Analysis of characteristics and cardiac anatomy of patients with conduction block after transcatheter aortic valve replacement with Venus-A valve_West China Medical Journal

Authors：

WANG Yong ¹ , ZHANG Chen ¹ , LIU Ting ¹ , LUO Xiaolin ¹ , RAO Rongsheng ² , ZHAO Gang ³ , QIAN Dehui ¹ , YU Shiyong ¹ ,  JIN Jun ¹

1. Department of Cardiovascular Medicine, the Second Affiliated Hospital of Army Medical University, Chongqing 400037, P. R. China;
2. Department of Ultrasonography, the Second Affiliated Hospital of Army Medical University, Chongqing 400037, P. R. China;
3. Department of Radiology, the Second Affiliated Hospital of Army Medical University, Chongqing 400037, P. R. China;

Corresponding author：

JIN Jun, Email: xqyyjinjun@163.com

Keywords：

Aortic stenosis; Transcatheter aortic valve replacement; Conduction block

DOI：

10.7507/1002-0179.202008011

Video：

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Objective To analyze the characteristics and cardiac anatomy of patients with conduction block after transcatheter aortic valve replacement (TAVR) with Venus-A valve.Methods Retrospective analysis was conducted on the clinical data of patients with severe aortic stenosis who underwent TAVR with Venus-A valve in the Second Affiliated Hospital of Army Military Medical University from October 2017 to May 2020. According to the occurrence of heart conduction block after TAVR, the patients were divided into the blocked group and the unblocked group, and the differences in characteristics and cardiac anatomy between the two groups were compared.Results Forty-nine patients with severe aortic stenosis were included in the analysis, including 29 in the blocked group and 20 in the unblocked group. The incidence of atrial fibrillation in the blocked group was higher than that in the unblocked group (P=0.015), and there was no statistically significant difference in other preoperative indicators (P>0.05). There was no statistically significant difference in postoperative indicators between the blocked group and the unblocked group (P>0.05). Among bicuspid aortic valve, the ellipticity of left ventricular outflow tract and annulus in the blocked group were higher than those in the unblocked group (P<0.05), and the ratio of the short diameter of the left ventricular outflow tract to the bottom diameter of the implanted valve was smaller than that of the unblocked group (t=2.225, P=0.043). There was no significant difference in other cardiac anatomical indicators (P>0.05). As to tricuspid aortic valve cases, there was no significant difference in cardiac anatomic parameters between the blocked group and the unblocked group (P>0.05).Conclusions For bicuspid aortic valve patients with severe aortic stenosis and implanted with Venus-A valve, larger elliptic rate of annulus or left ventricular outflow tract, smaller proportion of left ventricular outflow tract diameter to the bottom diameter of implanted valve are associated with conduction block after TAVR. These anatomical patterns might be used as potential clinical indicators to predict postoperative conduction block.

Citation： WANG Yong, ZHANG Chen, LIU Ting, LUO Xiaolin, RAO Rongsheng, ZHAO Gang, QIAN Dehui, YU Shiyong, JIN Jun. Analysis of characteristics and cardiac anatomy of patients with conduction block after transcatheter aortic valve replacement with Venus-A valve. West China Medical Journal, 2020, 35(9): 1044-1049. doi: 10.7507/1002-0179.202008011 Copy

1.	Bavaria JE, Tommaso CL, Brindis RG, et al. 2018 AATS/ACC/SCAI/STS expert consensus systems of care document: operator and institutional recommendations and requirements for transcatheter aortic valve replacement: a joint report of the American Association for Thoracic Surgery, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol, 2019, 73(3): 340-374.
2.	Rodés-Cabau J, Ellenbogen KA, Krahn AD, et al. Management of conduction disturbances associated with transcatheter aortic valve replacement: JACC scientific expert panel. J Am Coll Cardiol, 2019, 74(8): 1086-1106.
3.	Piazza N, de Jaegere P, Schultz C, et al. Anatomy of the aortic valvar complex and its implications for transcatheter implantation of the aortic valve. Circ Cardiovasc Interv, 2008, 1(1): 74-81.
4.	Auffret V, Puri R, Urena M, et al. Conduction disturbances after transcatheter aortic valve replacement: current status and future perspectives. Circulation, 2017, 136(11): 1049-1069.
5.	Young Lee M, Chilakamarri Yeshwant S, Chava S, et al. Mechanisms of heart block after transcatheter aortic valve replacement - cardiac anatomy, clinical predictors and mechanical factors that contribute to permanent pacemaker implantation. Arrhythm Electrophysiol Rev, 2015, 4(2): 81-85.
6.	Barbanti M, Gulino S, Costa G, et al. Pathophysiology, incidence and predictors of conduction disturbances during transcatheter aortic valve implantation. Expert Rev Med Devices, 2017, 14(2): 135-147.
7.	Zhao ZG, Jilaihawi H, Feng Y, et al. Transcatheter aortic valve implantation in bicuspid anatomy. Nat Rev Cardiol, 2015, 12(2): 123-128.
8.	Xiong TY, Zhao ZG, Chen M. Bicuspid aortic stenosis in transcatheter aortic valve replacement era: emerging confusions hindering the standardization of the procedure. Cardiol J, 2018, 25(4): 542-544.
9.	刘庆荣, 吕守良, 吴永健. 国产 Venus A-Valve 人工主动脉瓣膜的设计特点. 中国医刊, 2015(1): 9-10.
10.	宋光远, 王墨扬, 王媛, 等. Venus-A 主动脉瓣膜介入治疗重度主动脉瓣狭窄的效果. 中华心血管病杂志, 2017, 45(10): 843-847.
11.	潘佳君, 唐小军, 乔帆, 等. 经导管主动脉瓣置换术后心脏传导阻滞情况分析. 第二军医大学学报, 2019, 40(8): 902-908.
12.	Liao YB, Zhao ZG, Wei X, et al. Transcatheter aortic valve implantation with the self-expandable venus A-valve and corevalve devices: preliminary experiences in China. Catheter Cardiovasc Interv, 2017, 89(S1): 528-533.
13.	Jilaihawi H, Chen M, Webb J, et al. A bicuspid aortic valve imaging classification for the TAVR era. JACC Cardiovasc Imaging, 2016, 9(10): 1145-1158.
14.	Hamdan A, Guetta V, Klempfner R, et al. Inverse relationship between membranous septal length and the risk of atrioventricular block in patients undergoing transcatheter aortic valve implantation. JACC Cardiovasc Interv, 2015, 8(9): 1218-1228.
15.	Zaid S, Sengupta A, Okoli K, et al. Novel anatomic predictors of new persistent left bundle branch block after evolut transcatheter aortic valve implantation. Am J Cardiol, 2020, 125(8): 1222-1229.
16.	中国医师协会心血管内科医师分会结构性心脏病专业委员会. 经导管主动脉瓣置换术中国专家共识 (2020 更新版). 中国介入心脏病学杂志, 2020, 28(6): 301-309.
17.	Kappetein AP, Head SJ, Généreux P, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the valve academic research consortium-2 consensus document. J Thorac Cardiovasc Surg, 2013, 145(1): 6-23.
18.	Miki T, Senoo K, Ohkura T, et al. Importance of preoperative computed tomography assessment of the membranous septal anatomy in patients undergoing transcatheter aortic valve replacement with a balloon-expandable valve. Circ J, 2020, 84(2): 269-276.
19.	Faroux L, Chen S, Muntané-Carol G, et al. Clinical impact of conduction disturbances in transcatheter aortic valve replacement recipients: a systematic review and meta-analysis. Eur Heart J, 2020, 41(29): 2771-2781.
20.	Fadahunsi OO, Olowoyeye A, Ukaigwe A, et al. Incidence, predictors, and outcomes of permanent pacemaker implantation following transcatheter aortic valve replacement: analysis from the U.S. Society of Thoracic Surgeons/American College of cardiology TVT registry. JACC Cardiovasc Interv, 2016, 9(21): 2189-2199.
21.	Siontis GC, Jüni P, Pilgrim T, et al. Predictors of permanent pacemaker implantation in patients with severe aortic stenosis undergoing TAVR: a meta-analysis. J Am Coll Cardiol, 2014, 64(2): 129-140.

1. Bavaria JE, Tommaso CL, Brindis RG, et al. 2018 AATS/ACC/SCAI/STS expert consensus systems of care document: operator and institutional recommendations and requirements for transcatheter aortic valve replacement: a joint report of the American Association for Thoracic Surgery, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol, 2019, 73(3): 340-374.
2. Rodés-Cabau J, Ellenbogen KA, Krahn AD, et al. Management of conduction disturbances associated with transcatheter aortic valve replacement: JACC scientific expert panel. J Am Coll Cardiol, 2019, 74(8): 1086-1106.
3. Piazza N, de Jaegere P, Schultz C, et al. Anatomy of the aortic valvar complex and its implications for transcatheter implantation of the aortic valve. Circ Cardiovasc Interv, 2008, 1(1): 74-81.
4. Auffret V, Puri R, Urena M, et al. Conduction disturbances after transcatheter aortic valve replacement: current status and future perspectives. Circulation, 2017, 136(11): 1049-1069.
5. Young Lee M, Chilakamarri Yeshwant S, Chava S, et al. Mechanisms of heart block after transcatheter aortic valve replacement - cardiac anatomy, clinical predictors and mechanical factors that contribute to permanent pacemaker implantation. Arrhythm Electrophysiol Rev, 2015, 4(2): 81-85.
6. Barbanti M, Gulino S, Costa G, et al. Pathophysiology, incidence and predictors of conduction disturbances during transcatheter aortic valve implantation. Expert Rev Med Devices, 2017, 14(2): 135-147.
7. Zhao ZG, Jilaihawi H, Feng Y, et al. Transcatheter aortic valve implantation in bicuspid anatomy. Nat Rev Cardiol, 2015, 12(2): 123-128.
8. Xiong TY, Zhao ZG, Chen M. Bicuspid aortic stenosis in transcatheter aortic valve replacement era: emerging confusions hindering the standardization of the procedure. Cardiol J, 2018, 25(4): 542-544.
9. 刘庆荣, 吕守良, 吴永健. 国产 Venus A-Valve 人工主动脉瓣膜的设计特点. 中国医刊, 2015(1): 9-10.
10. 宋光远, 王墨扬, 王媛, 等. Venus-A 主动脉瓣膜介入治疗重度主动脉瓣狭窄的效果. 中华心血管病杂志, 2017, 45(10): 843-847.
11. 潘佳君, 唐小军, 乔帆, 等. 经导管主动脉瓣置换术后心脏传导阻滞情况分析. 第二军医大学学报, 2019, 40(8): 902-908.
12. Liao YB, Zhao ZG, Wei X, et al. Transcatheter aortic valve implantation with the self-expandable venus A-valve and corevalve devices: preliminary experiences in China. Catheter Cardiovasc Interv, 2017, 89(S1): 528-533.
13. Jilaihawi H, Chen M, Webb J, et al. A bicuspid aortic valve imaging classification for the TAVR era. JACC Cardiovasc Imaging, 2016, 9(10): 1145-1158.
14. Hamdan A, Guetta V, Klempfner R, et al. Inverse relationship between membranous septal length and the risk of atrioventricular block in patients undergoing transcatheter aortic valve implantation. JACC Cardiovasc Interv, 2015, 8(9): 1218-1228.
15. Zaid S, Sengupta A, Okoli K, et al. Novel anatomic predictors of new persistent left bundle branch block after evolut transcatheter aortic valve implantation. Am J Cardiol, 2020, 125(8): 1222-1229.
16. 中国医师协会心血管内科医师分会结构性心脏病专业委员会. 经导管主动脉瓣置换术中国专家共识 (2020 更新版). 中国介入心脏病学杂志, 2020, 28(6): 301-309.
17. Kappetein AP, Head SJ, Généreux P, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the valve academic research consortium-2 consensus document. J Thorac Cardiovasc Surg, 2013, 145(1): 6-23.
18. Miki T, Senoo K, Ohkura T, et al. Importance of preoperative computed tomography assessment of the membranous septal anatomy in patients undergoing transcatheter aortic valve replacement with a balloon-expandable valve. Circ J, 2020, 84(2): 269-276.
19. Faroux L, Chen S, Muntané-Carol G, et al. Clinical impact of conduction disturbances in transcatheter aortic valve replacement recipients: a systematic review and meta-analysis. Eur Heart J, 2020, 41(29): 2771-2781.
20. Fadahunsi OO, Olowoyeye A, Ukaigwe A, et al. Incidence, predictors, and outcomes of permanent pacemaker implantation following transcatheter aortic valve replacement: analysis from the U.S. Society of Thoracic Surgeons/American College of cardiology TVT registry. JACC Cardiovasc Interv, 2016, 9(21): 2189-2199.
21. Siontis GC, Jüni P, Pilgrim T, et al. Predictors of permanent pacemaker implantation in patients with severe aortic stenosis undergoing TAVR: a meta-analysis. J Am Coll Cardiol, 2014, 64(2): 129-140.

West China Medical Journal

Analysis of characteristics and cardiac anatomy of patients with conduction block after transcatheter aortic valve replacement with Venus-A valve

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