Droppa Michal, Rudolph Tanja K, Baan Jan, Nielsen Niels-Erik, Baumgartner Helmut, Vendrik Jeroen, Froehlich Maren, Borst Oliver, Wöhrle Jochen, Gawaz Meinrad, Potratz Paul, Hack Luis P, Mauri Victor, Baranowski Jacek, Bramlage Peter, Kurucova Jana, Thoenes Martin, Rottbauer Wolfgang, Geisler Tobias
Department of Cardiology and Angiology, University Hospital of Tübingen, Tübingen, Germany.
Department of Cardiology, Heart Center, Cologne University, Cologne, Germany.
Heart Vessels. 2020 Dec;35(12):1735-1745. doi: 10.1007/s00380-020-01653-6. Epub 2020 Jun 26.
Permanent pacemaker implantation (PPI) is a widely recognized complication associated with TAVI (incidence up to 20%). Smaller registries have identified several variables associated with PPI. The objective was to validate patient- and transcatheter aortic valve implantation (TAVI)-related procedural variables associated with PPI. We performed a retrospective analysis of patients from six European centers undergoing TAVI with the Edwards SAPIEN 3 prosthesis. Baseline variables and pre-procedural ECG characteristics and CT-scans were taken into account. Data for 1745 patients were collected; 191 (10.9%) required PPI after TAVI. The baseline variables pulmonary hypertension (OR 1.64; 95% CI 1.01-2.59), QRS duration > 117 ms (OR 2.58; 95% CI 1.73-3.84), right bundle branch block (RBBB; OR 5.14; 95% CI 3.39-7.72), left anterior hemi block (OR 1.92; 95% CI 1.19-3.02) and first-degree atrioventricular block (AVB, OR 1.63; 95%CI 1.05-2.46) were significantly associated with PPI. RBBB (OR 8.11; 95% CI 3.19-21.86) and first-degree AVB (OR 2.39; 95% CI 1.18-4.66) remained significantly associated in a multivariate analysis. Procedure-related variables included access site (TF; OR 1.97; 95% CI 1.07-4.05), implanted valve size (29 mm; OR 1.88; 95% CI 1.35-2.59), mean TAVI valve implantation depth below the annulus > 30% (OR 3.75; 95% CI 2.01-6.98). Patients receiving PPI had longer ICU stays and later discharges. Acute kidney injury stage 2/3 was more common in patients with PPI until discharge (15.2 vs. 3.1%; p = 0.007), but was not statistically significant thereafter. Further differences in outcomes at 30 days did not reach significance. The data will aid pre- and post-procedural patient management and prevent adverse long-term outcomes.Clinical Trial: NCT03497611.
永久性起搏器植入（PPI）是经导管主动脉瓣置换术（TAVI）一种广为人知的并发症（发生率高达20%）。规模较小的登记研究已确定了几个与PPI相关的变量。目的是验证与PPI相关的患者及经导管主动脉瓣植入（TAVI）相关的手术变量。我们对来自六个欧洲中心接受使用爱德华 Sapien 3 瓣膜进行TAVI的患者进行了回顾性分析。考虑了基线变量、术前心电图特征和CT扫描。收集了1745例患者的数据；191例（10.9%）在TAVI后需要PPI。基线变量肺动脉高压（OR 1.64；95%CI 1.01 - 2.59）、QRS波时限>117毫秒（OR 2.58；95%CI 1.73 - 3.84）、右束支传导阻滞（RBBB；OR 5.14；95%CI 3.39 - 7.72）、左前半阻滞（OR 1.92；95%CI 1.19 - 3.02）和一度房室传导阻滞（AVB，OR 1.63；95%CI 1.05 - 2.46）与PPI显著相关。在多变量分析中，RBBB（OR 8.11；95%CI 3.19 - 21.86）和一度AVB（OR 2.39；95%CI 1.18 - 4.66）仍显著相关。与手术相关的变量包括入路部位（经股动脉；OR 1.97；95%CI 1.07 - 4.05）、植入瓣膜尺寸（29毫米；OR 1.88；95%CI 1.35 - 2.59）、平均TAVI瓣膜植入深度低于瓣环>30%（OR 3.75；95%CI 2.01 - 6.98）。接受PPI的患者在重症监护病房停留时间更长，出院更晚。直到出院，急性肾损伤2/3期在接受PPI的患者中更常见（15.2%对3.1%；p = 0.007），但此后无统计学意义。30天时结果的进一步差异未达到显著水平。这些数据将有助于术前和术后患者管理并预防不良长期结果。临床试验：NCT03497611。
