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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
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Impact of pre-existing right or left bundle branch block on patients undergoing surgical aortic valve replacement

Eilon Ram1,2, Yael Peled3, Irena Sarantsev1

  • 1Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|February 15, 2022
PubMed

Insights

Pre-existing bundle branch block increases pacemaker implantation and mortality risk after aortic valve replacement. Patients with bundle branch block face poorer long-term survival compared to those without this conduction abnormality.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Electrophysiology

Background:

  • Pre-existing bundle branch block (BBB) is a common finding in patients undergoing aortic valve (AV) replacement.
  • Limited contemporary data exist on the prognostic impact of BBB on clinical outcomes post-AV replacement.

Purpose of the Study:

  • To evaluate the impact of pre-existing left or right bundle branch block on clinical outcomes in patients undergoing AV replacement.

Main Methods:

  • Retrospective analysis of 2704 patients undergoing AV replacement between 2004 and 2020.
  • Comparison of clinical outcomes between patients with and without pre-existing bundle branch block.

Main Results:

  • Patients with pre-existing bundle branch block (7.5%) had higher in-hospital mortality (5.9% vs 2.9%, P=0.032) and significantly more new pacemaker implantations (28.6% vs 7.5% vs 2.8%, P<0.001).
  • Left bundle branch block was associated with higher mortality (11.9% vs 4.3%, P=0.003) compared to right bundle branch block.
  • The 10-year cumulative survival rate was lower for patients with bundle branch block (76.8% vs 82.8%, P=0.042).

Conclusions:

  • Pre-existing bundle branch block is associated with increased pacemaker implantation and all-cause mortality after AV replacement.
  • Patients with bundle branch block have worse long-term survival following AV replacement compared to those without conduction disturbances.
Abstract

Keywords:
Aortic valve replacementLeft bundle branch blockPermanent pacemaker implantationRight bundle branch block

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