Prognostic impact of permanent pacemaker implantation after transcatheter aortic valve replacement

1. Download : Download high-res image (253KB)
2. Download : Download full-size image

     

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。     

Updates on transcatheter aortic valve replacement: Techniques,complications, outcome,and prognosis

Transcatheter aortic valve replacement (TAVR) initially emerged as a therapeutic option for high-risk patients with severe aortic stenosis. Advancement in technologies since the first era of TAVRs, experience from previous obstacles, and lessons learned from complications have allowed the evolution of this procedure to the current state. This review focuses on the updates on the most current devices, complications, and outcomes of TAVR.     

Recent developments and controversies in transcatheter aortic valve implantation

Interventional cardiology has been revolutionised by transcatheter aortic valve implantation (TAVI), which has become established as the benchmark treatment for severe aortic stenosis in patients at high risk for surgical aortic valve replacement (AVR). Increased procedural familiarity and progression in device technology has enabled improvements to be made in complication rates, which have led to a commensurate expansion in the use of TAVI; it is now a viable alternative to AVR in patients at intermediate surgical risk, and has been used in cohorts such as those with bicuspid aortic valves or pure, severe aortic regurgitation. Given the rapid expansion in the use of TAVI, including cohorts of younger patients with fewer co‐morbidities, attention must be paid to further reducing remaining complications, such as cardiac tamponade or stroke. To this end, novel techniques and devices have been devised and trialled, with varying levels of success. Furthermore, significant work has gone into refining the technique with exploration of alternative imaging modalities, as well as alternative access routes to provide greater options for patients with challenging vascular anatomy. Whilst significant progress has been made with TAVI, areas of uncertainty remain such as the management of concomitant coronary artery disease and the optimum post‐procedure antiplatelet regimen. As such, research in this field continues apace, and is likely to continue as use of TAVI becomes more widespread. This review provides a summary of the existing evidence, as well as an overview of recent developments and contentious issues in the field of TAVI.     

Permanent pacemaker implantation late after transcatheter aortic valve implantation

1. Download : Download high-res image (163KB)
2. Download : Download full-size image

     

经导管主动脉瓣置换的介入瓣膜的现状及展望

经导管主动脉瓣置换术（TAVR）经过最近几年快速发展已经取得巨大进步。迄今为止全球接受TAVR的患者数已近3万例,已成为无法耐受传统手术患者的标准备选治疗措施。从目前已临床应用的介入瓣膜到正在实验研究的新型介入瓣膜可以看出,未来介入瓣膜的发展目标是尺寸更小、长期有效、安全性高、并发症少、操作简单及定位精准。随着TAVR的推广,新型介入瓣的研发,操作者经验的积累,以及长期随访的开展,将给TAVR提供更科学的病例选择标准,减少介入手术的相关并发症,提高更安全有效的治疗效果。未来此项技术还会逐渐扩大适用人群的范围,成为代替传统的主动脉瓣置换术举足轻重的治疗措施。     

Pacemaker dependency after transcatheter aortic valve replacement compared to surgical aortic valve replacement

Transcatheter aortic valve replacement (TAVR) is a standard treatment indicated for severe aortic stenosis in high-risk patients. The objective of this study was to evaluate the incidence of pacemaker dependency after permanent pacemaker implantation (PPI) following TAVR or surgical aortic valve replacement (SAVR) and the risk of mortality at a tertiary center in Korea.In this retrospective study conducted at a single tertiary center, clinical outcomes related to pacemaker dependency were evaluated for patients implanted with pacemakers after TAVR from January 2012 to November 2018 and post-SAVR from January 2005 to May 2015. Investigators reviewed patients’ electrocardiograms and baseline rhythms as well as conduction abnormalities. Pacemaker dependency was defined as a ventricular pacing rate > 90% with an intrinsic rate of <40 bpm during interrogation.Of 511 patients who underwent TAVR for severe AS, 37(7.3%) underwent PPI after a median duration of 6 (3–7) days, whereas pacemakers were implanted after a median interval of 13 (8–28) days post-SAVR in 10 of 663 patients (P < .001). Pacemaker dependency was observed in 36 (97.3%) patients during 7 days immediately post-TAVR and in 25 (64.9%) patients between 8 and 180 days post-TAVR. Pacemaker dependency occurred after 180 days in 17 (50%) patients with TAVR and in 4 (44.4%) patients with SAVR. Twelve (41.4%) patients were pacemaker-dependent after 365 days post-TAVR.Pacemaker dependency did not differ at 6 months after TAVR vs SAVR. In patients undergoing post-TAVR PPI, 58.6% were not pacemaker-dependent at 1 year after the TAVR procedure.