Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
Department of Cardiothoracic Surgery, New York University School of Medicine, New York, New York.
Ann Thorac Surg. 2018 Sep;106(3):685-690. doi: 10.1016/j.athoracsur.2018.03.055. Epub 2018 Apr 26.
Expandable, rapid deployment aortic valves may interfere with the cardiac conduction system, which can lead to permanent pacemaker implantation (PPI). We sought to characterize PPI after rapid deployment aortic valve replacement with the Edwards Intuity valve system (Edwards Lifesciences, Irvine, CA) and investigate associated factors.
We analyzed 708 patients from 29 centers in the Multicenter Experience With Rapid Deployment Edwards Intuity Valve System for Aortic Valve Replacement (TRANSFORM) trial undergoing rapid deployment aortic valve replacement with or without coronary artery bypass graft surgery without preexisting pacemakers. Intrinsic conduction status was recorded as well as PPI incidence through 1 year. The PPI indications were categorized based on expert review of patient PPI source documents. Multivariate analysis was conducted to identify characteristics associated with PPI.
After rapid deployment aortic valve replacement, the PPI incidence through 30 days (PPI) was 13.6%, with 10.9% due to atrioventricular block. In the 423 of 708 patients (59.7%) without any baseline conduction abnormalities, all-cause PPI was 8%, 5% for atrioventricular block. For PPIs inserted before discharge, the median time to PPI was 5 days, with 22% placed within 48 hours. Independent predictors of PPI were baseline right bundle branch block (odds ratio 7.35, p < 0.0001), female gender (2.62, p = 0.004), larger valve size (1.20, p = 0.016), and atrioventricular block (1.80, p = 0.062). Subset analysis revealed a greater than twofold difference in PPI among the largest enrolling centers.
Patient factors associated with PPI after rapid deployment aortic valve replacement were right bundle branch block, atrioventricular block, female gender, and larger valve size. Interestingly, a strong center-level effect was associated with PPI. This effect may reflect differences in practice patterns, such as postoperative drug management or timing to PPI. These findings provide a deeper understanding of PPI after rapid deployment aortic valve replacement and help guide clinical practice and patient management.
可扩张的快速部署主动脉瓣可能会干扰心脏传导系统，导致永久性起搏器植入（PPI）。我们旨在描述爱德华兹因蒂uity 瓣膜系统（爱德华生命科学公司，加利福尼亚州欧文）行快速部署主动脉瓣置换术后 PPI 的特征，并探讨相关因素。
我们分析了 29 个中心的 708 例接受快速部署主动脉瓣置换术的患者，其中包括行或不行冠状动脉旁路移植术的患者，且均无预置入起搏器。记录固有传导状态和 1 年内 PPI 的发生率。根据专家对患者 PPI 源文件的审查，对 PPI 指征进行分类。采用多变量分析确定与 PPI 相关的特征。
快速部署主动脉瓣置换术后 30 天内（PPI）的 PPI 发生率为 13.6%，其中 10.9%为房室传导阻滞。在 708 例患者中的 423 例（59.7%）无任何基线传导异常患者中，总 PPI 发生率为 8%，房室传导阻滞为 5%。对于出院前植入的 PPI，PPI 的中位时间为 5 天，22%在 48 小时内放置。PPI 的独立预测因素为基线右束支阻滞（优势比 7.35，p<0.0001）、女性（2.62，p=0.004）、更大的瓣膜尺寸（1.20，p=0.016）和房室传导阻滞（1.80，p=0.062）。亚组分析显示，在最大的入组中心之间，PPI 的差异超过两倍。
与快速部署主动脉瓣置换术后 PPI 相关的患者因素包括右束支阻滞、房室传导阻滞、女性和更大的瓣膜尺寸。有趣的是，PPI 与中心水平存在显著关联。这种效应可能反映了术后药物管理或 PPI 时机等实践模式的差异。这些发现加深了我们对快速部署主动脉瓣置换术后 PPI 的理解，有助于指导临床实践和患者管理。
