Effect of New-Onset Left Bundle Branch Block After Transcatheter Aortic Valve Implantation (CoreValve) on Mortality, Frequency of Re-Hospitalization, and Need for Pacemaker.

New-onset conduction disturbances are common after transcatheter aortic valve implantation (TAVI). The most common complication is left bundle branch block (LBBB). The clinical impact of new-onset LBBB after TAVI remains controversial. The aim of this study was to analyze the clinical impact of new-onset LBBB in terms of mortality and morbidity (need for pacemakers and admissions for heart failure) at long-term follow-up. From April 2008 to December 2014, 220 patients who had severe aortic stenosis were treated with the implantation of a CoreValve prosthesis. Sixty-seven of these patients were excluded from the analysis, including 22 patients with pre-existing LBBB and 45 with a permanent pacemaker, implanted previously or within 72 hours of implantation. The remaining 153 patients were divided into 2 groups: group 1 (n = 80), those with persistent new-onset LBBB, and group 2 (n = 73), those without conduction disturbances after treatment. Both groups were followed up at 1 month, 6 months, 12 months, and yearly thereafter. Persistent new-onset LBBB occurred in 80 patients (36%) immediately after TAVI; 73 patients (33%) did not develop conduction disturbances. The mean follow-up time of both groups was 32 ± 22 months (range 3 to 82 months), and there were no differences in time between the groups. There were no differences in mortality between the groups (39% vs 48%, p = 0.58). No differences were observed between the groups in re-hospitalizations for heart failure (11% vs 16%, p = 0.55). Group 1 did not require pacemaker implantation more often at follow-up (10% vs 13%, p = 0.38) than group 2. In conclusion, new-onset LBBB was not associated with a higher incidence of late need for a permanent pacemaker after CoreValve implantation. In addition, it was not associated with a higher risk of late mortality or re-hospitalization.

Infective endocarditis in patients receiving chronic hemodialysis: clinical features and outcome.

BACKGROUND AND AIM OF THE STUDY: Patients undergoing chronic hemodialysis are at increased risk of infective endocarditis (IE), and mortality is high in this group. The study aim was to determine clinical features and outcome of IE in patients with chronic renal failure and receiving hemodialysis. METHODS: Between 1987 and 2002, all consecutive patients with infective endocarditis treated at the authors' institution who were not intravenous drug abusers were selected prospectively. A comparative analysis was performed of patients undergoing hemodialysis and other patients in the series. RESULTS: A total of 241 cases of IE was diagnosed, and 14 patients (6%) were receiving hemodialysis. A lower frequency of known predisposing heart disease (14% versus 74%, p <0.01) and prosthetic valve endocarditis (0% versus 35%, p <0.05) and a higher rate of negative blood cultures (21% versus 12%, p <0.05) were detected in hemodialysis patients. Early surgery was performed in 50% of patients in both groups. The frequency of complications was similar in both groups, but early (43% versus 16%, p = 0.03) and late (22% versus 9%, p <0.05) mortality were higher in hemodialysis patients. CONCLUSION: Patients with IE who are undergoing hemodialysis have a lower frequency of predisposing heart disease and higher rates of negative blood cultures. Although patient groups were similarly treated, early and late mortality was significantly higher among those receiving dialysis.