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Related Concept Videos

Aortic Regurgitation III: Medical Management01:25

Aortic Regurgitation III: Medical Management

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Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
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Aneurysm III: Interprofessional Care01:26

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Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
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Aortic Regurgitation I: Introduction01:15

Aortic Regurgitation I: Introduction

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IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
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Mitral Stenosis I: Introduction01:22

Mitral Stenosis I: Introduction

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Mitral Valve Stenosis (MVS) is a heart condition where the mitral valve narrows, impeding blood circulation from the left atrium to the left ventricle. The etiology and pathophysiology of this condition are multifaceted, leading to a cascade of cardiovascular complications.Causes of Mitral Valve StenosisRheumatic Heart Disease: It is the main cause of mitral valve stenosis, particularly in developing nations. This condition arises from rheumatic fever, an inflammatory illness resulting from...
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Aortic Regurgitation IV: Nursing Management01:17

Aortic Regurgitation IV: Nursing Management

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A nurse managing a patient with aortic regurgitation begins with a comprehensive assessment, including a review of the patient's medical history, family history, and lifestyle factors. During the cardiac examination, the nurse listens for heart sounds and checks for signs of valve abnormalities. The nurse also observes for symptoms such as dyspnea, orthopnea, and paroxysmal nocturnal dyspnea and assesses the patient's endurance and daily activity tolerance.Based on the findings, the nurse...
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Mitral Valve Prolapse I: Introduction01:27

Mitral Valve Prolapse I: Introduction

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IntroductionThe mitral valve, one of the heart's four valves, regulates blood flow. These valves have flaps that open and close to direct blood properly through the heart and body. During each heartbeat, the flaps open for blood to pass through and seal shut to prevent backflow. Specifically, the mitral valve opens to allow blood flow from the heart's upper left chamber to the lower left chamber. It then closes securely as the lower left chamber contracts to pump blood to the body, preventing...
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Related Experiment Video

Updated: Sep 4, 2025

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
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New-onset persistent left bundle branch block following sutureless aortic valve replacement.

Victoria Vilalta1,2, Germán Cediel1, Siamak Mohammadi3

  • 1Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.

Heart (British Cardiac Society)
|July 16, 2022
PubMed
Summary

New-onset persistent left bundle branch block (NOP-LBBB) after sutureless surgical aortic valve replacement (SU-SAVR) affects nearly a quarter of patients. This condition increases the need for permanent pacemakers but does not impact mortality rates.

Keywords:
Aortic Valve StenosisHeart Valve ProsthesisOutcome Assessment, Health CarePacemaker, Artificial

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Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Electrophysiology

Background:

  • Sutureless surgical aortic valve replacement (SU-SAVR) is an alternative to traditional AVR.
  • New-onset left bundle branch block (NOP-LBBB) is a potential complication following cardiac procedures.
  • Understanding the implications of NOP-LBBB after SU-SAVR is crucial for patient management.

Purpose of the Study:

  • To determine the incidence of new-onset persistent left bundle branch block (NOP-LBBB) in patients undergoing SU-SAVR.
  • To identify predictive factors for NOP-LBBB.
  • To evaluate the prognostic significance of NOP-LBBB after SU-SAVR.

Main Methods:

  • A cohort of 329 patients without baseline conduction issues undergoing SU-SAVR with the Perceval valve were analyzed.
  • Patients were monitored post-procedure, with ECGs performed during hospitalization and at discharge.
  • NOP-LBBB was defined as LBBB present post-procedure and persisting at discharge. Clinical and echocardiographic data were collected.

Main Results:

  • New-onset LBBB occurred in 34.9% of patients, persisting in 23.1% (n=76) at discharge.
  • No baseline or procedural differences were found between NOP-LBBB and no/transient LBBB groups.
  • At a median 3.3-year follow-up, NOP-LBBB patients had higher rates of permanent pacemaker implantation (PPI) (14.5% vs 6.3%) but similar all-cause mortality, cardiac mortality, and heart failure readmissions.
  • NOP-LBBB was linked to a significant decrease in left ventricular ejection fraction (LVEF) at 1-year follow-up.

Conclusions:

  • New-onset persistent left bundle branch block (NOP-LBBB) occurs in approximately 23% of patients undergoing SU-SAVR without prior conduction disturbances.
  • NOP-LBBB is associated with a threefold increased risk of permanent pacemaker implantation (PPI).
  • NOP-LBBB negatively impacts left ventricular ejection fraction (LVEF) at follow-up, despite similar mortality and heart failure readmission rates compared to patients without persistent LBBB.