Incidence and predictors of left bundle branch block after transcatheter aortic valve implantation.

OBJECTIVE: The aim of this study was to evaluate the frequency and predictors of left bundle branch block (LBBB) after Transcatheter Aortic Valve Implantation (TAVI) using CoreValve and Edwards SAPIEN prosthesis. METHODS: 154 consecutive patients (53 male, mean age 81 ± 7 years) with severe symptomatic aortic stenosis underwent TAVI. Transfemoral AVI (CoreValve) was performed in 72 patients (47%). Transapical AVI (Edwards SAPIEN valve) was done with in n=82 patients (53%). Patient characteristics, valvular and left ventricular outflow tract geometry from pre- and postprocedural imaging (computed tomography, transesophageal echocardiography and callipered angiography) and procedural characteristics were evaluated to define predictors of new LBBB after TAVI. PATIENTS: Preprocedural LBBB was present in 15 patients (n=5 CoreValve, n=10 in Edwards SAPIEN). In 40 of 139 patients (29%) a new LBBB was observed after TAVI. The frequency of new LBBB was higher with CoreValve n=27 (38%) than with Edwards SAPIEN implantation n=13 (16%; p=0.006). Patients with new LBBB had larger valve implantation depth into the left ventricular outflow tract (9.0 ± 2.9 vs. 4.4 ± 2.5mm, p<0.001). In 18 of 40 patients (45%) the new LBBB was persistent at 30days. Predictors of new LBBB were prosthesis implantation depth into the left ventricular outflow tract (OR=1.185 95% CI 1.064-1.320 per additional mm implantation depth; p=0.002) and use of CoreValve prosthesis (OR=2.639 95% CI 1.314-5.813; p=0.007). CONCLUSION: TAVI is frequently associated with new LBBB. There is a higher frequency of persistent LBBB with the CoreValve system. Implantation depth is a critical factor for the development of new LBBB.

Thirty-day outcome after transcatheter aortic valve implantation compared with surgical valve replacement in patients with high-risk aortic stenosis: a matched comparison.

BACKGROUND: Transcatheter aortic valve implantation (TAVI) has become a therapeutic alternative to surgery for the treatment of severe aortic stenosis in high-surgical risk patients. The aim of this study was to compare 30-day mortality of high-risk patients treated by TAVI versus surgical aortic valve replacement. METHODS: A total of 175 patients (60 men; mean age, 80±6 years; Euroscore 21±13%) having undergone TAVI were compared with 175 matched patients (76 men; mean age, 79±3 years; Euroscore 17±9%), which have undergone conventional aortic valve replacement and were deemed to be high-risk patients by the cardiothoracic surgeons. Thirty-day mortality and major adverse events were recorded in both groups. Patients' characteristics were analyzed for predictors of mortality in the TAVI group. RESULTS: Twenty-one patients (12%) in the TAVI group and 13 patients (8%) in the surgical group died within 30 days of the procedure (P=0.165). Two patients (1%) in the TAVI group and one patient (0.5%) in the conventional surgery group had a major stroke (P=1.0). Seven patients (4%) in the TAVI group and 25 patients (14%) in the conventional surgery group required dialysis post procedure (P=0.0013). The average length of stay in the intensive care unit was lower in the TAVI group compared with the conventional surgical group (3.3±3.1 vs. 6.6±10.5 days; P<0.001). Age was the only independent predictor of mortality in the TAVI group (odds ratio=1.009; 95% confidence interval: 1.001-1.018 per additional year; P=0.0186) and in the total study population (odds ratio=1.007; 95% confidence interval: 1.001-1.013 per additional year; P=0.0186). CONCLUSION: In high-surgical risk patients, TAVI can be performed at a mortality risk comparable with conventional surgery with a reduced length of post interventional intensive care unit stay and less need for dialysis.