Predictive factors of new-onset conduction abnormalities after transcatheter aortic valve replacement in patients with bicuspid aortic valve: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Lilan ^1,2 , WANG Weimin ^1,2 , XU Qiaoru ^1,2 ,  WANG Bin ^1,2

1. Department of Emergency, Xiamen Cardiovascular Hospital Affiliated to Xiamen University, Xiamen 361005, P. R. China;
2. Medical School of Xiamen University, Xiamen 361005, P. R. China;

Corresponding author：

WANG Bin, Email: mocw361@163.com

Keywords：

Bicuspid aortic valve; Transcatheter aortic valve replacement; New-onset conduction abnormalities; Predictive factors; Meta-analysis

DOI：

10.7507/1672-2531.202303019

Video：

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Objective To systematically review the predictive factors of new-onset conduction abnormalities(NOCAs) after transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BAV) patients. Methods The CNKI, VIP, WanFang Data, PubMed, Cochrane Library and EMbase databases were electronically searched to collect the relevant studies on NOCAs after TAVR in patients with BAV from inception to December 5, 2022. Two researchers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.4 software. Results Six studies involving 758 patients with BAV were included. The results of the meta-analysis showed that age (MD=−1.48, 95%CI −2.73 to −0.23, P=0.02), chronic kidney disease (OR=0.14, 95%CI 0.06 to 0.34, P<0.01), preoperative left bundle branch block (LBBB) (OR=2.84, 95%CI 1.11 to 7.23, P=0.03), membranous septum length (MSL) (MD=0.93, 95%CI 0.05 to 1.80, P=0.04), implantation depth (ID) (MD=−2.06, 95%CI −2.96 to −1.16, P<0.01), the difference between MSL and ID (MD=3.05, 95%CI 1.92 to 4.18, P<0.01), and ID>MSL (OR=0.27, 95%CI 0.15 to 0.49, P<0.01) could be used as predictors of NOCAs. Conclusion Current evidence shows that age, chronic kidney disease, LBBB, MS, ID, the difference between MSL and ID, and ID>MSL could be used as predictors of NOCAs. Due to the limited quantity and quality of included studies, more high-quality studies are required to verify the above conclusion.

Citation： WANG Lilan, WANG Weimin, XU Qiaoru, WANG Bin. Predictive factors of new-onset conduction abnormalities after transcatheter aortic valve replacement in patients with bicuspid aortic valve: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2023, 23(6): 672-678. doi: 10.7507/1672-2531.202303019 Copy

1.	Siu SC, Silversides CK. Bicuspid aortic valve disease. J Am Coll Cardiol, 2010, 55(25): 2789-2800.
2.	Carabello BA, Paulus WJ. Aortic stenosis. Lancet, 2009, 373(9667): 956-966.
3.	Beppu S, Suzuki S, Matsuda H, et al. Rapidity of progression of aortic stenosis in patients with congenital bicuspid aortic valves. Am J Cardiol, 1993, 71(4): 322-327.
4.	Makkar RR, Yoon SH, Leon MB, et al. Association between transcatheter aortic valve replacement for bicuspid vs tricuspid aortic stenosis and mortality or stroke. JAMA, 2019, 321(22): 2193-2202.
5.	Yoon SH, Bleiziffer S, De Backer O, et al. Outcomes in transcatheter aortic valve replacement for bicuspid versus tricuspid aortic valve stenosis. J Am Coll Cardiol, 2017, 69(21): 2579-2589.
6.	Mylotte D, Lefevre T, Søndergaard L, et al. Transcatheter aortic valve replacement in bicuspid aortic valve disease. J Am Coll Cardiol, 2014, 64(22): 2330-2339.
7.	Hayashida K, Bouvier E, Lefèvre T, et al. Transcatheter aortic valve implantation for patients with severe bicuspid aortic valve stenosis. Circ Cardiovasc Interv, 2013, 6(3): 284-291.
8.	Guo Y, Zhou D, Dang M, et al. The predictors of conduction disturbances following transcatheter aortic valve replacement in patients with bicuspid aortic valve: a multicenter study. Front Cardiovasc Med, 2021, 8: 757190.
9.	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.
10.	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.
11.	Wang T, Ou A, Xia P, et al. Predictors for the risk of permanent pacemaker implantation after transcatheter aortic valve replacement: a systematic review and meta-analysis. J Card Surg, 2022, 37(2): 377-405.
12.	Pinto RA, Proença T, Carvalho MM, et al. Long-term ventricular pacing dependency and pacemaker implantation predictors after transcatheter aortic valve replacement - a 1-year follow-up. Arq Bras Cardiol, 2022, 119(4): 522-530.
13.	Chen YH, Chang HH, Liao TW, et al. Membranous septum length predicts conduction disturbances following transcatheter aortic valve replacement. J Thorac Cardiovasc Surg, 2022, 164(1): 42-51.
14.	Aslan S, Demir AR, Çelik Ö, et al. Usefulness of membranous septum length in the prediction of major conduction disturbances in patients undergoing transcatheter aortic valve replacement with different devices. Kardiol Pol, 2020, 78(10): 1020-1028.
15.	Esposito G, Kumar N, Pugliese F, et al. Predictors of post-TAVI conduction abnormalities in patients with bicuspid aortic valves. Open Heart, 2022, 9(2): e001995.
16.	Hamdan A, Nassar M, Schwammenthal E, et al. Short membranous septum length in bicuspid aortic valve stenosis increases the risk of conduction disturbances. J Cardiovasc Comput Tomogr, 2021, 15(4): 339-347.
17.	Miyashita H, Moriyama N, Yamanaka F, et al. Predictors of conduction disturbances after transcatheter aortic valve implantation with balloon-expandable valve for bicuspid aortic valve stenosis. J Cardiovasc Electrophysiol, 2022, 33(7): 1576-1586.
18.	Ou YW, He JJ, Zhou X, et al. The incidence and predictors of high-degree atrioventricular block in patients with bicuspid aortic valve receiving self-expandable transcatheter aortic valve implantation. J Geriatr Cardiol, 2021, 18(10): 825-835.
19.	Xiong TY, Liao YB, Li YJ, et al. Permanent pacemaker implantation after transcatheter aortic valve replacement in bicuspid aortic valve patients. J Interv Cardiol, 2018, 31(6): 878-884.
20.	Forrest JK, Ramlawi B, Deeb GM, et al. Transcatheter aortic valve replacement in low-risk patients with bicuspid aortic valve stenosis. JAMA Cardiol, 2021, 6(1): 50-57.
21.	Roberts WC, Janning KG, Ko JM, et al. Frequency of congenitally bicuspid aortic valves in patients ≥80 years of age undergoing aortic valve replacement for aortic stenosis (with or without aortic regurgitation) and implications for transcatheter aortic valve implantation. Am J Cardiol, 2012, 109(11): 1632-1636.
22.	Abu Rmilah AA, Al-Zu'bi H, Haq IU, et al. Predicting permanent pacemaker implantation following transcatheter aortic valve replacement: a contemporary meta-analysis of 981, 168 patients. Heart Rhythm O2, 2022, 3(4): 385-392.
23.	Boonyakiatwattana W, Maneesai A, Chaithiraphan V, et al. Preprocedural and procedural variables that predict new-onset conduction disturbances after transcatheter aortic valve replacement. BMC Cardiovasc Disord, 2022, 22(1): 135.
24.	Ueshima D, Nai Fovino L, Brener SJ, et al. Transcatheter aortic valve replacement for bicuspid aortic valve stenosis with first- and new-generation bioprostheses: a systematic review and meta-analysis. Int J Cardiol, 2020, 298: 76-82.
25.	Zhang J, Li X, Xu F, et al. Pooled-analysis of association of sievers bicuspid aortic valve morphology with new permanent pacemaker and conduction abnormalities after transcatheter aortic valve replacement. Front Cardiovasc Med, 2022, 9: 884911.
26.	De Torres-Alba F, Kaleschke G, Diller GP, et al. Changes in the pacemaker rate after transition from edwards SAPIEN XT to SAPIEN 3 transcatheter aortic valve implantation: the critical role of valve implantation height. JACC Cardiovasc Interv, 2016, 9(8): 805-813.
27.	Khawaja MZ, Rajani R, Cook A, et al. Permanent pacemaker insertion after corevalve transcatheter aortic valve implantation: incidence and contributing factors (the UK CoreValve Collaborative). Circulation, 2011, 123(9): 951-960.

1. Siu SC, Silversides CK. Bicuspid aortic valve disease. J Am Coll Cardiol, 2010, 55(25): 2789-2800.
2. Carabello BA, Paulus WJ. Aortic stenosis. Lancet, 2009, 373(9667): 956-966.
3. Beppu S, Suzuki S, Matsuda H, et al. Rapidity of progression of aortic stenosis in patients with congenital bicuspid aortic valves. Am J Cardiol, 1993, 71(4): 322-327.
4. Makkar RR, Yoon SH, Leon MB, et al. Association between transcatheter aortic valve replacement for bicuspid vs tricuspid aortic stenosis and mortality or stroke. JAMA, 2019, 321(22): 2193-2202.
5. Yoon SH, Bleiziffer S, De Backer O, et al. Outcomes in transcatheter aortic valve replacement for bicuspid versus tricuspid aortic valve stenosis. J Am Coll Cardiol, 2017, 69(21): 2579-2589.
6. Mylotte D, Lefevre T, Søndergaard L, et al. Transcatheter aortic valve replacement in bicuspid aortic valve disease. J Am Coll Cardiol, 2014, 64(22): 2330-2339.
7. Hayashida K, Bouvier E, Lefèvre T, et al. Transcatheter aortic valve implantation for patients with severe bicuspid aortic valve stenosis. Circ Cardiovasc Interv, 2013, 6(3): 284-291.
8. Guo Y, Zhou D, Dang M, et al. The predictors of conduction disturbances following transcatheter aortic valve replacement in patients with bicuspid aortic valve: a multicenter study. Front Cardiovasc Med, 2021, 8: 757190.
9. 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.
10. 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.
11. Wang T, Ou A, Xia P, et al. Predictors for the risk of permanent pacemaker implantation after transcatheter aortic valve replacement: a systematic review and meta-analysis. J Card Surg, 2022, 37(2): 377-405.
12. Pinto RA, Proença T, Carvalho MM, et al. Long-term ventricular pacing dependency and pacemaker implantation predictors after transcatheter aortic valve replacement - a 1-year follow-up. Arq Bras Cardiol, 2022, 119(4): 522-530.
13. Chen YH, Chang HH, Liao TW, et al. Membranous septum length predicts conduction disturbances following transcatheter aortic valve replacement. J Thorac Cardiovasc Surg, 2022, 164(1): 42-51.
14. Aslan S, Demir AR, Çelik Ö, et al. Usefulness of membranous septum length in the prediction of major conduction disturbances in patients undergoing transcatheter aortic valve replacement with different devices. Kardiol Pol, 2020, 78(10): 1020-1028.
15. Esposito G, Kumar N, Pugliese F, et al. Predictors of post-TAVI conduction abnormalities in patients with bicuspid aortic valves. Open Heart, 2022, 9(2): e001995.
16. Hamdan A, Nassar M, Schwammenthal E, et al. Short membranous septum length in bicuspid aortic valve stenosis increases the risk of conduction disturbances. J Cardiovasc Comput Tomogr, 2021, 15(4): 339-347.
17. Miyashita H, Moriyama N, Yamanaka F, et al. Predictors of conduction disturbances after transcatheter aortic valve implantation with balloon-expandable valve for bicuspid aortic valve stenosis. J Cardiovasc Electrophysiol, 2022, 33(7): 1576-1586.
18. Ou YW, He JJ, Zhou X, et al. The incidence and predictors of high-degree atrioventricular block in patients with bicuspid aortic valve receiving self-expandable transcatheter aortic valve implantation. J Geriatr Cardiol, 2021, 18(10): 825-835.
19. Xiong TY, Liao YB, Li YJ, et al. Permanent pacemaker implantation after transcatheter aortic valve replacement in bicuspid aortic valve patients. J Interv Cardiol, 2018, 31(6): 878-884.
20. Forrest JK, Ramlawi B, Deeb GM, et al. Transcatheter aortic valve replacement in low-risk patients with bicuspid aortic valve stenosis. JAMA Cardiol, 2021, 6(1): 50-57.
21. Roberts WC, Janning KG, Ko JM, et al. Frequency of congenitally bicuspid aortic valves in patients ≥80 years of age undergoing aortic valve replacement for aortic stenosis (with or without aortic regurgitation) and implications for transcatheter aortic valve implantation. Am J Cardiol, 2012, 109(11): 1632-1636.
22. Abu Rmilah AA, Al-Zu'bi H, Haq IU, et al. Predicting permanent pacemaker implantation following transcatheter aortic valve replacement: a contemporary meta-analysis of 981, 168 patients. Heart Rhythm O2, 2022, 3(4): 385-392.
23. Boonyakiatwattana W, Maneesai A, Chaithiraphan V, et al. Preprocedural and procedural variables that predict new-onset conduction disturbances after transcatheter aortic valve replacement. BMC Cardiovasc Disord, 2022, 22(1): 135.
24. Ueshima D, Nai Fovino L, Brener SJ, et al. Transcatheter aortic valve replacement for bicuspid aortic valve stenosis with first- and new-generation bioprostheses: a systematic review and meta-analysis. Int J Cardiol, 2020, 298: 76-82.
25. Zhang J, Li X, Xu F, et al. Pooled-analysis of association of sievers bicuspid aortic valve morphology with new permanent pacemaker and conduction abnormalities after transcatheter aortic valve replacement. Front Cardiovasc Med, 2022, 9: 884911.
26. De Torres-Alba F, Kaleschke G, Diller GP, et al. Changes in the pacemaker rate after transition from edwards SAPIEN XT to SAPIEN 3 transcatheter aortic valve implantation: the critical role of valve implantation height. JACC Cardiovasc Interv, 2016, 9(8): 805-813.
27. Khawaja MZ, Rajani R, Cook A, et al. Permanent pacemaker insertion after corevalve transcatheter aortic valve implantation: incidence and contributing factors (the UK CoreValve Collaborative). Circulation, 2011, 123(9): 951-960.

Chinese Journal of Evidence-Based Medicine

Predictive factors of new-onset conduction abnormalities after transcatheter aortic valve replacement in patients with bicuspid aortic valve: a meta-analysis

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