Risk Factors for Delayed Atrioventricular Block after Aortic Valve Surgery: A Retrospective Study

Authors

  • Qiaoyun Wang Emergency Department, Jiaozhou Central Hospital of Qingdao, 266300 Qingdao, Shandong, China
  • Yuhuan Tian Operating Room, Qingdao Fifth People's Hospital, 266000 Qingdao, Shandong, China
  • Yuping Jiang Medical Record Department, Qingdao Fifth People's Hospital, 266000 Qingdao, Shandong, China

DOI:

https://doi.org/10.59958/hsf.7325

Keywords:

aortic valve, post-operation, atrioventricular block

Abstract

Objective: This study aimed to examine the potential factors that contribute to the occurrence of delayed high-grade atrioventricular block (DHAVB) following transcatheter aortic valve replacement (TAVR). Methods: A retrospective analysis was conducted on the clinical data of 115 patients who underwent TAVR at Jiaozhou Central Hospital of Qingdao Hospital between January 2018, and June 2023. A follow-up period of 30 days post-operation was observed for all patients. The patients were categorized into two groups on the basis of the occurrence of DHAVB: DHAVB group (n = 35) and control group (n = 80). The general clinical data preoperative and postoperative heart disease characteristics of the groups were compared. The risk factors associated with DHAVB after TAVR were analyzed. Results: The mean systolic blood pressure (SBP) level of the DHAVB group significantly increased compared with that of the control group, whereas the heart rate (HR) level significantly reduced (p < 0.05). The average preoperative left ventricular ejection fraction (LVEF) was significantly lower in the DHAVB group than in the control group (p < 0.05). The control group exhibited a significantly higher prevalence of preoperative QRS wave broadening, severe calcification of the aortic valve, and right bundle branch block than the control group (p < 0.05). Spearman's correlation and logistic regression analyses identified increased SBP, decreased HR, diminished LVEF, the presence of preoperative and postoperative right bundle branch block, and thickened interventricular septum were as risk factors for DHAVB in patients undergoing TAVR (p < 0.05). Conclusion: Close surveillance of blood pressure, heart rate, and cardiac function is recommended for individuals undergoing TAVR. Pre-operative and post-operative electrocardiography and echocardiography are valuable tools in identifying potential risk factors for DHAVB, offering a solid foundation for effective patient prognostic management.

References

Avvedimento M, Tang GHL. Transcatheter aortic valve replacement (TAVR): Recent updates. Progress in Cardiovascular Diseases. 2021; 69: 73–83.

Jack G, Arora S, Strassle PD, Sitammagari K, Gangani K, Yeung M, et al. Differences in Inpatient Outcomes After Surgical Aortic Valve Replacement at Transcatheter Aortic Valve Replacement (TAVR) and Non-TAVR Centers. Journal of the American Heart Association. 2019; 8: e013794.

Ziv-Baran T, Zelman RB, Dombrowski P, Schaub AE, Mohr R, Loberman D. Surgical versus trans-catheter aortic valve replacement (SAVR vs TAVR) in patients with aortic stenosis: Experience in a community hospital. Medicine. 2019; 98: e17915.

Dobson LE, Musa TA, Uddin A, Fairbairn TA, Bebb OJ, Swoboda PP, et al. The impact of trans-catheter aortic valve replacement induced left-bundle branch block on cardiac reverse remodeling. Journal of Cardiovascular Magnetic Resonance. 2017; 19: 22.

Fischer Q, Himbert D, Webb JG, Eltchaninoff H, Muñoz-García AJ, Tamburino C, et al. Impact of Preexisting Left Bundle Branch Block in Transcatheter Aortic Valve Replacement Recipients. Circulation. Cardiovascular Interventions. 2018; 11: e006927.

Muntané-Carol G, Portero-Portaz JJ, Alméndarez M, Pascual I, Junquera L, Alperi A, et al. Persistent Intraprocedural Atrioventricular Block in Patients Undergoing Transcatheter Aortic Valve Replacement. JACC. Cardiovascular Interventions. 2021; 14: 1502–1503.

Wang J, Liu S, Han X, Chen Y, Chen H, Wan Z, et al. Prognostic Outcome of New-Onset Left Bundle Branch Block After Transcatheter Aortic Valve Replacement in Patients With Aortic Stenosis: A Systematic Review and Meta-Analysis. Frontiers in Cardiovascular Medicine. 2022; 9: 842929.

Birgersdotter-Green U, Eskander MA. Delayed Atrioventricular Block Following Transcatheter Aortic Valve Replacement: Risk Stratification or Crystal Ball? Journal of the American College of Cardiology. 2019; 73: 2548–2549.

Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, et al. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Journal of the American College of Cardiology. 2019; 74: e51–e156.

Jang SY, Ju EY, Seo SR, Choi JY, Park SJ, Kim DK, et al. Changes in the etiology of valvular heart disease in the rapidly aging Korean population. International Journal of Cardiology. 2014; 174: 355–359.

Binder RK, Dweck M, Prendergast B. The year in cardiology: valvular heart disease. European Heart Journal. 2020; 41: 912–920.

Shrestha M, Maeding I, Höffler K, Koigeldiyev N, Marsch G, Siemeni T, et al. Aortic valve replacement in geriatric patients with small aortic roots: are sutureless valves the future? Interactive Cardiovascular and Thoracic Surgery. 2013; 17: 778–782.

Geuens L, Van Hoof L, Van De Bruaene A, Rega F, Meuris B, Verbrugghe P. Aortic valve replacement in non-elderly: the gap between reality, guidelines and evidence. European Journal of Cardio-Thoracic Surgery. 2023; 64: ezad318.

Gennari M, Tang GHL, Taramasso M, Russo G, Haager PK, Barbanti M, et al. Minimum requirements in emergency kits for bailout strategies in TAVR complications. Journal of Cardiac Surgery. 2022; 37: 2053–2059.

Auffret V, Puri R, Urena M, Chamandi C, Rodriguez-Gabella T, Philippon F, et al. Conduction Disturbances After Transcatheter Aortic Valve Replacement: Current Status and Future Perspectives. Circulation. 2017; 136: 1049–1069.

Gang UJO, Jøns C, Jørgensen RM, Abildstrøm SZ, Messier MD, Haarbo J, et al. Clinical significance of late high-degree atrioventricular block in patients with left ventricular dysfunction after an acute myocardial infarction–a Cardiac Arrhythmias and Risk Stratification After Acute Myocardial Infarction (CARISMA) substudy. American Heart Journal. 2011; 162: 542–547.

Kerola T, Eranti A, Aro AL, Haukilahti MA, Holkeri A, Junttila MJ, et al. Risk Factors Associated With Atrioventricular Block. JAMA Network Open. 2019; 2: e194176.

Alqarawi W, Sadek MM, Golian M, Hibbert B, Redpath CJ, Nair GM, et al. A new electrocardiographic definition of left bundle branch block (LBBB) in patients after transcatheter aortic valve replacement (TAVR). Journal of Electrocardiology. 2020; 63: 167–172.

Gu M, Hu Y, Hua W, Niu H, Zhou X, Zhang S. Electrocardiographic characteristics of distal His bundle pacing in a patient with left bundle branch block. Pacing and Clinical Electrophysiology. 2019; 42: 1594–1596.

Barone A, Grieco D, Gizzi A, Molinari L, Zaltieri M, Massaroni C, et al. A Simulation Study of the Effects of His Bundle Pacing in Left Bundle Branch Block. Medical Engineering & Physics. 2022; 107: 103847.

Sinhal A, Altwegg L, Pasupati S, Humphries KH, Allard M, Martin P, et al. Atrioventricular block after transcatheter balloon expandable aortic valve implantation. JACC. Cardiovascular Interventions. 2008; 1: 305–309.

Auffret V, Webb JG, Eltchaninoff H, Muñoz-García AJ, Himbert D, Tamburino C, et al. Clinical Impact of Baseline Right Bundle Branch Block in Patients Undergoing Transcatheter Aortic Valve Replacement. JACC. Cardiovascular Interventions. 2017; 10: 1564–1574.

Gulati R, Wang A. Left Bundle Branch Block Before Transcatheter Aortic Valve Replacement. Circulation. Cardiovascular Interventions. 2018; 11: e007361.

Kerola T, Nieminen T, Hartikainen J, Sotala P, Huikuri HV. Age and Gender as Determinants of the Conduction System Disease in the General Population. Europace. 2019; 21: 926–932.

Hamdan A, Guetta V, Klempfner R, Konen E, Raanani E, Glikson M, et al. Inverse Relationship Between Membranous Septal Length and the Risk of Atrioventricular Block in Patients Undergoing Transcatheter Aortic Valve Implantation. JACC. Cardiovascular Interventions. 2015; 8: 1218–1228.

Vijayakumar V, Santhoshini T, Govindarajulu D, Mushahida S. Anesthetic challenges in a pregnant patient with post mitral valve replacement, complete heart block, and coagulopathy coming for emergency cesarean section: A case report. Saudi Journal of Anaesthesia. 2019; 13: 237–239.

Siontis GCM, Jüni P, Pilgrim T, Stortecky S, Büllesfeld L, Meier B, et al. Predictors of permanent pacemaker implantation in patients with severe aortic stenosis undergoing TAVR: a meta-analysis. Journal of the American College of Cardiology. 2014; 64: 129–140.

Sammour Y, Sato K, Kumar A, Gajulapalli RD, Lak H, Chawla S, et al. Impact of baseline conduction abnormalities on outcomes after transcatheter aortic valve replacement with SAPIEN-3. Catheterization and Cardiovascular Interventions. 2021; 98: E127–E138.

Azzalini L, Ghoshhajra BB, Elmariah S, Passeri JJ, Inglessis I, Palacios IF, et al. The aortic valve calcium nodule score (AVCNS) independently predicts paravalvular regurgitation after transcatheter aortic valve replacement (TAVR). Journal of Cardiovascular Computed Tomography. 2014; 8: 131–140.

Voudris KV, Wong SC, Kaple R, Kampaktsis PN, de Biasi AR, Weiss JS, et al. Transapical transcatheter aortic valve replacement in patients with or without prior coronary artery bypass graft operation. Journal of Cardiothoracic Surgery. 2016; 11: 158.

Published

2024-05-10

How to Cite

Wang, Q., Tian, Y., & Jiang, Y. (2024). Risk Factors for Delayed Atrioventricular Block after Aortic Valve Surgery: A Retrospective Study. The Heart Surgery Forum, 27(5), E465-E472. https://doi.org/10.59958/hsf.7325

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