Association of preoperative systemic inflammation with postoperative conduction block in TAVI patients

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Severe aortic stenosis (n=155). Intervention: Preoperative systemic inflammation markers (e.g., Neutrophil-to-lymphocyte ratio) vs. Lower levels of systemic inflammation markers. Primary outcome: Postoperative conduction block (OR 1.1630, 95% CI 1.0189-1.3276, p=0.0253).

Dongsheng Di; Chengxin Zhang; Wenhui Gong; Shenglin Ge

doi:10.3389/fcvm.2025.1671841

October 3, 2025Frontiers in Cardiovascular MedicineOpen Access

Association of preoperative systemic inflammation with postoperative conduction block in TAVI patients

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Key result

Higher preoperative neutrophil-to-lymphocyte ratio was associated with an increased risk of postoperative conduction block following transcatheter aortic valve implantation.

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Why the study?

Conduction block is a frequent complication following TAVI, and although systemic inflammation may play a role in its development, evidence is limited.

Are elevated preoperative systemic inflammation markers associated with an increased risk of postoperative conduction block and altered cardiac function in patients undergoing TAVI?

Study Design

Type

Cohort (n=155)

Multicenter

No

Structured PICO

Are elevated preoperative systemic inflammation markers associated with an increased risk of postoperative conduction block and altered cardiac function in patients undergoing TAVI?

P

Population

155 patients with severe aortic stenosis undergoing transcatheter aortic valve implantation, evaluated for the association between preoperative systemic inflammation markers and in-hospital postoperative conduction block.

E

Exposure

Preoperative systemic inflammation markers (systemic immune-inflammation index [SII], neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], and lymphocyte-to-monocyte ratio [LMR]) assessed within 24 hours prior to TAVI.

O

Outcome

Postoperative cardiac outcomes (ejection fraction, left ventricular volume, and left atrial size measured by TTE prior to discharge) and postoperative conduction block (new-onset left bundle branch block, complete atrioventricular block, or need for permanent pacemaker implantation).

Main Result

Odds Ratio: 1.163 (95% CI 1.0189–1.3276)

p-value: p=0.0253

Preoperative systemic inflammation markers, particularly NLR, PLR, and SII, are independently associated with an increased risk of conduction block following TAVI, suggesting their potential utility in risk stratification.

Limitations

Single-center design limits generalizability
Lack of data on anatomical and procedural factors like valve-septum distance and implantation depth
Inflammatory markers measured only once preoperatively without serial profiling
Lack of advanced electrophysiological mapping to detect subclinical abnormalities
No long-term follow-up data for pacemaker dependency or late conduction disturbances
Single-center prospective cohort study, which may limit generalizability
Residual or unmeasured confounding regarding anatomical and procedural factors (e.g., valve-septum distance, implantation depth, oversizing, and valve type and sizing) which were not systematically collected

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Implication

May aid preoperative conduction block risk stratification in TAVI; hypothesis-generating and requires prospective validation.

Abstract

Background Conduction block (CB) is a frequent complication following transcatheter aortic valve implantation (TAVI). Systemic inflammation may play a role in its development, but evidence is limited. Methods This prospective study included 155 patients who underwent TAVI. Preoperative systemic inflammation markers—including systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR)—were analyzed in relation to postoperative conduction block and cardiac function using logistic and linear regression models, as well as restricted cubic spline analysis. Results Postoperative conduction block occurred in 35.5% of patients. Higher preoperative SII (OR = 1.0009; P = 0.0289), NLR (OR = 1.1630; P = 0.0253), and PLR (OR = 1.0079; P = 0.0065) were significantly associated with increased CB risk, while higher LMR was protective (OR = 0.7435; P = 0.0194). LMR was also independently associated with reduced ejection fraction and increased left ventricular volume. Gender subgroup analysis showed stronger associations in females. Conclusion Preoperative systemic inflammation is independently associated with conduction block and cardiac function outcomes after TAVI. Inflammation-based biomarkers may serve as useful tools for risk stratification and perioperative planning.

Discussion

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Cite This Study

Di et al. (2025) conducted a cohort in Severe aortic stenosis (n=155). Preoperative systemic inflammation markers (e.g., Neutrophil-to-lymphocyte ratio) vs. Lower levels of systemic inflammation markers was evaluated on Postoperative conduction block (OR 1.1630, 95% CI 1.0189-1.3276, p=0.0253). Higher preoperative neutrophil-to-lymphocyte ratio was associated with an increased risk of postoperative conduction block following transcatheter aortic valve implantation.

synapsesocial.com/papers/6a819d32d433ecbb06e1d8b7 https://doi.org/10.3389/fcvm.2025.1671841

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Association of preoperative systemic inflammation with postoperative conduction block in TAVI patients

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Association of preoperative systemic inflammation with postoperative conduction block in TAVI patients

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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