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We evaluated the incidence, prognosis, and predictive factors of new onset of persistent left bundle branch block (NOP-LBBB) after rapid-deployment aortic valve replacement (RD-AVR). This was an observational, retrospective, single-center study of 274 consecutive patients with no baseline ventricular conduction disorder and no previous permanent pacemaker implantation (PPI) who underwent RD-AVR with an INTUITY valve (n = 55) or INTUITY Elite Valve (n = 219) (Edwards Lifesciences). Transthoracic echocardiography and 12-lead electrocardiography was performed preoperatively, at discharge, and at 1-month and 1-year intervals. The incidence, prognosis, and predictive factors of NOP-LBBB were evaluated. NOP-LBBB occurred in 58 patients (21.2%) after discharge. In multivariate analysis, age (P <.01), INTUITY valve diameter ≥23 mm (P =.02), and INTUITY Elite implantation (P =.01) were independent predictors of NOP-LBBB. By 1:1 propensity matching analysis between the NOP-LBBB group and the control group, there were no significant differences in 1-year overall mortality (P =.23), hospitalization for congestive heart failure (P =.99), or PPI (P =.99). NOP-LBBB exposed patients to a high rate of dysrhythmic events (12.1% vs 1.4%, P <.01) and was associated with a significant decrease in left ventricular ejection fraction (0.62 ± 0.095 vs 0.652 ± 0.0783, P =.02) without an impact on New York Heart Association functional status (1.25 ± 0.32 and 1.52 ± 0.70, P =.32). PPI was performed in 17 patients (6.2%) before discharge, including 14 NOP-LBBB patients. NOP-LBBB after RD-AVR is prevalent in patients with no prior conduction disorders. INTUITY Elite is associated with a significantly higher rate of NOP-LBBB. The persistence of NOP-LBBB predisposed patients to the occurrence of high-grade conduction disorders and might have led to PPI but did not increase death or hospitalization for congestive heart failure. [Display omitted] [ABSTRACT FROM AUTHOR]

Background Aortic valve replacement in elderly patients with a small aortic annulus remains challenging. Patient–prosthesis mismatch (PPM) should be prevented without impacting operative mortality. Hemodynamic benefits resulting from rapid-deployment aortic valve replacement with the Edwards Intuity bioprosthesis for this indication were evaluated. Methods Elective patients with severe aortic stenosis who required an Edwards Intuity bioprosthesis, size 19 mm and 21 mm, were prospectively included between July 2012 and July 2014. Transthoracic echocardiography was performed preoperatively and at 1-month follow-up. Results Sixty-six consecutive patients (mean age, 78 ± 6.4 years; 54.5% women) were included. The Intuity 19 mm was inserted in 29 patients, and the Intuity 21 mm was inserted in 37 patients. No deaths or aortic annulus ruptures occurred. Mean aortic cross-clamp time was 42.7 ± 18.2 minutes. At the 1-month follow-up, mean New York Heart Association classification was 1.6 ± 0.5 versus 2.2 ± 0.8 ( p < 0.001). The mean gradient decreased from 59 ± 17.6 mm Hg to 13.7 ± 4.4 mm Hg ( p < 0.001). Mean indexed effective orifice area was 0.77 ± 0.17 cm 2 /m 2 for the Intuity 19 mm and 1.01 ± 0.32 cm 2 /m 2 for the Intuity 21 mm. Twenty-one patients (32%) had a moderate PPM (indexed effective orifice area < 0.85 cm 2 /m 2 ), and 10 patients (15%) had a severe PPM (indexed effective orifice area < 0.65 cm 2 /m 2 ). The mean gradient was 15.1 ± 3.5 mm Hg and 16.9 ± 4.9 mm Hg in the moderate PPM group and severe PPM group, respectively ( p = 0.3). The left ventricular mass index dramatically decreased from 153.2 ± 32.7 g/m 2 to 118.4 ± 20.2 g/m 2 ( p < 0.001), and only 1 patient (1.5%) had a periprosthetic regurgitation greater than 1. Conclusions Regarding the low rate of severe PPM and the early regression of left ventricular mass, these preliminary studies indicate the potential benefit of the Intuity bioprosthesis in patients with a small aortic annulus. Midterm results should be evaluated. [ABSTRACT FROM AUTHOR]

Management of heparin-induced thrombocytopenia (HIT) entails cessation of heparin and initiation of a nonheparin parenteral anticoagulant such as danaparoid. Danaparoid cross-reactivity with HIT antibodies is an uncommon complication of treatment of HIT. We report the case of confirmed HIT and in vivo cross-reactivity with danaparoid, complicating severe sepsis due to an infectious endocarditis treated by cardiac surgery. [ABSTRACT FROM AUTHOR]

We report the first case of a successful implantation of the new Edwards Intuity rapid-deployment bioprosthesis in a 50-year-old man with acute failure of a Freestyle Medtronic root with severe aortic regurgitation and massive calcification of the root and both coronary buttons. [Copyright &y& Elsevier]