Conduction disorders after aortic valve replacement with rapid-deployment bioprostheses: early occurrence and one-year evolution

Abstract

Background: Rapid-deployment bioprostheses represent one of the newest aortic valve substitutes introduced into clinical practice. The aim of this retrospective single-center study was to evaluate the occurrence of conduction disorders (CDs) after rapid-deployment aortic valve implantation at discharge and at 1-year follow-up, and to identify risk factors for CDs and permanent pacemaker implantation (PPI). Methods: All patients who reached 1-year follow-up after isolated or combined aortic valve replacement (AVR) with rapid-deployment bioprostheses (Intuity Elite, Edwards Lifesciences, Irvine, CA) at our institution were included in this study. Standard 12-lead electrocardiograms (ECGs) were recorded before the procedure (within 24 hours), after the procedure as soon as the patient was moved to the intensive care unit (ICU), every day during in-hospital stay and at 1-year follow-up. The primary endpoint was the incidence of postoperative CDs at discharge and at 1-year follow up. Patients were divided in two groups: those who developed the primary endpoint (Group CD) and those who didn't (Group Non-CD). Results: A total of 98 consecutive patients were included in the study. At discharge, the primary endpoint occurred in 40 patients (40.8%). In particular, new CDs and PPI occurred in 33 (33.7%) and in 7 (7.1%) patients, respectively. Valve size was the only independent predictor of primary endpoint at discharge. At 1-year, 30 patients (31.3%) presented with CDs or pacemaker-induced rhythm. In particular, in 25 patients of Group CD (64.1%), 1-year follow-up ECG revealed the persistence of the same CD as at discharge or pacemaker-induced rhythm, while 14 patients (35.9%) showed recovery of their CD. Age and prosthesis size were identified as independent predictors of CDs/pacemaker-induced rhythm at 1-year follow-up. Conclusions: According to our data, nearly 40% of patients develop a new CD after rapid-deployment aortic valve implantation. Of these, one third recover after one year. Bioprosthesis size and age were identified as independent risk factors for occurrence of CD after surgery.

Pearls, pitfalls, and surgical indications of the Intuity TM heart valve: A rapid deployment bioprosthesis. A systematic review of the literature

“…The incidence of more than moderate PVL at 5‐years was 0.6% for the Intuity and 1% for the Perceval valve. The incidence of PPI ranged between 4.1% and 8.45% (Supporting Information: Table ) 40–42 . The Intuity valve short‐term mortality ranged between 0.9% and 12.4% while long‐term mortality ranged between 2.6% and 20% (Supporting Information: Table ) 2,43–52 .…”

“…The 6). [40][41][42] The Intuity valve short-term mortality ranged between 0.9% and 12.4% while long-term mortality ranged between 2.6% and 20% (Supporting Information: Table 7). 2,[43][44][45][46][47][48][49][50][51][52] Surgical indications included aortic valve stenosis and mixed valve pathology (Figure 1).…”

Predictors of New and Persistent New Left Bundle Branch Block One Year after the Implantation of a Sutureless and Rapid-Deployment Aortic Valve Prosthesis

“…Considering the frequency of LBBB occurrence after surgical AVR, the frequency of new LBBB following AVR seems to be greater than in other studies comparing surgical patients, including the most recently published analysis comprising patients after SURD AVR, in which the frequency reached more than 17% [ 8 ]. In a study carried out by D’Onofrio et al, it was revealed that nearly 40% of patients develop a new conduction disorder after rapid-deployment aortic valve implantation [ 15 ]. Of these, 1/3 recover after 1 year.…”