Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
J Am Soc Echocardiogr. 2019 Nov;32(11):1416-1425. doi: 10.1016/j.echo.2019.06.012. Epub 2019 Aug 26.
The role of basal septal hypertrophy (BSH) on preprocedural transthoracic echocardiography in transcatheter aortic valve replacement (TAVR) is unknown.
Medical charts and preprocedural transthoracic echocardiograms of 378 patients who underwent TAVR were examined. The association between BSH and the primary composite outcome of valve pop-out, recapture, embolization, aborted procedure, conversion to open procedure, new conduction disturbance, or need for permanent pacemaker ≤30 days after TAVR was evaluated. Patients with preexisting pacemakers were excluded. Sensitivity analyses were performed varying the definition of BSH.
Of 296 TAVR patients (78.3%) with interpretable images, 55 (18.6%) had BSH at a median of 40 days (interquartile range, 19-62 days) before TAVR. Age and sex were similar among those with and without BSH. BSH patients received postdilation more frequently (BSH+ vs BSH-: 41.8% vs 29.9%, P = .04). A total of 50 individuals (16.9%) received pacemakers within 30 days, and 128 (43.2%) developed conduction disturbances (with left bundle branch block most common), without differences between groups. BSH was unrelated to the primary outcome on multivariate analysis (adjusted odds ratio BSH+ vs BSH-, 0.94; 95% CI, 0.42-2.11; P = .88).
In this convenience sample of TAVR recipients at a large academic medical center, patients with BSH were more likely to receive postdilation. BSH was not associated with procedural or conduction outcomes after TAVR in patients without preexisting pacemakers.
经胸超声心动图术前基底隔肥厚（BSH）在经导管主动脉瓣置换术（TAVR）中的作用尚不清楚。
检查了 378 例行 TAVR 患者的病历和术前经胸超声心动图。评估 BSH 与瓣膜弹出、再捕获、栓塞、程序中止、转为开放手术、新发传导障碍或 TAVR 后 30 天内需要永久性起搏器之间的主要复合终点的关系。排除了有预先存在起搏器的患者。对 BSH 的不同定义进行了敏感性分析。
在 296 例行 TAVR 患者（78.3%）中有可解释的图像中，55 例（18.6%）在 TAVR 前中位数为 40 天（四分位距，19-62 天）时存在 BSH。有和没有 BSH 的患者年龄和性别相似。BSH 患者更频繁地接受后扩张（BSH+比 BSH-：41.8%比 29.9%，P=0.04）。共有 50 人（16.9%）在 30 天内接受起搏器，128 人（43.2%）发生传导障碍（最常见的是左束支传导阻滞），两组之间无差异。在多变量分析中，BSH 与主要结局无关（BSH+比 BSH-的调整优势比，0.94；95%CI，0.42-2.11；P=0.88）。
在大型学术医疗中心的 TAVR 接受者的便利样本中，BSH 患者更有可能接受后扩张。在没有预先存在起搏器的患者中，BSH 与 TAVR 后的程序或传导结局无关。
