Influence of balloon post-dilatation on cardiac conduction in patients undergoing transcatheter aortic valve replacement: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XUE Wuchao , LIU Yang , JIN Ping , ZHAI Meng’en , LU Linhe , ZHU Yan ,  YANG Jian

Department of Cardiovascular Surgery, Xijing Hospital, Air Force Medical University, Xi’an, 710032, P. R. China;

Corresponding author：

YANG Jian, Email: yangjian1212@hotmail.com

Keywords：

Transcatheter aortic valve replacement; balloon post-dilatation; cardiac conduction block; permanent pacemaker implantation; left ventricular ejection fraction

DOI：

10.7507/1007-4848.202405025

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Objective To analyze the impact of balloon post-dilation on cardiac conduction in patients undergoing transcatheter aortic valve replacement (TAVR). Methods From 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. Results A total of 126 patients were included, including 83 males and 43 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). After TAVR, 9 (7.1%) patients developed new atrioventricular block, 5 (4.0%) patients developed complete right bundle branch block, and 33 (26.2%) patients developed 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). Conclusion Postoperative 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.

1.	Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med, 2019, 380(18): 1695-1705.
2.	Popma JJ, Deeb GM, Yakubov SJ, et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med, 2019, 380(18): 1706-1715.
3.	Forrest JK, Kaple RK, Tang GHL, et al. Three generations of self-expanding transcatheter aortic valves: A report from the STS/ACC TVT Registry. JACC Cardiovasc Interv, 2020, 13(2): 170-179.
4.	Hellhammer K, Piayda K, Afzal S, et al. The latest evolution of the medtronic CoreValve system in the era of transcatheter aortic valve replacement: Matched comparison of the Evolut PRO and Evolut R. JACC Cardiovasc Interv, 2018, 11(22): 2314-2322.
5.	Seiffert M, Fujita B, Avanesov M, et al. Device landing zone calcification and its impact on residual regurgitation after transcatheter aortic valve implantation with different devices. Eur Heart J Cardiovasc Imaging, 2016, 17(5): 576-584.
6.	Pollari F, Dell'Aquila AM, Söhn C, et al. Risk factors for paravalvular leak after transcatheter aortic valve replacement. J Thorac Cardiovasc Surg, 2019, 157(4): 1406-1415.
7.	Nombela-Franco L, Barbosa Ribeiro H, Allende R, et al. Role of balloon postdilation following trancatheter aortic valve implantation. Minerva Cardioangiol, 2013, 61(5): 499-512.
8.	Harrison JK, Hughes GC, Reardon MJ, et al. Balloon post-dilation following implantation of a self-expanding transcatheter aortic valve bioprosthesis. JACC Cardiovasc Interv, 2017, 10(2): 168-175.
9.	李瑞锋, 韩克, 张勇, 等. 经导管主动脉瓣置换术术后永久起搏器植入的预测因素Meta分析. 中国介入心脏病学杂志, 2021, 29(11): 624-633.Li RF, Han K, Zhang Y, et al. Predictors of permanent pacemaker implantation after transcatheter aortic valve replacement: A Meta-analysis. Chin J Interv Cardiol, 2021, 29(11): 624-633.
10.	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 (VARC-2). Eur J Cardiothorac Surg, 2012, 42(5): S45-S60.
11.	Nazif TM, Williams MR, Hahn RT, et al. Clinical implications of new-onset left bundle branch block after transcatheter aortic valve replacement: Analysis of the PARTNER experience. Eur Heart J, 2014, 35(24): 1599-1607.
12.	Gaede L, Blumenstein J, Liebetrau C, et al. Outcome after transvascular transcatheter aortic valve implantation in 2016. Eur Heart J, 2018, 39(8): 667-675.
13.	Faroux L, Chen S, Muntané-Carol G, et al. Clinical impact of conduction disturbances in transcatheter aortic valve replacement recipients: A systematic review and meta-analysis. Eur Heart J, 2020, 41(29): 2771-2781.
14.	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.
15.	Li J, Meng Z, Yan W, et al. Computational study of the balloon dilation steps on transcatheter aortic valve replacement. Front Bioeng Biotechnol, 2023 Dec 20: 11: 1333138.
16.	Van Mieghem NM, El Faquir N, Rahhab Z, et al. Incidence and predictors of debris embolizing to the brain during transcatheter aortic valve implantation. JACC Cardiovasc Interv, 2015, 8(5): 718-724.
17.	Nappi F, Mazzocchi L, Spadaccio C, et al. CoreValve vs. Sapien 3 transcatheter aortic valve replacement: A finite element analysis study. Bioengineering (Basel), 2021, 8(5): 52.
18.	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.
19.	Jilaihawi H, Zhao Z, Du R, et al. Minimizing permanent pacemaker following repositionable self-expanding transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2019, 12(18): 1796-1807.
20.	Athappan G, Patvardhan E, Tuzcu EM, et al. Incidence, predictors, and outcomes of aortic regurgitation after transcatheter aortic valve replacement: Meta-analysis and systematic review of literature. J Am Coll Cardiol, 2013, 61(15): 1585-1595.
21.	Giustino G, Van der Boon RM, Molina-Martin de Nicolas J, et al. Impact of permanent pacemaker on mortality after transcatheter aortic valve implantation: The PRAGMATIC (Pooled Rotterdam-Milan-Toulouse in Collaboration) pacemaker substudy. EuroIntervention, 2016, 12(9): 1185-1193.
22.	Forrest JK, Mangi AA, Popma JJ, et al. Early outcomes with the Evolut PRO repositionable self-expanding transcatheter aortic valve with pericardial wrap. JACC Cardiovasc Interv, 2018, 11(2): 160-168.
23.	Harrison JK, Hughes GC, Reardon MJ, et al. Balloon post-dilation following implantation of a self-expanding transcatheter aortic valve bioprosthesis. JACC Cardiovasc Interv, 2017, 10(2): 168-175.
24.	Toutouzas K, Synetos A, Tousoulis D, et al. Predictors for permanent pacemaker implantation after core valve implantation in patients without preexisting ECG conduction disturbances: The role of a new echocardiographic index. Int J Cardiol, 2014, 172(3): 601-603.
25.	Onishi T, Komori O, Ando T, et al. Effectiveness of high implantation of SAPIEN 3 in preventing pacemaker implantation: A propensity score analysis. Arch Cardiovasc Dis, 2023, 116(2): 79-87.
26.	Pollari F, Großmann I, Vogt F, et al. Risk factors for atrioventricular block after transcatheter aortic valve implantation: A single-centre analysis including assessment of aortic calcifications and follow-up. Europace, 2019, 21(5): 787-795.

1. Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med, 2019, 380(18): 1695-1705.
2. Popma JJ, Deeb GM, Yakubov SJ, et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med, 2019, 380(18): 1706-1715.
3. Forrest JK, Kaple RK, Tang GHL, et al. Three generations of self-expanding transcatheter aortic valves: A report from the STS/ACC TVT Registry. JACC Cardiovasc Interv, 2020, 13(2): 170-179.
4. Hellhammer K, Piayda K, Afzal S, et al. The latest evolution of the medtronic CoreValve system in the era of transcatheter aortic valve replacement: Matched comparison of the Evolut PRO and Evolut R. JACC Cardiovasc Interv, 2018, 11(22): 2314-2322.
5. Seiffert M, Fujita B, Avanesov M, et al. Device landing zone calcification and its impact on residual regurgitation after transcatheter aortic valve implantation with different devices. Eur Heart J Cardiovasc Imaging, 2016, 17(5): 576-584.
6. Pollari F, Dell'Aquila AM, Söhn C, et al. Risk factors for paravalvular leak after transcatheter aortic valve replacement. J Thorac Cardiovasc Surg, 2019, 157(4): 1406-1415.
7. Nombela-Franco L, Barbosa Ribeiro H, Allende R, et al. Role of balloon postdilation following trancatheter aortic valve implantation. Minerva Cardioangiol, 2013, 61(5): 499-512.
8. Harrison JK, Hughes GC, Reardon MJ, et al. Balloon post-dilation following implantation of a self-expanding transcatheter aortic valve bioprosthesis. JACC Cardiovasc Interv, 2017, 10(2): 168-175.
9. 李瑞锋, 韩克, 张勇, 等. 经导管主动脉瓣置换术术后永久起搏器植入的预测因素Meta分析. 中国介入心脏病学杂志, 2021, 29(11): 624-633.Li RF, Han K, Zhang Y, et al. Predictors of permanent pacemaker implantation after transcatheter aortic valve replacement: A Meta-analysis. Chin J Interv Cardiol, 2021, 29(11): 624-633.
10. 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 (VARC-2). Eur J Cardiothorac Surg, 2012, 42(5): S45-S60.
11. Nazif TM, Williams MR, Hahn RT, et al. Clinical implications of new-onset left bundle branch block after transcatheter aortic valve replacement: Analysis of the PARTNER experience. Eur Heart J, 2014, 35(24): 1599-1607.
12. Gaede L, Blumenstein J, Liebetrau C, et al. Outcome after transvascular transcatheter aortic valve implantation in 2016. Eur Heart J, 2018, 39(8): 667-675.
13. Faroux L, Chen S, Muntané-Carol G, et al. Clinical impact of conduction disturbances in transcatheter aortic valve replacement recipients: A systematic review and meta-analysis. Eur Heart J, 2020, 41(29): 2771-2781.
14. 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.
15. Li J, Meng Z, Yan W, et al. Computational study of the balloon dilation steps on transcatheter aortic valve replacement. Front Bioeng Biotechnol, 2023 Dec 20: 11: 1333138.
16. Van Mieghem NM, El Faquir N, Rahhab Z, et al. Incidence and predictors of debris embolizing to the brain during transcatheter aortic valve implantation. JACC Cardiovasc Interv, 2015, 8(5): 718-724.
17. Nappi F, Mazzocchi L, Spadaccio C, et al. CoreValve vs. Sapien 3 transcatheter aortic valve replacement: A finite element analysis study. Bioengineering (Basel), 2021, 8(5): 52.
18. 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.
19. Jilaihawi H, Zhao Z, Du R, et al. Minimizing permanent pacemaker following repositionable self-expanding transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2019, 12(18): 1796-1807.
20. Athappan G, Patvardhan E, Tuzcu EM, et al. Incidence, predictors, and outcomes of aortic regurgitation after transcatheter aortic valve replacement: Meta-analysis and systematic review of literature. J Am Coll Cardiol, 2013, 61(15): 1585-1595.
21. Giustino G, Van der Boon RM, Molina-Martin de Nicolas J, et al. Impact of permanent pacemaker on mortality after transcatheter aortic valve implantation: The PRAGMATIC (Pooled Rotterdam-Milan-Toulouse in Collaboration) pacemaker substudy. EuroIntervention, 2016, 12(9): 1185-1193.
22. Forrest JK, Mangi AA, Popma JJ, et al. Early outcomes with the Evolut PRO repositionable self-expanding transcatheter aortic valve with pericardial wrap. JACC Cardiovasc Interv, 2018, 11(2): 160-168.
23. Harrison JK, Hughes GC, Reardon MJ, et al. Balloon post-dilation following implantation of a self-expanding transcatheter aortic valve bioprosthesis. JACC Cardiovasc Interv, 2017, 10(2): 168-175.
24. Toutouzas K, Synetos A, Tousoulis D, et al. Predictors for permanent pacemaker implantation after core valve implantation in patients without preexisting ECG conduction disturbances: The role of a new echocardiographic index. Int J Cardiol, 2014, 172(3): 601-603.
25. Onishi T, Komori O, Ando T, et al. Effectiveness of high implantation of SAPIEN 3 in preventing pacemaker implantation: A propensity score analysis. Arch Cardiovasc Dis, 2023, 116(2): 79-87.
26. Pollari F, Großmann I, Vogt F, et al. Risk factors for atrioventricular block after transcatheter aortic valve implantation: A single-centre analysis including assessment of aortic calcifications and follow-up. Europace, 2019, 21(5): 787-795.

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