Medical Clinic I, University RWTH Aachen, Germany.
Int J Cardiol. 2012 Sep 20;160(1):26-30. doi: 10.1016/j.ijcard.2011.03.004. Epub 2011 Mar 31.
The aim of this study was to evaluate the frequency and predictors of left bundle branch block (LBBB) after Transcatheter Aortic Valve Implantation (TAVI) using CoreValve and Edwards SAPIEN prosthesis.
154 consecutive patients (53 male, mean age 81 ± 7 years) with severe symptomatic aortic stenosis underwent TAVI. Transfemoral AVI (CoreValve) was performed in 72 patients (47%). Transapical AVI (Edwards SAPIEN valve) was done with in n=82 patients (53%). Patient characteristics, valvular and left ventricular outflow tract geometry from pre- and postprocedural imaging (computed tomography, transesophageal echocardiography and callipered angiography) and procedural characteristics were evaluated to define predictors of new LBBB after TAVI.
Preprocedural LBBB was present in 15 patients (n=5 CoreValve, n=10 in Edwards SAPIEN). In 40 of 139 patients (29%) a new LBBB was observed after TAVI. The frequency of new LBBB was higher with CoreValve n=27 (38%) than with Edwards SAPIEN implantation n=13 (16%; p=0.006). Patients with new LBBB had larger valve implantation depth into the left ventricular outflow tract (9.0 ± 2.9 vs. 4.4 ± 2.5mm, p<0.001). In 18 of 40 patients (45%) the new LBBB was persistent at 30days. Predictors of new LBBB were prosthesis implantation depth into the left ventricular outflow tract (OR=1.185 95% CI 1.064-1.320 per additional mm implantation depth; p=0.002) and use of CoreValve prosthesis (OR=2.639 95% CI 1.314-5.813; p=0.007).
TAVI is frequently associated with new LBBB. There is a higher frequency of persistent LBBB with the CoreValve system. Implantation depth is a critical factor for the development of new LBBB.
本研究旨在评估经导管主动脉瓣置换术（TAVI）使用 CoreValve 和 Edwards SAPIEN 人工瓣膜后左束支传导阻滞（LBBB）的发生频率和预测因素。
154 例连续严重症状性主动脉瓣狭窄患者（53 例男性，平均年龄 81±7 岁）接受了 TAVI。72 例患者（47%）行经股动脉 AVI（CoreValve）。82 例患者（53%）行经心尖 AVI（Edwards SAPIEN 瓣膜）。评估患者特征、术前和术后影像学（计算机断层扫描、经食管超声心动图和卡尺血管造影）和手术特征，以确定 TAVI 后新发 LBBB 的预测因素。
术前存在 LBBB 的患者有 15 例（n=5 例 CoreValve，n=10 例 Edwards SAPIEN）。在 139 例患者中的 40 例（29%）中，TAVI 后出现新发 LBBB。CoreValve 植入患者中出现新 LBBB 的频率（n=27，38%）高于 Edwards SAPIEN 植入患者（n=13，16%；p=0.006）。新发 LBBB 患者的瓣膜植入深度进入左心室流出道较大（9.0±2.9 vs. 4.4±2.5mm，p<0.001）。在 40 例患者中的 18 例（45%），新发 LBBB 在 30 天持续存在。新发 LBBB 的预测因素是左心室流出道内人工瓣膜植入深度（每增加 1mm 植入深度，OR=1.185，95%CI 1.064-1.320，p=0.002）和使用 CoreValve 人工瓣膜（OR=2.639，95%CI 1.314-5.813，p=0.007）。
TAVI 常伴有新发 LBBB。CoreValve 系统新发 LBBB 持续存在的频率更高。植入深度是新发 LBBB 发展的关键因素。
