Department of Cardiac Surgery, La Timone Hospital, Marseille, France.
Research Unit EA 3279, Aix-Marseille University, Public Health Service, Marseille, France.
Ann Thorac Surg. 2023 Jun;115(6):1446-1454. doi: 10.1016/j.athoracsur.2022.07.038. Epub 2022 Aug 8.
We evaluated 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).
This was an observational, retrospective, single-center study of 274 consecutive patients with no baseline ventricular conduction disorder and no previous permanent pacemaker implantation (PPI) who underwent RD-AVR with an INTUITY valve (n = 55) or INTUITY Elite Valve (n = 219) (Edwards Lifesciences). Transthoracic echocardiography and 12-lead electrocardiography was performed preoperatively, at discharge, and at 1-month and 1-year intervals. The incidence, prognosis, and predictive factors of NOP-LBBB were evaluated.
NOP-LBBB occurred in 58 patients (21.2%) after discharge. In multivariate analysis, age (P < .01), INTUITY valve diameter ≥23 mm (P = .02), and INTUITY Elite implantation (P = .01) were independent predictors of NOP-LBBB. By 1:1 propensity matching analysis between the NOP-LBBB group and the control group, there were no significant differences in 1-year overall mortality (P = .23), hospitalization for congestive heart failure (P = .99), or PPI (P = .99). NOP-LBBB exposed patients to a high rate of dysrhythmic events (12.1% vs 1.4%, P < .01) and was associated with a significant decrease in left ventricular ejection fraction (0.62 ± 0.095 vs 0.652 ± 0.0783, P = .02) without an impact on New York Heart Association functional status (1.25 ± 0.32 and 1.52 ± 0.70, P = .32). PPI was performed in 17 patients (6.2%) before discharge, including 14 NOP-LBBB patients.
NOP-LBBB after RD-AVR is prevalent in patients with no prior conduction disorders. INTUITY Elite is associated with a significantly higher rate of NOP-LBBB. The persistence of NOP-LBBB predisposed patients to the occurrence of high-grade conduction disorders and might have led to PPI but did not increase death or hospitalization for congestive heart failure.
我们评估了快速部署主动脉瓣置换术（RD-AVR）后新发持续性左束支传导阻滞（NOP-LBBB）的发生率、预后和预测因素。
这是一项观察性、回顾性、单中心研究，共纳入 274 例无基线室性传导障碍且无既往永久性起搏器植入（PPI）的连续患者，均接受了采用 INTUITY 瓣膜（n=55）或 INTUITY Elite 瓣膜（n=219）（爱德华兹生命科学公司）进行的 RD-AVR。术前、出院时以及 1 个月和 1 年时进行经胸超声心动图和 12 导联心电图检查。评估 NOP-LBBB 的发生率、预后和预测因素。
出院后 58 例（21.2%）患者出现 NOP-LBBB。多变量分析显示，年龄（P<.01）、INTUITY 瓣膜直径≥23 mm（P=.02）和 INTUITY Elite 植入（P=.01）是 NOP-LBBB 的独立预测因素。通过 NOP-LBBB 组与对照组的 1:1 倾向匹配分析，1 年总死亡率（P=.23）、充血性心力衰竭住院率（P=.99）或 PPI（P=.99）无显著差异。NOP-LBBB 暴露患者心律失常事件发生率较高（12.1% vs 1.4%，P<.01），左心室射血分数显著降低（0.62±0.095 vs 0.652±0.0783，P=.02），但纽约心脏协会功能状态无影响（1.25±0.32 和 1.52±0.70，P=.32）。17 例（6.2%）患者在出院前进行了 PPI，其中 14 例为 NOP-LBBB 患者。
RD-AVR 后新发持续性左束支传导阻滞在无先前传导障碍的患者中较为常见。INTUITY Elite 与更高的 NOP-LBBB 发生率显著相关。NOP-LBBB 的持续存在使患者更容易发生高级别传导障碍，并可能导致 PPI，但并未增加死亡或充血性心力衰竭住院率。
