Maastricht University Medical Center, Maastricht, Netherlands.
Circulation. 2012 Aug 7;126(6):720-8. doi: 10.1161/CIRCULATIONAHA.112.101055. Epub 2012 Jul 12.
Transcatheter aortic valve implantation (TAVI) is a novel therapy for treatment of severe aortic stenosis. Although 30% to 50% of patients develop new left bundle-branch block (LBBB), its effect on clinical outcome is unclear.
Data were collected in a multicenter registry encompassing TAVI patients from 2005 until 2010. The all-cause mortality rate at follow-up was compared between patients who did and did not develop new LBBB. Of 679 patients analyzed, 387 (57.0%) underwent TAVI with the Medtronic CoreValve System and 292 (43.0%) with the Edwards SAPIEN valve. A total of 233 patients (34.3%) developed new LBBB. Median follow-up was 449.5 (interquartile range, 174-834) days in patients with and 450 (interquartile range, 253-725) days in patients without LBBB (P=0.90). All-cause mortality was 37.8% (n=88) in patients with LBBB and 24.0% (n=107) in patients without LBBB (P=0.002). By multivariate regression analysis, independent predictors of all-cause mortality were TAVI-induced LBBB (hazard ratio [HR], 1.54; confidence interval [CI], 1.12-2.10), chronic obstructive lung disease (HR, 1.56; CI, 1.15-2.10), female sex (HR, 1.39; CI, 1.04-1.85), left ventricular ejection fraction ≤50% (HR, 1.38; CI, 1.02-1.86), and baseline creatinine (HR, 1.32; CI, 1.19-1.43). LBBB was more frequent after implantation of the Medtronic CoreValve System than after Edwards SAPIEN implantation (51.1% and 12.0%, respectively; P<0.001), but device type did not influence the mortality risk of TAVI-induced LBBB.
All-cause mortality after TAVI is higher in patients who develop LBBB than in patients who do not. TAVI-induced LBBB is an independent predictor of mortality.
经导管主动脉瓣植入术（TAVI）是一种治疗严重主动脉瓣狭窄的新疗法。尽管 30%至 50%的患者会出现新的左束支传导阻滞（LBBB），但其对临床结果的影响尚不清楚。
该多中心注册研究纳入了 2005 年至 2010 年接受 TAVI 的患者。比较了随访期间发生和未发生新发 LBBB 的患者的全因死亡率。在分析的 679 例患者中，387 例（57.0%）接受了美敦力 CoreValve 系统的 TAVI，292 例（43.0%）接受了爱德华兹 SAPIEN 瓣膜的 TAVI。共有 233 例（34.3%）患者出现新发 LBBB。在发生 LBBB 的患者中，中位随访时间为 449.5（四分位距，174-834）天，未发生 LBBB 的患者为 450（四分位距，253-725）天（P=0.90）。发生 LBBB 的患者全因死亡率为 37.8%（n=88），未发生 LBBB 的患者为 24.0%（n=107）（P=0.002）。多变量回归分析显示，全因死亡的独立预测因素包括 TAVI 诱导的 LBBB（风险比[HR]，1.54；置信区间[CI]，1.12-2.10）、慢性阻塞性肺疾病（HR，1.56；CI，1.15-2.10）、女性（HR，1.39；CI，1.04-1.85）、左心室射血分数≤50%（HR，1.38；CI，1.02-1.86）和基线肌酐（HR，1.32；CI，1.19-1.43）。与爱德华兹 SAPIEN 瓣膜植入相比，美敦力 CoreValve 系统植入后 LBBB 更为常见（分别为 51.1%和 12.0%；P<0.001），但器械类型并不影响 TAVI 诱导的 LBBB 的死亡率风险。
与未发生 LBBB 的患者相比，发生 LBBB 的 TAVI 患者的全因死亡率更高。TAVI 诱导的 LBBB 是死亡的独立预测因素。
