Baranov Aleksey A, Badoian Aram G, Khelimskii Dmitrii A, Tsydenova Aryuna Yu, Peregudov Ivan S, Beloborodov Vladimir V, Filippenko Aleksey G, Khalkhozhaev Toyche U, Krestyaninov Oleg V
Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russian Federation.
Braz J Cardiovasc Surg. 2025 May 30;40(3):e20240187. doi: 10.21470/1678-9741-2024-0187.
The clinical significance of new-onset left bundle branch block (LBBB) after transcatheter aortic valve replacement (TAVR) remains controversial. In the presented study, we aimed to assess the impact of new LBBB on clinical outcomes after TAVR.
A total of 473 patients underwent TAVR for severe aortic stenosis between 2015 and 2023. According to the exclusion criteria, the study cohort comprised of 322 patients for analysis. The primary endpoint was cardiovascular death, with secondary endpoints including all-cause mortality and permanent pacemaker implantation (PPI) during follow-up.
Patients with new LBBB had a significantly smaller indexed aortic valve area (0.3 ± 0.1 vs. 0.4 ± 0.1, P < 0.01) and interventricular membranous septum length (6.2 ± 1.6 vs. 6.9 ± 1.8, P < 0.01). By multivariable analysis, new LBBB remained an independent predictor of cardiovascular death (hazard ratio [HR] 7.09, 95% confidence interval [CI] 1.16 - 43.50, P = 0.03) during the 2.9-year follow-up period. There were no significant differences in the incidence of all-cause mortality (HR 0.48, 95% CI 0.17 - 1.37, P = 0.16) and PPI (HR 2.61, 95% CI 0.85 - 0.80, P = 0.08) between patients with new LBBB compared to those without it.
New LBBB after TAVR procedure is associated with an increased risk of death from cardiovascular causes, but it did not increase the risk of all-cause mortality and PPI over the long-term period.
经导管主动脉瓣置换术（TAVR）后新发左束支传导阻滞（LBBB）的临床意义仍存在争议。在本研究中，我们旨在评估新发LBBB对TAVR术后临床结局的影响。
2015年至2023年间，共有473例患者因严重主动脉瓣狭窄接受了TAVR。根据排除标准，研究队列包括322例患者进行分析。主要终点是心血管死亡，次要终点包括随访期间的全因死亡率和永久起搏器植入（PPI）。
新发LBBB患者的主动脉瓣面积指数明显较小（0.3±0.1 vs. 0.4±0.1，P<0.01），室间隔膜部长度较短（6.2±1.6 vs. 6.9±1.8，P<0.01）。通过多变量分析，新发LBBB在2.9年的随访期内仍然是心血管死亡的独立预测因素（风险比[HR] 7.09，95%置信区间[CI] 1.16 - 43.50，P = 0.03）。新发LBBB患者与未发生新发LBBB的患者相比，全因死亡率（HR 0.48，95% CI 0.17 - 1.37，P = 0.16）和PPI（HR 2.61，95% CI 0.85 - 0.80，P = 0.08）的发生率没有显著差异。
TAVR术后新发LBBB与心血管原因导致的死亡风险增加相关，但长期来看，它并未增加全因死亡率和PPI的风险。
