Affiliation:
1. From the Catharina Hospital, Eindhoven (P.H., G.R.G.B., A.H.M.S.); Cardiovascular Research Institute Maastricht, Maastricht (P.H., F.W.P.); Maastricht University Medical Center, Maastricht (L.A.F.M.V.G., T.T.P., V.v.O., M.H.P., J.G.M.); Erasmus Medical Center, Rotterdam (P.d.J., R.M.A.v.d.B.); Sint-Antonius Hospital, Nieuwegein (B.M.S., J.M.t.B.); Leiden University Medical Center, Leiden (F.v.d.K., M.J.S.); Amsterdam Medical Center, Amsterdam (J.B., R.C.); Amphia Hospital, Breda (P.d.H., M.B.); and...
Abstract
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.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Physiology (medical),Cardiology and Cardiovascular Medicine
Cited by
243 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献