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Original research
New-onset persistent left bundle branch block following sutureless aortic valve replacement
  1. Victoria Vilalta1,2,
  2. Germán Cediel1,
  3. Siamak Mohammadi3,
  4. Helena López1,
  5. Dimitri Kalavrouziotis3,
  6. Helena Resta1,
  7. Eric Dumont3,
  8. Pierre Voisine3,
  9. François Philippon3,
  10. Claudia Escabia1,
  11. Andrea Borrellas1,
  12. Alberto Alperi3,
  13. Eduard Fernandez-Nofrerias1,
  14. Xavier Carrillo1,
  15. Vassili Panagides3,
  16. Antoni Bayes-Genis1,2,
  17. Josep Rodés-Cabau3
  1. 1 Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
  2. 2 Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
  3. 3 Department of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
  1. Correspondence to Dr Josep Rodés-Cabau, Department of Cardiology and Cardiac Surgery, Quebec Heart & Lung Institute, Quebec City, Quebec, Canada; josep.rodes{at}criucpq.ulaval.ca

Abstract

Objective To evaluate the incidence, predictive factors and prognostic value of new-onset persistent left bundle branch block (NOP-LBBB) in patients undergoing sutureless surgical aortic valve replacement (SU-SAVR).

Methods A total of 329 consecutive patients without baseline conduction disturbances or previous permanent pacemaker implantation (PPI) who underwent SU-SAVR with the Perceval valve (LivaNova Group, Saluggia, Italy) in two centres from 2013 to 2019 were included. Patients were on continuous ECG monitoring during hospitalisation and 12-lead ECG was performed after the procedure and at hospital discharge. NOP-LBBB was defined as a new postprocedural LBBB that persisted at hospital discharge. Baseline, procedural and follow-up clinical and echocardiography data were collected in a dedicated database.

Results New-onset LBBB was observed in 115 (34.9%) patients, and in 76 (23.1%) persisted at hospital discharge. There were no differences in baseline and procedural characteristics between patients with (n=76) and without (n=253) NOP-LBBB. After a median follow-up of 3.3 years (2.3–4.4 years), patients with NOP-LBBB had a higher incidence of PPI (14.5% vs 6.3%, p=0.016), but exhibited similar rates of all-cause mortality (19.4% vs 19.2%, p=0.428), cardiac mortality (8.1% vs 9.4%, p=0.805) and heart failure readmission (21.0% vs 23.2%, p=0.648), compared with the no/transient LBBB group. NOP-LBBB was associated with a decrease in left ventricular ejection fraction (LVEF) at 1-year follow-up (delta: −5.7 vs +0.2, p<0.001).

Conclusions NOP-LBBB occurred in approximately a quarter of patients without prior conduction disturbances who underwent SU-SAVR and was associated with a threefold increased risk of PPI along with a negative impact on LVEF at follow-up.

  • Aortic Valve Stenosis
  • Heart Valve Prosthesis
  • Pacemaker, Artificial
  • Outcome Assessment, Health Care

Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Twitter @victoria_vilata, @GermanECediel, @Xavi_Carrillo7

  • Contributors VV and JR-C conceived and designed the study. VV, HL, HR, CE, AB, AA and VP acquired the data and participated in data interpretation. VV wrote the first draft of the report. VV and GC performed the data analyses, with input from JR-C and AB-G. All authors were involved in data analysis and interpretation, and in drafting and critically revising the report. All authors approved the final version of the manuscript and ensured the accuracy and integrity of the work. All authors had access to all the data in the study and had final responsibility for the decision to submit for publication. JR-C is responsible for the overall content of the study as guarantor.

  • Funding AA was supported by a grant from the Fundación Alfonso Martin Escudero (Madrid, Spain). JR-C holds the Research Chair "Fondation Famille Jacques Larivière" for the Development of Structural Heart Disease Interventions.

  • Competing interests JR-C is consultant for and has received institutional research grants from Edwards Lifesciences, Medtronic and Boston Scientific.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.