초록접수 현황
| 17F-220 | 구연 발표 |
Rapid Deployment Edwards INTUITY Valve System and Conduction Disturbance Issue
Ho Hyun Ko, M.D., Wan Kee Kim, M.D., Min Ho Ju, M.D., Ho Jin Kim, M.D., Joon Bum Kim, M.D., Sung-Ho Jung, M.D., Suk Jung Choo, M.D., Cheol Hyun Chung, M.D., Jae Won Lee, M.D.
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
Purpose : Recent large-scale multi-center registry (TRANSFROM trial) showed excellent operative and postoperative profiles with the use of EDWARDS INTUITY Elite valve systems for aortic valve replacement (AVR), however, a high rate of pacemaker implantation (PPM, 11.9%) raised a concern of conduction disturbances with this technique.
Methods : Between Feb 2016 and Jul 2017, 32 patients (age, 69.7±7.35 years; 40.4% female) who underwent isolated AVR using the INTUITY systems were retrospectively reviewed. Perioperative outcomes were evaluated with a particular interest on the incidence of conduction disturbances. 72 patients who underwent AVR with Carpentier-Edwards PERIMOUNT Magna during the same period served as controls (Intuity vs. Magna group).
Results : Baseline demographic, clinical and echocardiographic parameters were similar for both groups. Aortic clamping (53.7±21.9min versus 76.8±22.2min, P<0.001) and cardiopulmonary bypass times (86.9±38.8min versus 117.6±37.6min, P<0.001) were significantly shorter in the Intuity group. There was no operative mortality. The rates of PPM were similar for both groups (3.1% vs. 4.2%; P=0.79), however, the rates of new left-bundle branch block (LBBB; 18.8% vs. 2.8%, P=0.01) and intraventricular conduction delay (31.2% vs. 11.1%, P=0.02) were significantly higher with the Intuity group than the Magna group. Conditional logistic regression analyses also confirmed the results (LBBB: HR, 8.08, 95% CI 1.74-57.57; intraventricular conduction delay: HR 3.04, 95% CI 1.28-10.68).
Conclusion : Despite the advantages of reduction in procedural times with excellent operative outcomes, conduction disturbances seem to increase with the use of the Intuity system. Therefore, this technique may not be feasible in patients with pre-existing conduction disturbances.
Methods : Between Feb 2016 and Jul 2017, 32 patients (age, 69.7±7.35 years; 40.4% female) who underwent isolated AVR using the INTUITY systems were retrospectively reviewed. Perioperative outcomes were evaluated with a particular interest on the incidence of conduction disturbances. 72 patients who underwent AVR with Carpentier-Edwards PERIMOUNT Magna during the same period served as controls (Intuity vs. Magna group).
Results : Baseline demographic, clinical and echocardiographic parameters were similar for both groups. Aortic clamping (53.7±21.9min versus 76.8±22.2min, P<0.001) and cardiopulmonary bypass times (86.9±38.8min versus 117.6±37.6min, P<0.001) were significantly shorter in the Intuity group. There was no operative mortality. The rates of PPM were similar for both groups (3.1% vs. 4.2%; P=0.79), however, the rates of new left-bundle branch block (LBBB; 18.8% vs. 2.8%, P=0.01) and intraventricular conduction delay (31.2% vs. 11.1%, P=0.02) were significantly higher with the Intuity group than the Magna group. Conditional logistic regression analyses also confirmed the results (LBBB: HR, 8.08, 95% CI 1.74-57.57; intraventricular conduction delay: HR 3.04, 95% CI 1.28-10.68).
Conclusion : Despite the advantages of reduction in procedural times with excellent operative outcomes, conduction disturbances seem to increase with the use of the Intuity system. Therefore, this technique may not be feasible in patients with pre-existing conduction disturbances.
책임저자: Joon Bum Kim
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
발표자: Ho Hyun Ko, E-mail : xeros1518@nate.com