Department of Cardiology, University of Health Sciences Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Department of Cardiology, University of Health Sciences Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
Kardiol Pol. 2020 Oct 23;78(10):1020-1028. doi: 10.33963/KP.15538. Epub 2020 Jul 29.
Conduction disturbances (CD) are one of the most common adverse events after transcatheter aortic valve replacement (TAVR), and seem to be dependent on the device used as well as anatomical factors.
The aim of this study was to evaluate whether the length of the membranous septum (MS) could provide useful information about the risk of CD and to examine the impact of the MS on CD after TAVR using different devices.
This study included 140 patients undergoing TAVR with a balloon‑expandable valve or self‑‑expanding valve. The length of the MS was assessed by preoperative computed tomography. ΔMSID was calculated as the length of the MS minus implantation depth.
A total of 24 patients (17%) received a permanent pacemaker (PPM), 53 (38%) developed new‑‑onset left bundle‑branch block (LBBB) following TAVR. The MS length was shown to be the strongest independent predictor of new‑onset LBBB (odds ratio [OR], 3.05; 95% CI, 1.96-4.77; P <0.001) and PPM implantation (OR, 3.76; 95% CI, 2.01-7.06; P <0.001). ΔMSID was also inversely associated with the development of LBBB and the need for PPM. In a head‑to‑head comparison, ΔMSID values were found to be statistically lower in the self‑expanding valve group (-0.8 mm vs 0.7 mm; P <0.001).
A short MS and ΔMSID with a negative value increase the risk of CD. Assessment of the MS length prior to TAVR might serve as an additional tool to guide clinical decision‑making and appropriate device selection to reduce the the risk of CD.
传导障碍（CD）是经导管主动脉瓣置换术（TAVR）后最常见的不良事件之一，似乎与所使用的器械以及解剖因素有关。
本研究旨在评估膜间隔（MS）的长度是否能为 CD 风险提供有用信息，并检查 MS 在使用不同器械进行 TAVR 后的 CD 影响。
本研究纳入了 140 例行 TAVR 的患者，其中使用球囊扩张瓣膜或自膨式瓣膜。术前通过计算机断层扫描评估 MS 的长度。ΔMSID 定义为 MS 长度减去植入深度。
共有 24 例（17%）患者需要植入永久性起搏器（PPM），53 例（38%）患者在 TAVR 后新发左束支传导阻滞（LBBB）。MS 长度是新发 LBBB（优势比 [OR]，3.05；95%置信区间，1.96-4.77；P<0.001）和 PPM 植入（OR，3.76；95%置信区间，2.01-7.06；P<0.001）的最强独立预测因素。ΔMSID 也与 LBBB 的发生和 PPM 的需求呈负相关。在直接比较中，发现自膨式瓣膜组的 ΔMSID 值显著更低（-0.8 毫米比 0.7 毫米；P<0.001）。
MS 较短和 ΔMSID 值为负值会增加 CD 的风险。TAVR 前评估 MS 长度可能成为指导临床决策和选择合适器械以降低 CD 风险的附加工具。
