Permanent pacemaker implantation late after transcatheter aortic valve implantation

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国产自膨式经导管主动脉瓣膜置换术后严重传导损伤相关因素分析

目的 分析应用国产自膨式瓣膜行经导管主动脉瓣置换术（transcatheter aortic valve implantation,TAVR）后严重传导损伤的相关因素并评估其预测效能。方法 回顾性纳入2016年12月至2022年10月于我院应用国产自膨式主动脉瓣膜行TAVR患者84例,根据术后是否出现严重传导损伤分为正常组和传导损伤组,比较两组因素差异。分析并纳入回归模型,绘制受试者工作曲线（receiver operating characteristic curve, ROC）,计算预测效能并评估效能差异。结果 左室流出道（Left ventricular outflow tract,LVOT）面积（正常组vs.传导损伤组：478.70±139.84mm2 vs. 368.97±134.97 mm2, P=0.002）、LVOT面积/瓣环面积（104.41±15.99% vs. 87.05±13.59%, P<0.001）、室间隔膜部长度(8.27±2.74mm vs. 6.45±2.92mm, P=0.005)、室间隔膜部长度和植入深度的差值（membranous septum minus implantation depth, ΔMSID）（3.53±3.73 vs. 0.83±3.45mm, P=0.003）存在显著统计学差异。多因素logistic回归分析显示,LVOT面积/瓣环面积（OR值：0.917[0.975-0.960]每增加1%, P=0.004）、ΔMSID（OR值：0.660[0.515-0.846] 每增加1mm, P=0.001）是TAVR术后严重传导损伤的独立危险因素。ROC曲线示LVOT面积/瓣环面积、ΔMSID的曲线下面积分别为 0.792[0.690-0.873]、0.768[0.663-0.853],联合两因素的曲线下面积为0.908[0.825-0.920]。DeLong检验显示单因素与联合指标的预测存在统计学差异（vs. LVOT面积/瓣环面积 P=0.045;vs. ΔMSID P=0.006）。结论 LVOT面积/瓣环面积、ΔMSID是TAVR术后出现严重传导损伤的独立危险因素,可用于预测术后新发传导损伤的发生,联合指标较单因素预测效能更高。     

国产自膨式经导管主动脉瓣置换术后严重传导损伤相关因素分析

目的 分析应用国产自膨式瓣膜行经导管主动脉瓣置换术(TAVR)后严重传导损伤的相关因素并评估其预测效能。方法 回顾性纳入2016年12月至2022年10月于中国人民解放军总医院第一医学中心应用国产自膨式主动脉瓣膜行TAVR患者。根据术后结果分为正常组和传导损伤组,采用logistic回归分析筛选相关因素。绘制受试者工作特征(ROC)曲线,计算预测效能并评估效能差异。采用SPSS 26.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、U检验及χ²检验。结果 纳入患者84例,其中正常组60例,传导损伤组24例。2组间左室流出道(LVOT)面积、LVOT面积/瓣环面积、室间隔膜部长度、室间隔膜部长度和植入深度的差值(ΔMSID)比较,差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示,LVOT面积/瓣环面积(OR=0.874,95%CI 0.797～0.959,P=0.004)、ΔMSID(OR=0.660,95%CI 0.515～0.846,P=0.001)是TAVR术后严重传导损伤的独立危险因素。ROC曲线示LVOT面积/瓣环面...     

Conduction disorders in the setting of transcatheter aortic valve implantation: a clinical perspective

The presence of periprocedural conduction disorders (CDs) and the need for permanent pacemaker (PPM) after transcatheter aortic valve implantation (TAVI) are frequent findings in clinical practice. Notwithstanding, robust information on the prognostic and therapeutic implications of these complications are lacking. The newly occurrence of CD after TAVI seems related to the trauma of the conduction system during procedure. On the contrary, major predictors for PPM implantation after TAVI seem to be the use of CoreValve prosthesis (Medtronic, Minneapolis, MN) and the presence of CD before TAVI. An accurate pre‐TAVI screening, careful valve implantation, as well as post‐TAVI monitoring must be pursued to prevent avoidable PPM implantation. The aim of this report is to analyze the available data on this field and to propose some practical clinical tips to prevent or to manage these complications. © 2013 Wiley Periodicals, Inc.