Evolution and analysis of the transcatheter aortic valve implant

13 de February de 2020

The Transcatheter Aortic Valve Implantation (TAVI) is emerging as the most frequent approach to the treatment of aortic stenosis, which is the most frequent valvular disease and in increasing prevalence given population aging.

One of the most frequent drawback of the TAVI procedure is cardiac conduction alterations, which, although not prognostically serious, involve resource consumption with eventual pacemaker implantation in 5-15% of patients. The most frequent conduction disorder (CD), new-onset persistent left bundle branch block occurs in 25% of the procedures and it has been associated with an increased risk of advanced CD requiring permanent pacemaker implantation (PPI) and may induce a reduction in ventricular function.

This multicenter collaborative study published in the American Journal of Cardiology, sought to determine, in patients with persistent left bundle branch block after TAVI, the incidence and factors associated with its reversibility or pacemaker implantation at 1 year of tracing.

In this study the hospitals of Canada, USA, France and Spain have participated. The study has been led by the Quebec Heart and Lung Institute Laval University by Dr. Josep Rodés senior researcher at TAVI. Given the limited caseload of TAVI per center, these network studies are necessary to achieve the necessary sample sizes.

This study is part of a line of research already initiated with the MARE study (J Am Coll Cardiol Cardiovasc Interv 2018; 11: 1495-1505) in which the Marqués de Valdecilla University Hospital also participated and whose research was conducted by Dr. Gabriela Veiga Fernandez.

The study concluded that the new persistent left bundle branch block after TAVI was resolved in one third of the patients a year of follow-up, but no clinical or electrocardiographic variable was associated with recovery. In contrast, a non-sinus rhythm at the start of the study and a longer prolongation in the PR segment were associated with a higher risk of requiring a pacemaker implant within the year after TAVI.

Ref. Late Electrocardiographic Changes in Patients With New-Onset Left Bundle Branch Block Following Transcatheter Aortic Valve Implantation. Faroux L, Muntané-Carol G1, Urena M, Nombela-Franco L, Amat-Santos I, Kleiman N, Munoz-Garcia A, Atienza F, Serra V, Deyell MW, Veiga-Fernandez G, Masson JB, Canadas-Godoy V, Himbert D, Fischer Q, Castrodeza J, Elizaga J, Pascual JF, Webb JG, de la Torre JM, Asmarats L, Pelletier-Beaumont E, Alméndarez M1, Couture T1, Philippon F1, Rodes-Cabau J12. DOI: 10.1016/j.amjcard.2019.11.025