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

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

Corresponding author：

AN Jinghui, Email: Anjinghui2009@126.com

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 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.

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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.Dai HY, Zhu QF, LIU XB. Research status of cardiac conduction block after transcatheter aortic valve replacement. West China Med J, 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.
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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.

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.Professional Committee of Structural Heart Disease, Branch of Cardiovascular Physicians, Chinese Medical Doctor Association. Chinese expert consensus on transcatheter aortic valve replacement (2020 Update edition). Chin J Intervent Cardiol, 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.Chen DD, Pan WZ, Chen SS, et al. Structural heart disease annual report 2022. Chin J Heart Rhythm (Electron Ed), 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.Pan JJ, An C, Tang XX, et al. Heart block and its complications after transcatheter aortic valve replacement. Int J Cardiovasc Dis, 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.Kong XQ, Gao XF, Zhang J, et al. Research progress of transcatheter aortic valve replacement-related new valve prostheses. West China Med J, 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.Dai HY, Zhu QF, LIU XB. Research status of cardiac conduction block after transcatheter aortic valve replacement. West China Med J, 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.Dang MQ, Fan JQ, Zhu QF, et al. Interpretation of consensus of Chinese experts on transcatheter aortic vaIve repIacement (2020 update). J Electrocardiol Circ, 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

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