Sammour Yasser M, Lak Hassan, Chahine Johnny, Abushouk Abdelrahman, Chawla Sanchit, Kadri Amer, Alkhalaileh Feras, Kumar Sachin, Ghimire Bindesh, Svensson Lars, Popovic Zoran, Tarakji Khaldoun, Wazni Oussama, Reed Grant W, Yun James, Puri Rishi, Krishnaswamy Amar, Kapadia Samir R
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Catheter Cardiovasc Interv. 2023 Jan;101(1):187-196. doi: 10.1002/ccd.30488. Epub 2022 Nov 15.
New-onset left bundle branch block (LBBB) can develop after transcatheter aortic valve replacement (TAVR) resulting in worse outcomes.
Describe clinical and echocardiographic outcomes with new-onset LBBB after TAVR.
We included consecutive patients who underwent transfemoral-TAVR with SAPIEN-3 (S3) valve between April 2015 and December 2018. Exclusion criteria included pre-existing LBBB, right BBB, left anterior hemiblock, left posterior hemiblock, wide QRS ≥ 120ms, prior permanent pacemaker (PPM), and nontransfemoral access.
Among 612 patients, 11.4% developed new-onset LBBB upon discharge. The length of stay was longer with new-onset LBBB compared with no LBBB [3 (2-5) days versus 2 (1-3) days; p < 0.001]. New-onset LBBB was associated with higher rates of 30-day PPM requirement (18.6% vs. 5.4%; p < 0.001) and 1-year heart failure hospitalizations (10.7% vs. 4.4%; p = 0.033). There was no difference in 3-year mortality between both groups (30.9% vs. 30.6%; p = 0.829). Further, new-onset LBBB was associated with lower left ventricular ejection fraction (LVEF) at both 30 days (55.9 ± 11.4% vs. 59.3 ± 9%; p = 0.026) and 1 year (55 ± 12% vs. 60.1 ± 8.9%; p = 0.002). These changes were still present when we stratified patients according to baseline LVEF (≥50% or <50%). New-onset LBBBs were associated with a higher 1-year LV end-diastolic volume index (51.4 ± 18.6 vs. 46.4 ± 15.1 ml/m ; p = 0.036), and LV end-systolic volume index (23.2 ± 14.1 vs. 18.9 ± 9.7 ml/m ; p = 0.009). Compared with resolved new-onset LBBB, persistent new-onset LBBB was associated with worse LVEF and higher PPM at 1 year.
New-onset LBBB after S3 TAVR was associated with higher PPM requirement, worse LVEF, higher LV volumes, and increased heart failure hospitalizations, with no difference in mortality.
经导管主动脉瓣置换术（TAVR）后可出现新发左束支传导阻滞（LBBB），导致预后更差。
描述TAVR后新发LBBB的临床和超声心动图结果。
我们纳入了2015年4月至2018年12月期间连续接受经股动脉SAPIEN-3（S3）瓣膜TAVR的患者。排除标准包括既往存在LBBB、右束支传导阻滞、左前分支阻滞、左后分支阻滞、宽QRS≥120ms、既往永久性起搏器（PPM）以及非经股动脉途径。
在612例患者中，11.4%在出院时出现新发LBBB。与未发生LBBB相比，新发LBBB患者的住院时间更长[3（2 - 5）天对2（1 - 3）天；p < 0.001]。新发LBBB与30天PPM需求率较高（18.6%对5.4%；p < 0.001）和1年心力衰竭住院率较高（10.7%对4.4%；p = 0.033）相关。两组3年死亡率无差异（30.9%对30.6%；p = 0.829）。此外，新发LBBB在30天时（55.9±11.4%对59.3±9%；p = 0.026）和1年时（55±12%对60.1±8.9%；p = 0.002）均与较低的左心室射血分数（LVEF）相关。当我们根据基线LVEF（≥50%或<50%）对患者进行分层时，这些变化仍然存在。新发LBBB与较高的1年左心室舒张末期容积指数（51.4±18.6对46.4±15.1ml/m；p = 0.036）和左心室收缩末期容积指数（23.2±14.1对18.9±9.7ml/m；p = 0.009）相关。与新发LBBB消失的患者相比，持续性新发LBBB在1年时与更差的LVEF和更高的PPM相关。
S3 TAVR后新发LBBB与更高的PPM需求、更差的LVEF、更大的左心室容积以及增加的心力衰竭住院率相关，死亡率无差异。
