Department of Cardiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany.
Clin Res Cardiol. 2018 Aug;107(8):688-697. doi: 10.1007/s00392-018-1235-1. Epub 2018 Apr 17.
To identify predictors of paravalvular regurgitation (PVR) and permanent pacemaker implantation (PPI) following TAVR with a next-generation self-expanding device.
Device landing zone (DLZ) calcification, angiographic implantation depth, and baseline and procedural characteristics were analyzed in 212 patients being treated with the ACURATE neo aortic bioprosthesis. PVR was none/trace in 57.1% and ≥ mild in 42.9% (37% mild, 6% moderate). DLZ calcification (705 (IQR 240-624) vs. 382 (IQR 240-624) mm; P < 0.001) as well as absolute calcium asymmetry (233 ± 159 vs. 151 ± 151 mm; P < 0.001) was significantly higher in patients with PVR ≥ mild. On multivariate analysis, calcification of the aortic valve cusps (AVC) > 410.6 mm was independently associated with PVR ≥ mild. PPI rate was 10.3% (n = 20). Patients with and without need for PPI had similar total DLZ calcium volume (740 (IQR 378-920) vs. 536 (IQR 315-822) mm; P = 0.263), but exhibited different calcium distribution patterns: LVOT calcium > 41.4 mm in the sector below the left coronary cusp (LVOT) was associated with increased PPI risk (26.9 vs. 7.7%; P = 0.008).
The quantity of AVC calcium predicts residual PVR. Multivariable analysis identified LVOT calcium, pre-existing RBBB, and age > 82.7 years as independent predictors of PPI. Based on these risk factors, a patient's individual PPI risk can be stratified ranging from 3.8 to 100%.
使用新一代自膨式瓣膜评估经导管主动脉瓣置换术（TAVR）后瓣周漏（PVR）和永久性心脏起搏器植入（PPI）的预测因子。
在 212 名接受 ACURATE neo 主动脉生物瓣治疗的患者中，分析了器械着陆区（DLZ）钙化、血管造影植入深度以及基线和手术特征。PVR 为无/微量的占 57.1%，≥轻度的占 42.9%（37%轻度，6%中度）。PVR≥轻度患者的 DLZ 钙化（705（IQR 240-624）比 382（IQR 240-624）mm；P<0.001）和绝对钙不对称性（233±159 比 151±151mm；P<0.001）明显更高。多变量分析显示，主动脉瓣叶（AVC）钙化>410.6mm 与 PVR≥轻度独立相关。PPI 发生率为 10.3%（n=20）。需要和不需要 PPI 的患者总 DLZ 钙体积相似（740（IQR 378-920）比 536（IQR 315-822）mm；P=0.263），但钙分布模式不同：左冠瓣下方左心室流出道（LVOT）的钙>41.4mm 与 PPI 风险增加相关（26.9%比 7.7%；P=0.008）。
AVC 钙的数量预测残余 PVR。多变量分析确定了 LVOT 钙、预先存在的右束支阻滞和年龄>82.7 岁是 PPI 的独立预测因子。基于这些危险因素，患者的个体 PPI 风险可以分层，范围从 3.8%到 100%。
