. However, higher mortality was not observed in the RDAVR group.

Keywords

aortic valve and root - heart valve surgery

Authors' Contribution

The authors confirm that they had full freedom of investigation, full control of the design of the study, methods used, outcome parameters and results, analysis of data, and production of the written report.

Publikationsverlauf

Eingereicht: 10. Juni 2024

Angenommen: 07. November 2024

Accepted Manuscript online:
08. November 2024

Artikel online veröffentlicht:
16. Januar 2025

• References

• 1 Schlömicher M, Bechtel M, Useini D. et al. Single-center outcomes with rapid deployment aortic valve replacement. Thorac Cardiovasc Surg 2020; 69: 405-411
• 2 Schlömicher M, Bechtel M, Taghiyev Z. et al. Intermediate outcomes after rapid deployment aortic valve replacement in multiple valve surgery. Thorac Cardiovasc Surg 2020; 68 (07) 595-601
• 3 Bechtel M, Schlömicher M, Moustafine V, Strauch JT. Rapid deployment aortic valve replacement in the setting of concomitant mitral valve procedures. Eur J Cardiothorac Surg 2017; 51 (04) 792-793
• 4 Schlömicher M, Taghiyev Z, AlJabery Y. et al. Rapid deployment aortic valve replacement in a minimal access setting: intermediate clinical and echocardiographic outcomes. Eur J Cardiothorac Surg 2018; 54 (02) 354-360
• 5 Schlömicher M, Bechtel M, Taghiyev Z. et al. The use of rapid deployment valves in combined aortic and mitral valve surgery: one-year clinical and echocardiographic outcomes. Innovations (Phila) 2017; 12 (03) 201-206
• 6 Andreas M, Coti I, Rosenhek R. et al. Intermediate-term outcome of 500 consecutive rapid-deployment surgical aortic valve procedures†. Eur J Cardiothorac Surg 2019; 55 (03) 527-533
• 7 Herry M, Laghlam D, Touboul O. et al. Pacemaker implantation after aortic valve replacement: rapid-deployment Intuity® compared to conventional bioprostheses. Eur J Cardiothorac Surg 2020; 58 (02) 335-342
• 8 Schlömicher M, Useini D, Haldenwang PL. et al. Outcomes in patients with left bundle branch block after rapid deployment aortic valve replacement. Thorac Cardiovasc Surg 2022; 71: 528-534
• 9 Surawicz B, Childers R, Deal BJ. et al; American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology, American College of Cardiology Foundation, Heart Rhythm Society, Endorsed by the International Society for Computerized Electrocardiology. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part III: intraventricular conduction disturbances: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. J Am Coll Cardiol 2009; 53 (11) 976-981
• 10 Brignole M, Auricchio A, Baron-Esquivias G. et al; ESC Committee for Practice Guidelines (CPG), Document Reviewers. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J 2013; 34 (29) 2281-2329
• 11 Kappetein AP, Head SJ, Généreux P. et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. J Am Coll Cardiol 2012; 60 (15) 1438-1454
• 12 Romano MA, Koeckert M, Mumtaz MA. et al; TRANSFORM Trial Investigators. Permanent pacemaker implantation after rapid deployment aortic valve replacement. Ann Thorac Surg 2018; 106 (03) 685-690
• 13 Coti I, Schukro C, Drevinja F. et al. Conduction disturbances following surgical aortic valve replacement with a rapid-deployment bioprosthesis. J Thorac Cardiovasc Surg 2020; 162: 803-811
• 14 Chamandi C, Barbanti M, Munoz-Garcia A. et al. Long-term outcomes in patients with new-onset persistent left bundle branch block following TAVR. JACC Cardiovasc Interv 2019; 12 (12) 1175-1184
• 15 Auffret V, Puri R, Urena M. et al. Conduction disturbances after transcatheter aortic valve replacement: current status and future perspectives. Circulation 2017; 136 (11) 1049-1069
• 16 van Rosendael PJ, Delgado V, Bax JJ. Pacemaker implantation rate after transcatheter aortic valve implantation with early and new-generation devices: a systematic review. Eur Heart J 2018; 39 (21) 2003-2013
• 17 Houthuizen P, Van Garsse LAFM, Poels TT. et al. Left bundle-branch block induced by transcatheter aortic valve implantation increases risk of death. Circulation 2012; 126 (06) 720-728
• 18 Schymik G, Tzamalis P, Bramlage P. et al. Clinical impact of a new left bundle branch block following TAVI implantation: 1-year results of the TAVIK cohort. Clin Res Cardiol 2015; 104 (04) 351-362
• 19 Carrabba N, Valenti R, Migliorini A. et al. Impact on left ventricular function and remodeling and on 1-year outcome in patients with left bundle branch block after transcatheter aortic valve im- plantation. Am J Cardiol 2015; 116 (01) 125-131
• 20 Franzoni I, Latib A, Maisano F. et al. Comparison of incidence and predictors of left bundle branch block after transcatheter aortic valve implantation using the CoreValve versus the Edwards valve. Am J Cardiol 2013; 112 (04) 554-559
• 21 Haldenwang P, Trampisch M, Schlömicher M. et al. Risk factors for acute kidney injury following TA-TAVI or minimally invasive aortic valve replacement: which procedure is less kidney damaging in elderly patients?. Thorac Cardiovasc Surg 2014; 62 (06) 482-488
• 22 Rivard L, Schram G, Asgar A. et al. Electrocardiographic and electrophysiological predictors of atrioventricular block after transcatheter aortic valve replacement. Heart Rhythm 2015; 12 (02) 321-329
• 23 Erdogan HB, Kayalar N, Ardal H. et al. Risk factors for requirement of permanent pacemaker implantation after aortic valve replacement. J Card Surg 2006; 21 (03) 211-215 , discussion 216–217
• 24 Koplan BA, Stevenson WG, Epstein LM, Aranki SF, Maisel WH. Development and validation of a simple risk score to predict the need for permanent pacing after cardiac valve surgery. J Am Coll Cardiol 2003; 41 (05) 795-801
• 25 Barnhart GR, Accola KD, Grossi EA. et al; TRANSFORM Trial Investigators. TRANSFORM (Multicenter Experience With Rapid Deployment Edwards INTUITY Valve System for Aortic Valve Replacement) US clinical trial: performance of a rapid deployment aortic valve. J Thorac Cardiovasc Surg 2017; 153 (02) 241-251.e2
• 26 Glaser N, Persson M, Dalén M, Sartipy U. Long-term outcomes associated with permanent pacemaker implantation after surgical aortic valve replacement. JAMA Netw Open 2021; 4 (07) e2116564