Background
Transcatheter aortic valve replacement (TAVR) has emerged as an alternative treatment for patients with symptomatic aortic stenosis who are at high risk for surgical aortic valve ...replacement. The development of conduction abnormalities is a major complication in the postprocedural period of TAVR.
Objectives
The objective of this study was to investigate the development of postprocedural conduction abnormalities and the requirement of permanent pacemaker (PPM) implantation in patients undergoing TAVR.
Methods
Data from 137 consecutive patients who underwent TAVR (Edwards SAPIEN valve, Edwards Lifesciences, Irvine, CA, USA) between June 2008 and October 2012 were reviewed. Patients with prior history of PPM (n = 27) were excluded. The role of various predictors for pacemaker implantation after TAVR, including the valve index (calculated as valve size/left ventricular outflow tract diameter × 100) was investigated.
Results
A total of 31/110 (28.2%) patients required implantation of a PPM after TAVR. The median time to implantation of a PPM was 5 days after the procedure. The development of postprocedural complete heart block was the most common indication for implantation of a PPM (16/31; 51.6%). On multivariate analysis, the presence of preexisting right bundle branch block (RBBB) was found to be a strong predictor of PPM implantation after TAVR (adjusted odds ratio: 4.87; 95% confidence interval: 1.29–18.46, P = 0.020). Using the receiver operated curve analysis, a cut‐off value of valve index of 128 was found to be a strong predictor for PPM implantation with a sensitivity of 73% and specificity of 61% (c statistic = 0.68).
Conclusions
This study identified the presence of prior RBBB and a valve index of 128 as important risk factors for PPM implantation after TAVR. A larger implanted valve size relative to left ventricular outflow tract diameter leads to a greater compression of the intrinsic conduction system, increasing the need for pacemaker placement.
Objectives. We reviewed the spectrum of disease and early outcomes of patients undergoing ascending aortic surgery for Giant cell aortitis (GCA). Design. Of 1 259 patients undergoing repair of ...ascending aortic aneurysms between January 1993 and July 2006, 100 had histologic evidence of GCA or lymphoplasmacytic aortitis. Results. Operative Mortality was 4% (4/100). One patient underwent aortoplasty and aortic valve replacement (AVR). Among 99 patients undergoing graft replacement of the ascending aorta, distal disease required hemiarch replacement in 33 and total arch replacement in 14. Proximal aneurismal disease of the root was managed by mechanical or biological root replacement (n=18), Yacoub remodeling (n=2) or David reimplantation (n=9). Another 12 patients had separate AVR and ascending graft, while 26 had AR corrected by restoration of proper sinotubular junction diameter. In total, of 63 patients with AR, 38 had a valve-preserving procedure (61%). Conclusions. Ascending aortic aneurismal disease due to GCA is frequently associated with proximal and/or distal disease. Valve sparing procedures are technically feasible for many, although late durability is uncertain.
Background. The risk of aortic valve replacement (AVR) after previous coronary artery bypass grafting (CABG) is controversial. Its magnitude influences the threshold for recommending this procedure ...and has been cited in arguments regarding the optimal management of mild aortic stenosis at primary CABG. We therefore reviewed our experience with reoperative AVR ± CABG and the primary combined procedure.
Methods. Between January 1, 1985, and June 30, 1996, 427 patients underwent primary AVR + CABG, and 52 underwent AVR ± CABG after prior CABG. Demographics, operative characteristics, and operative results were compared between groups. Data for all patients were pooled and analyzed collectively for risk factors influencing mortality.
Results. The extent of native coronary artery disease and the incidence of prior myocardial infarction and stroke were greater in the reoperative group. Aortic cross-clamp and cardiopulmonary bypass times were slightly shorter, and fewer distal anastomoses were performed in the reoperative group. Operative mortality (primary group, 6.3% versus reoperative group, 7.4%) and morbidity were similar. Stepwise multivariate logistic regression analysis identified age, perioperative myocardial infarction, intraaortic balloon support, ventricular arrhythmia, perioperative stroke, and development of renal failure or acute respiratory distress syndrome, but not reoperative status, as predictors of mortality.
Conclusions. The risk of AVR after previous CABG is similar to that for primary AVR + CABG. Valve replacement should, therefore, be pursued despite prior CABG when hemodynamically significant aortic stenosis develops. Furthermore, a circumspect approach to “prophylactic” AVR for mild aortic stenosis at primary CABG seems warranted.
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