Development of advanced conduction disturbances following balloon‐expandable transcatheter aortic valve replacement leads to poorer clinical outcomes
Abstract Background Transcatheter aortic valve replacement (TAVR) is a reliable method of treating patients with severe aortic stenosis, but is associated with postprocedure conduction defects. Objective The purpose of this study was to compare clinical outcomes in patients who developed advanced co...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-08-01
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| Series: | Journal of Arrhythmia |
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| Online Access: | https://doi.org/10.1002/joa3.12383 |
| _version_ | 1818315819212341248 |
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| author | Hasan Ashraf Floyd D. Fortuin John Sweeney Patrick A. DeValeria Louis A. Lanza Gary Ramsay Pedro Maranzano Lorna Patrick Luis R. Scott |
| author_facet | Hasan Ashraf Floyd D. Fortuin John Sweeney Patrick A. DeValeria Louis A. Lanza Gary Ramsay Pedro Maranzano Lorna Patrick Luis R. Scott |
| author_sort | Hasan Ashraf |
| collection | DOAJ |
| description | Abstract Background Transcatheter aortic valve replacement (TAVR) is a reliable method of treating patients with severe aortic stenosis, but is associated with postprocedure conduction defects. Objective The purpose of this study was to compare clinical outcomes in patients who developed advanced conduction defects post‐TAVR to those who did not. Methods We conducted a retrospective chart review of 243 patients who underwent balloon‐expandable TAVR with the Edwards Sapien valve to determine the incidence of advanced conduction defects in our cohort. We compared clinical outcomes including overall mortality, improvement in symptomatology, and improvement in left ventricular ejection fraction. Results Among the 243 patients included in the study, 9.1% (22/243) required permanent pacemaker (PPM); 19.8% (48/243) developed left bundle branch block (LBBB), and 71.2% (173/243) did not develop any permanent advanced conduction defects. Overall 1‐year mortality was similar across all three groups. There was significant improvement in New York Heart Association functional capacity of all groups post‐TAVR, but this was much less in the PPM group (45.5% vs 68.8%, P = .04). Postprocedure from TAVR, patients with LBBB or PM were less likely to have improvement in their ejection fraction (net loss of −0.7% for LBBB and −5.7% for PPM compared to a net gain of 2.3% for no‐LBBB/PM (P = .02). Conclusion Patients who develop LBBB or require PM post‐TAVR with Edwards Sapien valves are less likely to improve New York Heart Association functional capacity and more likely to have no improvement or deterioration of their pre‐TAVR left ventricular ejection fraction. |
| first_indexed | 2024-12-13T09:11:35Z |
| format | Article |
| id | doaj.art-66de92b687fc445988082140eb7abbc7 |
| institution | Directory Open Access Journal |
| issn | 1880-4276 1883-2148 |
| language | English |
| last_indexed | 2024-12-13T09:11:35Z |
| publishDate | 2020-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Arrhythmia |
| spelling | doaj.art-66de92b687fc445988082140eb7abbc72022-12-21T23:52:56ZengWileyJournal of Arrhythmia1880-42761883-21482020-08-0136475576110.1002/joa3.12383Development of advanced conduction disturbances following balloon‐expandable transcatheter aortic valve replacement leads to poorer clinical outcomesHasan Ashraf0Floyd D. Fortuin1John Sweeney2Patrick A. DeValeria3Louis A. Lanza4Gary Ramsay5Pedro Maranzano6Lorna Patrick7Luis R. Scott8Department of Cardiovascular Medicine Mayo Clinic Phoenix AZ USADepartment of Cardiovascular Medicine Mayo Clinic Phoenix AZ USADepartment of Cardiovascular Medicine Mayo Clinic Phoenix AZ USADepartment of Cardiovascular Surgery Mayo Clinic Phoenix AZ USADepartment of Cardiovascular Surgery Mayo Clinic Phoenix AZ USADepartment of Cardiovascular Medicine Mayo Clinic Phoenix AZ USADepartment of Cardiovascular Medicine Mayo Clinic Phoenix AZ USADepartment of Cardiovascular Medicine Mayo Clinic Phoenix AZ USADepartment of Cardiovascular Medicine Mayo Clinic Phoenix AZ USAAbstract Background Transcatheter aortic valve replacement (TAVR) is a reliable method of treating patients with severe aortic stenosis, but is associated with postprocedure conduction defects. Objective The purpose of this study was to compare clinical outcomes in patients who developed advanced conduction defects post‐TAVR to those who did not. Methods We conducted a retrospective chart review of 243 patients who underwent balloon‐expandable TAVR with the Edwards Sapien valve to determine the incidence of advanced conduction defects in our cohort. We compared clinical outcomes including overall mortality, improvement in symptomatology, and improvement in left ventricular ejection fraction. Results Among the 243 patients included in the study, 9.1% (22/243) required permanent pacemaker (PPM); 19.8% (48/243) developed left bundle branch block (LBBB), and 71.2% (173/243) did not develop any permanent advanced conduction defects. Overall 1‐year mortality was similar across all three groups. There was significant improvement in New York Heart Association functional capacity of all groups post‐TAVR, but this was much less in the PPM group (45.5% vs 68.8%, P = .04). Postprocedure from TAVR, patients with LBBB or PM were less likely to have improvement in their ejection fraction (net loss of −0.7% for LBBB and −5.7% for PPM compared to a net gain of 2.3% for no‐LBBB/PM (P = .02). Conclusion Patients who develop LBBB or require PM post‐TAVR with Edwards Sapien valves are less likely to improve New York Heart Association functional capacity and more likely to have no improvement or deterioration of their pre‐TAVR left ventricular ejection fraction.https://doi.org/10.1002/joa3.12383clinical outcomesleft bundle branch blockpacemakerright bundle branch blockTAVR |
| spellingShingle | Hasan Ashraf Floyd D. Fortuin John Sweeney Patrick A. DeValeria Louis A. Lanza Gary Ramsay Pedro Maranzano Lorna Patrick Luis R. Scott Development of advanced conduction disturbances following balloon‐expandable transcatheter aortic valve replacement leads to poorer clinical outcomes Journal of Arrhythmia clinical outcomes left bundle branch block pacemaker right bundle branch block TAVR |
| title | Development of advanced conduction disturbances following balloon‐expandable transcatheter aortic valve replacement leads to poorer clinical outcomes |
| title_full | Development of advanced conduction disturbances following balloon‐expandable transcatheter aortic valve replacement leads to poorer clinical outcomes |
| title_fullStr | Development of advanced conduction disturbances following balloon‐expandable transcatheter aortic valve replacement leads to poorer clinical outcomes |
| title_full_unstemmed | Development of advanced conduction disturbances following balloon‐expandable transcatheter aortic valve replacement leads to poorer clinical outcomes |
| title_short | Development of advanced conduction disturbances following balloon‐expandable transcatheter aortic valve replacement leads to poorer clinical outcomes |
| title_sort | development of advanced conduction disturbances following balloon expandable transcatheter aortic valve replacement leads to poorer clinical outcomes |
| topic | clinical outcomes left bundle branch block pacemaker right bundle branch block TAVR |
| url | https://doi.org/10.1002/joa3.12383 |
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