Cardiac conduction block is one of the most common perioperative complications of transcatheter aortic valve replacement (TAVR), a proportion of which will resolve spontaneously over time, but its incidence has not decreased with the iteration of instruments. It is associated with poor prognosis of patients. The prevention and management strategies of cardiac conduction block after TAVR are still being explored. This paper expounds the mechanism, influence, incidence, predictors, management of cardiac conduction block and indications, timing of permanent pacemaker implantation to provide a reference for the prevention and management of cardiac conduction block after TAVR in clinical practice.
ObjectiveTo analyze the impact of balloon post-dilation on cardiac conduction in patients undergoing transcatheter aortic valve replacement (TAVR). MethodsFrom June 2021 to December 2022, patients with severe aortic valve stenosis or regurgitation who underwent TAVR surgery using domestically produced valves at Xijing Hospital, Air Force Military Medical University were selected. The occurrence of intraoperative and postoperative cardiac conduction block was recorded. According to whether balloon post-dilation was performed during the surgery, patients were divided into the post-dilation group and the non-post-dilation group. The baseline data, postoperative cardiac conduction block occurrence, and cardiac function of the two groups were analyzed. ResultsA total of 126 patients were included, including 52 males and 74 females, with an average age of (66.6±7.6) years. There were 30 patients in the post-dilation group and 96 patients in the non-post-dilation group. On the first day after TAVR, the average QRS intervals in the post-dilation group and the non-post-dilation group were (105.6±13.8) ms and (125.9±28.2) ms, respectively (P=0.017). At discharge, the average PR intervals in the two groups were (168.7±36.8) ms and (192.1±44.2) ms, respectively (P=0.024). At discharge, 9 (7.1%) patients developed new atrioventricular block, 5 (4.0%) patients developed new complete right bundle branch block, and 33 (26.2%) patients developed new complete left bundle branch block. During hospitalization, 2 (1.6%) patients received permanent cardiac pacemakers, both of whom were in the non-post-dilation group. There was no statistical difference in postoperative left ventricular structure and function between the two groups (P>0.05). ConclusionPostoperative expansion using domestically produced interventional valves for TAVR do not increase the incidence of early atrioventricular block and permanent cardiac pacemaker implantation after valve implantation, and there are no significant changes in cardiac structure and function in patients with conduction block in the short term after surgery.
ObjectiveTo investigate the new-onset conduction block after transcatheter aortic valve replacement (TAVR) and summarize the relevant experience. Methods The perioperative data of TAVR patients in the Second Hospital of Hebei Medical University from January 2016 to February 2023 were collected, and the new-onset incidence of conduction block after TAVR was analyzed retrospectively. Results Finally 352 patients were included, including 225 males and 127 females, with an average age of (67.2±5.1) years, among whom 256 patients were treated with Venus-A valves, 69 patients with Vita-Flow valves, and 27 patients with J-Valve valves. There were 38 (10.8%) patients of new-onset postoperative block. There were 6 (1.7%) patients of new-onset postoperative grade Ⅲ atrioventricular block, including 5 (2.0%) patients of Venus-A and 1 (1.4%) patient of Vita-Flow. Conduction function was restored in 2 patients within 14 days after surgery, and failed to be restored in 4 patients, who then received permanent pacemaker implantation in the Department of Cardiology. There were 27 (7.7%) patients of new left bundle branch block after surgery, including 22 (8.6%) patients of Venus-A, 4 (5.8%) patients of Vita-Flow and 1 (3.7%) patient of J-Valve; and conduction function was restored within 7 days after surgery in 23 patients, and 5 (1.4%) patients developed new right bundle branch blocks after surgery including 4 (1.5%) patients of Venus-A and 1 (1.4%) patient of Vita-Flow. Conclusion New-onset conduction block is a common complication after TAVR, and the new-onset rate of left bundle branch block is the highest, followed by the grade Ⅲ atrioventricular block. Mastering reasonable methods and applying appropriate strategies can effectively reduce the new-onset rate of postoperative conduction block and improve the overall success rate of TAVR surgery.
ObjectiveTo investigate the mid-to-long-term clinical outcomes of elderly patients undergoing simultaneous valve-in-valve (ViV) implantation during transcatheter aortic valve replacement (TAVR), and to summarize relevant experience. MethodsClinical data of elderly patients who received TAVR at the Second Hospital of Hebei Medical University between January 2017 and January 2023 were collected. Patients were divided into a simple TAVR group and a ViV group according to whether concomitant ViV implantation was performed intraoperatively. Perioperative, postoperative 1-year and 3-year all-cause mortality, complications and echocardiographic hemodynamic parameters were compared between the two groups. A paired design was adopted for the 1-year and 3-year follow-up in the ViV group, and only patients with complete follow-up data at both time points were included in the study. The loss-to-follow-up rate was calculated, and follow-up bias was adjusted. ResultsA total of 428 patients were enrolled, including 407 patients in the simple TAVR group (298 males and 109 females), with a mean age of (67.6±6.3) years; and 21 patients in the ViV group (13 males and 8 females), with a mean age of (68.3±6.3) years. The overall 1-year follow-up rate was 91.8%, and the 3-year rate was 88.1%. In the simple TAVR group, 372 patients completed 1-year follow-up and 356 completed 3-year follow-up, and the cumulative loss-to-follow-up rate was 12.5% over 3 years. All patients in the ViV group finished both 1-year and 3-year follow-up. There were no statistically significant differences between the two groups in all-cause mortality at 1 and 3 years after surgery, distribution of paravalvular leakage (PVL) grade, permanent pacemaker implantation, heart failure readmission, mitral valve dysfunction, valve thrombosis or stroke incidence (P>0.05). No significant intergroup differences were observed in mean aortic transvalvular gradient, effective orifice area and left ventricular ejection fraction at each follow-up time point (P>0.05). Intragroup paired comparisons within the ViV group also showed no statistically significant differences in the all-cause mortality, complications or echocardiographic parameters between 1-year and 3-year follow-up (P>0.05). The incidence of intraoperative simultaneous ViV implantation in our center was 4.9%. The predisposing factors were, in descending order, isolated severe aortic regurgitation, bicuspid aortic valve and asymmetric annular calcification. The proportion of ViV implantation using the first-generation delivery system was markedly higher than that using the second-generation retrievable delivery system (76.2% vs. 23.8%). ConclusionSimultaneous ViV implantation during TAVR is a feasible technique for intraoperative management of PVL, which can significantly reduce the severity of PVL. It yields reliable mid-to-long-term outcomes in terms of all-cause mortality, conduction block, heart failure, stroke and valvular hemodynamic performance.
