New-onset conduction block after transcatheter aortic valve replacement: A retrospective analysis in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Hang , WANG Huajun , SHI Fengwu , LIU Su , MA Qianli , AN Jinghui

1. Department of Cardiac Surgery, Second Hospital of Hebei Medical University, Shijiazhuang, 050000, P. R. China;

Corresponding author：

AN Jinghui, Email:

Keywords：

Transcatheter aortic valve replacement; conduction block; permanent pacemaker implantation

DOI：

10.7507/1007-4848.202311035

Video：

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Objective To 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 2016 to 2023 were collected, and the new-onset incidence of conduction block after TAVR was analyzed retrospectively. Results There were 352 patients of TAVR operation (256 patients of Venus-A, 69 patients of Vita-Flow, 27 patients of J-Valve), among whom 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%) 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 block is a common complication after TAVR, 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 also effectively reduce the new rate of postoperative conduction block and improve the overall success rate of TAVR surgery.

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12.	Glikson M, Nielsen JC, Kronborg MB, et al. 2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J, 2021, 42(35): 3427-3520.
13.	Siontis GC, Jüni P, Pilgrim T, et al. Predictors of permanent pacemaker implantation in patients with severe aortic stenosis undergoing TAVR: A meta-analysis. J Am Coll Cardiol, 2014, 64(2): 129-140.

1. 中国医师协会心血管内科医师分会结构性心脏病专业委员会. 经导管主动脉瓣置换术中国专家共识(2020更新版). 中国介入心脏病学杂志, 2020, 28(6): 301-309.
2. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2022, 43(7): 561-632.
3. 陈丹丹, 潘文志, 陈莎莎, 等. 结构性心脏病年度报告2022. 中华心脏与心律电子杂志, 2023, 11(3): 129-140.
4. Bowdish ME, D'Agostino RS, Thourani VH, et al. STS adult cardiac surgery database: 2021 update on outcomes, quality, and research. Ann Thorac Surg, 2021, 111(6): 1770-1780.
5. 潘佳君, 安朝, 唐小军, 等. 经导管主动脉瓣置换术后心脏传导阻滞及其并发症相关研究. 国际心血管病杂志, 2023, 50(1): 61-64.
6. 孔祥权, 高晓飞, 张娟, 等. 经导管主动脉瓣置换术相关新瓣膜的研究进展. 华西医学, 2023, 38(9): 1309-1313.
7. 戴晗怡, 朱齐丰, 刘先宝. 经导管主动脉瓣置换术后传导阻滞的研究现状. 华西医学, 2021, 36(9): 1167-1171.
8. Sammour Y, Krishnaswamy A, Kumar A, et al. Incidence, predictors, and implications of permanent pacemaker requirement after transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2021, 14(2): 115-134.
9. 党梦秋, 范嘉祺, 朱齐丰, 等. 《经导管主动脉瓣置换术中国专家共识(2020更新版)》解读. 心电与循环, 2021, 40(1): 1-5.
10. 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.
11. Chen S, Chau KH, Nazif TM. The incidence and impact of cardiac conduction disturbances after transcatheter aortic valve replacement. Ann Cardiothorac Surg, 2020, 9(6): 452-467.
12. Glikson M, Nielsen JC, Kronborg MB, et al. 2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J, 2021, 42(35): 3427-3520.
13. Siontis GC, Jüni P, Pilgrim T, et al. Predictors of permanent pacemaker implantation in patients with severe aortic stenosis undergoing TAVR: A meta-analysis. J Am Coll Cardiol, 2014, 64(2): 129-140.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesNew-onset conduction block after transcatheter aortic valve replacement: A retrospective analysis in a single center

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