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Conduction disturbances in low-surgical-risk patients undergoing transcatheter aortic valve replacement with

Fourat Zouari1, Francisco Campelo-Parada2, Anthony Matta1

  • 1Department of Cardiology, Rangueil University Hospital, Toulouse, France.

Cardiovascular Intervention and Therapeutics
|July 7, 2020
PubMed

Insights

Conduction disturbances (CD) after transcatheter aortic valve replacement (TAVR) remain a concern, even in low-risk patients. Valve implantation depth, baseline QRS duration, and aortic gradient predict CD, impacting TAVR expansion.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Transcatheter aortic valve replacement (TAVR) has advanced, yet conduction disturbances (CD) persist at higher rates than surgical aortic valve replacement.
  • CD remains a significant barrier to expanding TAVR to younger, low-risk patient populations.

Purpose of the Study:

  • To investigate the incidence and predictors of CD in low-risk patients undergoing TAVR.
  • To compare CD rates between low-risk and intermediate-/high-risk patients undergoing TAVR.

Main Methods:

  • Retrospective analysis of 637 patients without pre-existing CD who underwent TAVR.
  • Subgroup analysis of 116 low-risk patients.
  • Assessment of CD at discharge and 1-year follow-up, including pacemaker implantation and new persistent left bundle branch block (LBBB).

Main Results:

  • Up to 25% of low-risk patients experienced persistent CD at discharge.
  • Pacemaker implantation and new persistent LBBB rates were similar between low-risk and intermediate-/high-risk groups.
  • Valve implantation depth, baseline QRS duration, and mean aortic transvalvular gradient were independent predictors of CD in low-risk patients.

Conclusions:

  • Low-risk patients undergoing TAVR exhibit similar CD rates to higher-risk groups.
  • Valve implantation depth is a key predictor of CD in this population.
  • Baseline QRS duration and aortic gradient also contribute to CD risk, necessitating careful patient selection and procedural monitoring.

Keywords:
Conduction disturbancesLBBBPacemakerTAVR

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