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Master Thesis

Incidence, facteurs prédictifs et impact pronostique à long terme de la survenue d’un bloc de branche gauche persistant après remplacement valvulaire aortique par bioprothèse à déploiement rapide

Abstract : Background: Sutureless aortic bioprostheses have been developed in order to simplify the surgical procedure. The first studies relative to INTUITY bioprosthesis suggest a higher prevalence of postoperative conductance disorders compared to conventional surgical aortic valve replacement. Objectives: The aim of this study was to evaluate the incidence, the predictive factors and prognosis of the occurrence of persistent left bundle branch block (LBBB) after aortic valve replacement (AVR) with INTUITY. Methods: This study was an observational, retrospective, monocentric study. A total of 274 consecutive patients with no baseline ventricular conduction disturbances or previous permanent pacemaker implantation (PPI) who underwent aortic valve replacement (AVR) with INTUITY were included. 12-lead ECG and TTE were performed postoperatively, at discharge, at 1 month and at 1-year FU. One patient was lost at a mean follow-up of 13.8 ± 3 months and ECG tracing was available in 94.5% of patients. Results: New-onset LBBB was observed in 67 patients (24.5%) and were observed at discharge in 58 patients (21.2%). Seventeen patients (6.2%) incurred postoperative PPI, mainly following a positive electrophysiological investigation. Age (p <0.01) and INTUITY valve diameter ³ 23 mm (p = 0.03) were independent predictors of persistent LBBB. Persistent LBBB exposed patients to a high rate of severe conductance events (12.1% vs 1,4%, p < 0,01) without increasing the mortality risk (p= 0.2) at 1-year FU. Persistent LBBB was associated with a decrease in LVEF (62 ± 9,5% vs 65,2 ± 7,83%, p = 0,02) without impact on NYHA functional status or hospitalization for congestive heart failure (CHF) (3,4% vs 4,6%, p = 1,00). Conclusion: Up to 20% of patients with no prior conduction disturbances incurred new LBBB following INTUITY implantation. LBBB persistence exposes patients to the occurrence of high-grade conductance disorders and PPI without increasing mortality and occurrence of CHF.
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Marine Bouchat. Incidence, facteurs prédictifs et impact pronostique à long terme de la survenue d’un bloc de branche gauche persistant après remplacement valvulaire aortique par bioprothèse à déploiement rapide. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02515180⟩

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