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Valvular & structural heart diseaseCohort study

Conduction Disturbances and Outcome After Surgical Aortic Valve Replacement in Patients With Bicuspid and Tricuspid Aortic Stenosis

CirculationPublished

  • Cohort study
  • consecutive patients
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Authors' conclusion

New-onset LBBB after SAVR is associated with increased all-cause mortality during follow-up, and is more frequent complication in BAV AS patients compared with TAV-AS patients. BAV-AS patients with fusion of the right- and non-coronary cusps have an increased risk for conduction disturbances after SAVR.

Study context

Population
Patients without preoperative conduction disorder undergoing isolated surgical aortic valve replacement (SAVR) (± ascending aortic surgery), 2005–2022
Participants
1,147 patients
Exposure
BAV-AS vs TAV-AS
  • Bicuspid aortic valve (BAV)n = 589
  • Tricuspid aortic valve (TAV)n = 558reference
Outcome
New-onset third-degree AV block or new-onset LBBB
Follow-up
During index hospitalization

Main finding

As reported in the abstract

New-onset third-degree AV block and new-onset LBBB · index hospitalization

Third-degree AV block

P = 0.001

New-onset LBBB

P = 0.013

Overall incidence of third-degree atrioventricular (AV) block
4.5%
Overall incidence of new-onset left bundle-branch block (LBBB)
7.8%

Observational data: associations, not effects.

Further findings

OutcomeEstimateP value
All-cause mortality by new-onset conduction disturbance · median follow-up 8.2 yearsadjusted HR 1.60 (95% CI 1.12–2.30)P = 0.011
Conduction disturbances by BAV subtype (right/non-coronary cusp fusion; subgroup, n=307 classifiable) — BAV right/non-coronary cusp fusion vs TAV · third-degree AV blockaOR 8.33 (95% CI 3.31–20.97)P < 0.001
Conduction disturbances by BAV subtype (right/non-coronary cusp fusion; subgroup, n=307 classifiable) — BAV right/non-coronary cusp fusion vs TAV · new-onset LBBBaOR 4.03 (95% CI 1.84–8.82)P < 0.001

All-cause mortality by new-onset conduction disturbance · median follow-up 8.2 years

New-onset third-degree AV block not associated with worse prognosis

Conduction disturbances by BAV subtype (right/non-coronary cusp fusion; subgroup, n=307 classifiable)

No significant association for other BAV subtypes

Original publication

Conduction Disturbances and Outcome After Surgical Aortic Valve Replacement in Patients With Bicuspid and Tricuspid Aortic Stenosis. Circulation. Published 23 October 2024. doi:10.1161/circulationaha.124.070753
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Summarised from the published abstract; every number is checked against it