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 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. ResultsThere 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.
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 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). 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.