Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Ann Thorac Surg. 2019 Sep;108(3):700-707. doi: 10.1016/j.athoracsur.2019.03.056. Epub 2019 Apr 26.
Damage to the cardiac conduction system requiring permanent pacemaker implantation is a complication of aortic valve replacement (AVR) that may importantly affect quality of life. We investigated the prevalence of and preprocedure risk factors for new permanent pacemakers after surgical (SAVR) and transcatheter AVR (TAVR) at a single institution.
Preoperative variables and baseline electrocardiograms were reviewed for 5807 patients undergoing elective SAVR, with or without coronary artery bypass grafting, and 1292 undergoing TAVR, with or without percutaneous coronary intervention, from 2006 to 2017 at Cleveland Clinic. Patients with previous permanent pacemakers were excluded. Risk factors for permanent pacemaker implantation were identified using multivariable logistic regression analysis.
New permanent pacemakers were implanted in 151 (2.6%) after SAVR and in 125 (9.7%) after TAVR (whole group SAVR vs TAVR, P <.0001). Risk factors for pacemaker implantation after TAVR included preoperative conduction disturbances and type of prosthesis (SAPIEN, 9.5%; SAPIEN XT, 4.8%; SAPIEN 3, 10% [Edwards Lifesciences, Irvine, CA]; CoreValve, 30% [Medtronic, Minneapolis, MN]; and other TAVR, 10%). There were no reliable risk factors for pacemaker implantation after SAVR. Bicuspid valves, mechanical vs bioprosthetic valves, higher Society of Thoracic Surgeons risk score, and concomitant coronary artery bypass grafting were not associated with elevated risk.
At a high-volume institution in the current era, establishing a baseline for pacemaker implantation after AVR is necessary. Preoperative conduction disturbances and transcatheter valve type affect its prevalence. These data provide a benchmark that should be taken into account when considering TAVR in low-risk patients.
主动脉瓣置换术（AVR）后需要植入永久性起搏器的心脏传导系统损伤是一种并发症，可能会严重影响生活质量。我们在一家医疗机构调查了外科（SAVR）和经导管 AVR（TAVR）后新发永久性起搏器的患病率和术前危险因素。
对 2006 年至 2017 年在克利夫兰诊所接受择期 SAVR（伴或不伴冠状动脉旁路移植术）的 5807 例患者和接受 TAVR（伴或不伴经皮冠状动脉介入治疗）的 1292 例患者的术前变量和基线心电图进行了回顾性分析。排除有既往永久性起搏器的患者。使用多变量逻辑回归分析确定永久性起搏器植入的危险因素。
SAVR 后有 151 例（2.6%）和 TAVR 后有 125 例（9.7%）植入了永久性起搏器（SAVR 总体 vs TAVR，P<0.0001）。TAVR 后起搏器植入的危险因素包括术前传导障碍和瓣膜类型（SAPIEN，9.5%；SAPIEN XT，4.8%；SAPIEN 3，10%[爱德华兹生命科学公司，欧文，加利福尼亚州]；CoreValve，30%[美敦力，明尼苏达州]；和其他 TAVR，10%）。SAVR 后起搏器植入没有可靠的危险因素。二叶式主动脉瓣、机械瓣膜与生物瓣膜、较高的胸外科医生协会风险评分以及同时进行冠状动脉旁路移植术与风险升高无关。
在当前时代，在高容量医疗机构中，有必要确定 AVR 后起搏器植入的基线。术前传导障碍和经导管瓣膜类型会影响其患病率。这些数据提供了一个基准，在考虑低危患者的 TAVR 时应考虑这些数据。
