CARDIAC CONDUCTION DISTURBANCES FOLLOWING TRANSAPICAL «MEDLAB-KT» AORTIC VALVE IMPLANTATION: FIRST RESULTS

Aim: to assess cardiac conduction disturbances after transcatheter aortic valve replacement (TAVR) with the “MedLab-KT” device in early postoperative period.

Methods. The study comprised 80 patients (mean age 72,4±5,1 years; 42,5% males) undergoing successful TAVR with the “MedLab-KT”. Before operation, all patients were evaluated with 12-lead ECG and 24-hour Holter monitoring, transthoracic and transesophageal echocardiography, computed tomography, coronarography. In 29 (36,3%) patients cardiac conduction abnormalities were detected before operation: 1st degree atrioventricular (AV) block was found in 17 patients, including concomitant left anterior hemiblock (LAH) in 7 patients, and right bundle branch block (RBBB) in 3 (LAH+RBBB). Second degree AV-block type 1 was found in 1 patient. LAH – in 2, RBBB – in 5, and left bundle branch block (LBBB) – in 4. Post-operative follow-up was limited to hospital stay (13,4±7,4 days).

Results. De-novo conduction abnormalities (reversible and irreversible) were detected in 41 patients (51,3%). Post-TAVR complete AV-block was found in 6 (7,5%) patients, and required temporal pacing. In 4 of those patients AV-block was transient and resolved within 1 day. In 2 (2,5%) patients permanent pacing was required due to irreversible distal AV-block. In one case AV-block developed 2 days after TAVR in a patient with pre-existent 1st degree AV-block in combination with LAH+RBBB. Another patient developed complete AV-block at 3d day after TAVR; in this case there was pre-existent 1st degree AV-block plus LAH. Persistent interventricular block was found in 35 patients: complete LBBB - in 17 patients and complete RBBB – in 1 patient. There were no statistically significant predictors of conduction disturbance development following TAVR.

1. Евдокимов С.В., Базылев В.В., Россейкин Е.В и др. Протез аортального клапана сердца для транскатетерной имплантации; патент на изобретение RUS 2634418 21.06.2016

2. Евдокимов С.В., Базылев В.В., Евдокимов А.С. Шприц для создания давления в баллонном катетере; патент на изобретение RUS 173451 27.01.2017

3. Базылев В.В., Воеводин А.Б., Захарова А.С., Россейкин Е.В. Средне-отдаленные результаты транскатетерной имплантации протеза аортального клапана «МЕДЛАБ-КТ». Бюллетень НЦССХ им. А.Н. Бакулева РАМН Сердечно-сосудистые заболевания. 2018; 19(6):163.

4. Базылев В.В., Воеводин А.Б., Захарова А.С., Россейкин Е.В. Непосредственные клинические и гемодинамические результаты транскатетерной имплантации протеза аортального клапана «МедЛабКТ». Патология кровообращения и кардиохирургия. 2018;22(3):17-24.

5. Sundt T.M., Bailey M.S., Moon M.R. et al. Quality of life after aortic valve replacement at the age of >80 years. Circulation. 2000; 102 (19 Suppl. 3): III70-4.

6. Safian R.D., Berman A.D., Diver D.J. et al. Balloon aortic valvuloplasty in 170 consecutive patients. N. Engl. J. Med. 1988; 319 (3): 125-30.

7. Letac B., Cribier A., Koning R., Bellefleur J.P. Results of percutaneous transluminal valvuloplasty in 218 adults with valvular aortic stenosis. Am. J. Cardiol. 1988; 62 (9): 598-605.

8. Otto C.M., Mickel M.C., Kennedy J.W. et al. Three-year outcome after balloon aortic valvuloplasty. Insights into prognosis of valvular aortic stenosis. Circulation. 1994; 89 (2): 642-50.

9. Siontis G., Jüni P., Pilgrim T. et al. Predictors of perma nent pacemaker implantation in patients with severe aortic stenosis undergoing TAVR: a metaanalysis. J. Am. Coll. Cardiol. 2014; 64 (2): 129-40.

10. Базылев В.В., Гальцева Н.В. Физическая реабилитация больных после кардиохирургических вмешательств в отделении реанимации и интенсивной терапии. Бюллетень НЦССХ им. А.Н. Бакулева РАМН Сердечно-сосудистые заболевания. 2017; 18(6):216.

11. Макарова Н.В., Дурманов С.С., Козлов А.В. и др. Влияет ли ранняя активизация пациентов после имплантации электрокардиостимуляторов на частоту послеоперационных осложнений // Вестник аритмологии. 2013; 74: 40-44.

12. Глумсков А.Б., Дурманов С.С., Базылев В.В. Является ли правожелудочковый электрод электрокардиостимулятора независимым фактором риска в развитии трикуспидальной регургитации в раннем послеоперационном периоде? Одноцентровое проспективное исследование. Анналы аритмологии. 2017;14(1):21-28.

13. Stewart BF, Siscovick D, Lind BK et al. Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study. J Am Coll Cardiol. 1997;29:630-4.

14. O’Brien S., Shahian D., Filardo G. et al. The Society of Thoracic Surgeons 2008 cardiac risk models: part 2 - isolated valve surgery. Ann. Thorac. Surg. 2009; 88 (1 Suppl.): S23-42.

15. Никитина Т.Г., Акишбая М.О., Скопин И.И., Бокерия Л.А. Непосредственные и отдаленные результаты хирургической коррекции аортального стеноза. Грудная и сердечно-сосудистая хирургия. 2007; 49 (3): 12-8. [Nikitina T.G., Akishbaya M.O., Skopin I.I., Bockeria L.A. Immediate and lateresults of surgical correction of aortic stenosis. Russian Journal of Thoracic and Cardiovascular Surgery. 2007; 3: 12-8 (in Russ.).]

16. Gehlot A., Mullany C.J., Ilstrup D. et al. Aortic valve replacement in patients aged eighty years and older: early and long-term results. J. Thorac. Cardiovasc. Surg. 1996; 111 (5): 1026-36.

17. Cribier A, Eltchaninoff H, Bash A et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation. 2002;106:3006-8.

18. Smith CR, Leon MB, Mack MJ et al. PARTNER Trial Investigators: Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364:2187-98.

19. Leon MB, Smith CR, Mack M et al. PARTNER Trial Investigators: Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363:1597-607.

20. Gilard M, Eltchaninoff H, Iung B et al. Registry of transcatheter aortic-valve implantation in high-risk patients. N Engl J Med. 2012;366:1705-15.

21. Medtronic CoreValve ® System Demonstrates Positive Clinical Performance at Two Years in “Real World” ADVANCE Study.

22. Iung B., Baron G., Butchart E.G et al. A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease. Eur. Heart J. 2003; 24 (13): 1231-43.

23. Lee M., Yeshwant S.C., Chava S., Lustgarten D.L. Mechanisms of heart block after transcatether aortic valve replacement - cardiac anatomy, clinical predictors and mechanical factors that contribute to permanent pacemaker implantation. Arrhytm.Electrophysiol. Rev. 2015; 4 (2): 81-5.

24. Kawashima T, Sato F. Visualising anatomical evidences on atrioventricular conduction system for TAVI. Int J Cardiol. 2014;174:1-6.

25. Holmes D.R. Jr, Mack M.J., Kaul S. et al. 2012 ACCF/ AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement. J. Am. Coll. Cardiol. 2012; 59 (13): 1200-54.