经皮球囊扩张式主动脉瓣置换术患者术前计算机断层扫描评估膜性隔解剖结构的重要性。
Importance of Preoperative Computed Tomography Assessment of the Membranous Septal Anatomy in Patients Undergoing Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve.
机构信息
Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine.
Department of Cardiac Arrhythmia Research and Innovation, Kyoto Prefectural University of Medicine.
出版信息
Circ J. 2020 Jan 24;84(2):269-276. doi: 10.1253/circj.CJ-19-0823. Epub 2019 Dec 27.
BACKGROUND
Cardiac conduction disturbance (CD) is the most frequent complication following transcatheter aortic valve replacement (TAVR). This study examined whether the anatomy of the membranous septum (MS) could provide useful information about the risk of CD following TAVR with a balloon-expandable valve (BEV).
METHODS AND RESULTS
Among 132 consecutive patients, 106 (mean age, 85.6±5.1 years; 75 females) were included in the study. Using preoperative CT and angiography, MS length and implantation depth (ID) were assessed. The MS length minus the prosthesis ID was calculated (∆MSID). Correlation between CD, defined as new-onset left-bundle branch block (LBBB) or the need for permanent pacemaker (PPM) within 1 week after the procedure, and MS length were evaluated. A total of 19 patients (18%) developed CD following TAVR. MS length was significantly shorter in these patients than in those without CD (5.3±1.3 vs. 6.6±1.4; P<0.001), and was the important predictor of CD (odds ratio [OR]: 0.43, 95% confidence interval [CI]: 0.27-0.69, P<0.001). When considering the pre- and postprocedural parameters, the ∆MSID was smaller in patients with CD (-1.7±1.5 vs. 0.8±1.9, P<0.001), and emerged as the important predictor of CD (OR: 0.47, 95% CI: 0.33-0.69, P<0.001).
CONCLUSIONS
Short MS is associated with an increased risk of CD after TAVR with BEV.
背景
心脏传导障碍（CD）是经导管主动脉瓣置换术（TAVR）后最常见的并发症。本研究探讨了膜部间隔（MS）的解剖结构是否能为球囊扩张瓣（BEV）TAVR 后 CD 的风险提供有用信息。
方法和结果
在 132 例连续患者中，有 106 例（平均年龄 85.6±5.1 岁；75 例女性）纳入本研究。使用术前 CT 和血管造影评估 MS 长度和植入深度（ID）。计算 MS 长度与假体 ID 之差（∆MSID）。评估 CD（定义为术后 1 周内新发左束支传导阻滞（LBBB）或需要永久性起搏器（PPM））与 MS 长度之间的相关性。TAVR 后共有 19 例（18%）患者发生 CD。这些患者的 MS 长度明显短于无 CD 的患者（5.3±1.3 vs. 6.6±1.4；P<0.001），是 CD 的重要预测因素（比值比[OR]：0.43，95%置信区间[CI]：0.27-0.69，P<0.001）。考虑到术前和术后参数，CD 患者的 ∆MSID 较小（-1.7±1.5 vs. 0.8±1.9，P<0.001），是 CD 的重要预测因素（OR：0.47，95% CI：0.33-0.69，P<0.001）。
结论
短 MS 与 BEV 行 TAVR 后 CD 风险增加相关。
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