Cardiac conduction block after transcatheter aortic valve replacement
10.16781/j.0258-879x.2019.08.0902
- Author:
Jia-Jun PAN
1
Author Information
1. Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University (Second Military Medical University)
- Publication Type:Journal Article
- Keywords:
Complete left bundle branch block;
Left ventricular ejection fraction;
Pacemaker implantation;
Transcatheter aortic valve replacement
- From:
Academic Journal of Second Military Medical University
2019;40(8):902-908
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the effectiveness of transcatheter aortic valve replacement (TAVR) using domestic valves for treating aortic valve stenosis or regurgitation, and to explore the incidence of cardiac conduction block after surgery and its influence on the prognosis of the patients. Methods The patients with severe aortic valve stenosis or regurgitation receiving TAVR surgery in our department from Sep. 2017 to Jan. 2018 were enrolled in this study. The TAVR surgery was performed with domestic valves (J-Valve or Venus-A), and the outcomes and incidence of complications were assessed after surgery. The patients were observed for the incidence of new-onset cardiac conduction block during and after TAVR and the recovery of arrhythmia during hospitalization. According to the presence of cardiac conduction block at discharge, the patients were divided into normal rhythm group and conduction block group. The baseline and postoperative characteristics, and left ventricular structure and function were compared between the two groups. Results Sixteen patients were enrolled in this study, including 12 in the normal rhythm group and 4 in the conduction block group. Brain natriuretic peptide ([1 114.87±802.32] pg/mL vs [530.39±276.26] pg/mL, P=0.026), aortic transvalvular pressure difference ([83.06±37.76] mmHg vs [24.14±9.73] mmHg, P<0.001; 1 mmHg=0.133 kPa) , maximum transvalvular velocity of aortic valve ([466.00±82.30] cm/s vs [249.30±43.98] cm/s, P<0.001) and left ventricular end-diastolic diameters ([5.41±0.83] cm vs [4.93±0.52] cm, P=0.010) were significantly decreased after TAVR. After TAVR, there was no or only mild aortic valve regurgitation. Two patients with renal insufficiency developed deterioration of renal function, and one of whom received hemodialysis treatment. There were no death, acute myocardial infarction, stroke, or severe vascular complications during the hospitalization. A total of 4 patients (25.00%) had new-onset cardiac conduction block, including 1 patient with complete atrioventricular block who recovered to complete left bundle branch block, 1 patient with intraventricular block who progressed to complete left bundle branch block, and 2 patients with complete left bundle branch block during hospitalization. At discharge, the 4 patients still had complete left bundle branch block. There were no patients requiring permanent pacemaker implantation during the hospitalization. There were no significant differences in the postoperative liver function, renal function, hemoglobin, brain natriuretic peptide, or cardiac structure and function between normal rhythm group and conduction block group (all P>0.05). Conclusion TAVR with domestic valves can effectively reduce the aortic transvalvular pressure difference with fewer complications. It may cause complete left bundle branch block, which has no significant influence on the short-term adverse cardiac events and cardiac function after operation.
