Document Detail

Left bundle-branch block induced by transcatheter aortic valve implantation increases risk of death.
MedLine Citation:
PMID:  22791865     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Transcatheter aortic valve implantation (TAVI) is a novel therapy for treatment of severe aortic stenosis. Although 30% to 50% of patients develop new left bundle-branch block (LBBB), its effect on clinical outcome is unclear.
METHODS AND RESULTS: Data were collected in a multicenter registry encompassing TAVI patients from 2005 until 2010. The all-cause mortality rate at follow-up was compared between patients who did and did not develop new LBBB. Of 679 patients analyzed, 387 (57.0%) underwent TAVI with the Medtronic CoreValve System and 292 (43.0%) with the Edwards SAPIEN valve. A total of 233 patients (34.3%) developed new LBBB. Median follow-up was 449.5 (interquartile range, 174-834) days in patients with and 450 (interquartile range, 253-725) days in patients without LBBB (P=0.90). All-cause mortality was 37.8% (n=88) in patients with LBBB and 24.0% (n=107) in patients without LBBB (P=0.002). By multivariate regression analysis, independent predictors of all-cause mortality were TAVI-induced LBBB (hazard ratio [HR], 1.54; confidence interval [CI], 1.12-2.10), chronic obstructive lung disease (HR, 1.56; CI, 1.15-2.10), female sex (HR, 1.39; CI, 1.04-1.85), left ventricular ejection fraction ≤50% (HR, 1.38; CI, 1.02-1.86), and baseline creatinine (HR, 1.32; CI, 1.19-1.43). LBBB was more frequent after implantation of the Medtronic CoreValve System than after Edwards SAPIEN implantation (51.1% and 12.0%, respectively; P<0.001), but device type did not influence the mortality risk of TAVI-induced LBBB.
CONCLUSIONS: All-cause mortality after TAVI is higher in patients who develop LBBB than in patients who do not. TAVI-induced LBBB is an independent predictor of mortality.
Patrick Houthuizen; Leen A F M Van Garsse; Thomas T Poels; Peter de Jaegere; Robert M A van der Boon; Ben M Swinkels; Jurriën M Ten Berg; Frank van der Kley; Martin J Schalij; Jan Baan; Ricardo Cocchieri; Guus R G Brueren; Albert H M van Straten; Peter den Heijer; Mohamed Bentala; Vincent van Ommen; Jolanda Kluin; Pieter R Stella; Martin H Prins; Jos G Maessen; Frits W Prinzen
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Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2012-07-12
Journal Detail:
Title:  Circulation     Volume:  126     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-08-07     Completed Date:  2012-10-16     Revised Date:  2014-01-14    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  720-8     Citation Subset:  AIM; IM    
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MeSH Terms
Aged, 80 and over
Aortic Valve Stenosis / mortality*,  surgery*
Bundle-Branch Block / mortality*,  surgery*
Cardiac Catheterization / adverse effects*
Clinical Trials as Topic / trends
Follow-Up Studies
Heart Valve Prosthesis Implantation / adverse effects*
Kaplan-Meier Estimate
Risk Factors
Treatment Outcome
Comment In:
Circulation. 2013 Nov 26;128(22):e443   [PMID:  24276880 ]
Circulation. 2012 Aug 7;126(6):674-6   [PMID:  22791864 ]
Circulation. 2013 Nov 26;128(22):e444   [PMID:  24276881 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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