Incidence of Persistent Left Bundle Branch Block After Rapid-Deployment Aortic Valve Replacement

Area of Science:

• Cardiology
• Cardiac Surgery
• Medical Devices

Background:

• New onset of persistent left bundle branch block (NOP-LBBB) is a potential complication following rapid-deployment aortic valve replacement (RD-AVR).
• Understanding the incidence, prognosis, and predictive factors of NOP-LBBB is crucial for patient management after RD-AVR.

Purpose of the Study:

• To evaluate the incidence, prognosis, and predictive factors of new onset of persistent left bundle branch block (NOP-LBBB) after rapid-deployment aortic valve replacement (RD-AVR).

Main Methods:

• Observational, retrospective, single-center study of 274 patients undergoing RD-AVR.
• Utilized INTUITY or INTUITY Elite valves, with pre-operative and post-operative echocardiography and ECG monitoring.
• Multivariate and propensity matching analyses were employed to identify predictors and outcomes of NOP-LBBB.

Main Results:

• NOP-LBBB occurred in 21.2% of patients post-discharge.
• Independent predictors included older age, larger INTUITY valve diameter (≥23 mm), and INTUITY Elite implantation.
• NOP-LBBB was associated with increased dysrhythmic events and decreased left ventricular ejection fraction, but not with increased 1-year mortality or heart failure hospitalizations.

Conclusions:

• NOP-LBBB is a prevalent complication after RD-AVR in patients without prior conduction disorders.
• The INTUITY Elite valve is associated with a higher incidence of NOP-LBBB.
• Persistent NOP-LBBB may lead to high-grade conduction disorders and permanent pacemaker implantation but does not impact long-term mortality or heart failure hospitalizations.