Vilalta Victoria, Cediel Germán, Mohammadi Siamak, López Helena, Kalavrouziotis Dimitri, Resta Helena, Dumont Eric, Voisine Pierre, Philippon François, Escabia Claudia, Borrellas Andrea, Alperi Alberto, Fernandez-Nofrerias Eduard, Carrillo Xavier, Panagides Vassili, Bayes-Genis Antoni, Rodés-Cabau Josep
Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
Heart. 2022 Dec 22;109(2):143-150. doi: 10.1136/heartjnl-2022-321191.
To evaluate the incidence, predictive factors and prognostic value of new-onset persistent left bundle branch block (NOP-LBBB) in patients undergoing sutureless surgical aortic valve replacement (SU-SAVR).
A total of 329 consecutive patients without baseline conduction disturbances or previous permanent pacemaker implantation (PPI) who underwent SU-SAVR with the Perceval valve (LivaNova Group, Saluggia, Italy) in two centres from 2013 to 2019 were included. Patients were on continuous ECG monitoring during hospitalisation and 12-lead ECG was performed after the procedure and at hospital discharge. NOP-LBBB was defined as a new postprocedural LBBB that persisted at hospital discharge. Baseline, procedural and follow-up clinical and echocardiography data were collected in a dedicated database.
New-onset LBBB was observed in 115 (34.9%) patients, and in 76 (23.1%) persisted at hospital discharge. There were no differences in baseline and procedural characteristics between patients with (n=76) and without (n=253) NOP-LBBB. After a median follow-up of 3.3 years (2.3-4.4 years), patients with NOP-LBBB had a higher incidence of PPI (14.5% vs 6.3%, p=0.016), but exhibited similar rates of all-cause mortality (19.4% vs 19.2%, p=0.428), cardiac mortality (8.1% vs 9.4%, p=0.805) and heart failure readmission (21.0% vs 23.2%, p=0.648), compared with the no/transient LBBB group. NOP-LBBB was associated with a decrease in left ventricular ejection fraction (LVEF) at 1-year follow-up (delta: -5.7 vs +0.2, p<0.001).
NOP-LBBB occurred in approximately a quarter of patients without prior conduction disturbances who underwent SU-SAVR and was associated with a threefold increased risk of PPI along with a negative impact on LVEF at follow-up.
评估接受无缝合外科主动脉瓣置换术（SU-SAVR）患者中新发持续性左束支传导阻滞（NOP-LBBB）的发生率、预测因素及预后价值。
纳入2013年至2019年在两个中心接受Perceval瓣膜（意大利利瓦诺瓦集团，萨卢贾）SU-SAVR的329例无基线传导障碍或既往未植入永久性起搏器（PPI）的连续患者。患者住院期间持续进行心电图监测，术后及出院时进行12导联心电图检查。NOP-LBBB定义为术后新发且出院时仍持续存在的左束支传导阻滞。在专用数据库中收集基线、手术及随访的临床和超声心动图数据。
115例（34.9%）患者出现新发左束支传导阻滞，其中76例（23.1%）出院时仍持续存在。有NOP-LBBB（n=76）和无NOP-LBBB（n=253）的患者在基线和手术特征方面无差异。中位随访3.3年（2.3 - 4.4年）后，与无/短暂性左束支传导阻滞组相比，NOP-LBBB患者PPI发生率更高（14.5%对6.3%，p=0.016），但全因死亡率（分别为19.4%和19.2%，p=0.428）、心脏死亡率（分别为8.1%和9.4%，p=0.805）及心力衰竭再入院率（分别为21.0%和23.2%，p=0.648）相似。NOP-LBBB与1年随访时左心室射血分数（LVEF）降低相关（差值：-5.7对+0.2，p<0.001）。
在未发生过传导障碍且接受SU-SAVR的患者中，约四分之一出现NOP-LBBB，其与PPI风险增加三倍相关，且对随访时的LVEF有负面影响。
