Perioperative Conduction Disturbances After Transcatheter Aortic Valve Replacement
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- 作者：Kamrouz Ghadimi ; Prakash A. Patel ; Jacob T. Gutsche ; Aris Sophocles ; Saif Anwaruddin ; Wilson Y. Szeto ; John G.T. Augoustides
- 关键词：transcatheter aortic valve implantation ; heart block ; atrial fibrillation ; conduction disturbances ; Edwards Sapien valve ; Medtronic CoreValve ; balloon valvuloplasty ; left bundle-branch block ; right bundle-branch block ; echocardiography ; left atrial size ; permanent pacemaker ; aortic annulus ; left ventricular outflow tract ; conductive system anatomy ; Valve Academic Research Consortium ; bundle of His ; aortic cusp ; interventricular septum ; mitral annular calcification
- 刊名：Journal of Cardiothoracic and Vascular Anesthesia
- 出版年：December, 2013
- 年：2013
- 卷：27
- 期：6
- 页码：1414-1420
- 全文大小：827 K
文摘
Cardiac conduction disturbances after transcatheter aortic valve replacement (TAVR) are common and important. The risk factors and outcome effects of atrial fibrillation after TAVR recently have been appreciated. The paucity of clinical trials has resulted in the absence of clinical guidelines for the management of this important arrhythmia in this high-risk patient population. Given this evidence gap and clinical necessity, it is likely that clinical trials in the near future will be designed and implemented to address these issues.
Prompt recognition and proper management of atrioventricular block remain essential in the management of patients undergoing TAVR, because heart block of all types is common and may require permanent pacemaker implantation. The current evidence base has described the incidence, risk factors, and current outcomes of this conduction disturbance in detail. As the practice of TAVR evolves and novel valve prostheses are developed, a focus on minimizing damage to the cardiac conductive system remains paramount. It remains to be seen how the next generation of TAVR prostheses will affect the incidence, risk factors, and clinical outcomes of associated conduction disturbances.