Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra-Northwell, 300 Community Drive, 1DSU, Manhasset 11030, NY, USA.
J Interv Cardiol. 2020 Oct 20;2020:1807909. doi: 10.1155/2020/1807909. eCollection 2020.
Requirement of permanent pacemaker (PPM) implantation is a known and common postoperative consequence of transcatheter aortic valve replacement (TAVR). The Emory risk score has been recently developed to help risk stratify the need for PPM insertion in patients undergoing TAVR with SAPIEN 3 valves. Our aim was to assess the validity of this risk score in our patient population, as well as its applicability to patients receiving self-expanding valves.
We conducted a retrospective review of 479 TAVR patients without preoperative pacemakers from November 2016 through December 2018. Preoperative risk factors included in the Emory risk score were collected for each patient: preoperative QRS, preoperative right bundle branch block (RBBB), preoperative syncope, and degree of valve oversizing. Multivariable analysis of the individual variables within the scoring system to identify predictors of PPM placement was performed. The predictive discrimination of the risk score for the risk of PPM placement after TAVR was assessed with the area under the receiver operating characteristic curve (AUC).
Our results demonstrated that, of the 479 patients analyzed, 236 (49.3%) received balloon-expandable valves and 243 (50.7%) received self-expanding valves. Pacemaker rates were higher in patients receiving self-expanding valves than those receiving balloon-expandable valves (25.1% versus 16.1%, =0.018). The Emory risk score showed a moderate correlation with pacemaker requirement in patients receiving each valve type, with AUC for balloon-expandable and self-expanding valves of 0.657 and 0.645, respectively. Of the four risk score components, preoperative RBBB was the only predictor of pacemaker requirement with an AUC of 0.615 for both balloon-expandable and self-expanding valves. , the Emory risk score had modest predictive utility for PPM insertion after balloon-expandable and self-expanding TAVR. The risk score did not offer better discriminatory utility than that of preoperative RBBB alone. Understanding the determinants of PPM insertion after TAVR can better guide patient education and postoperative management.
经导管主动脉瓣置换术（TAVR）后需要植入永久性起搏器（PPM）是已知的常见术后后果。Emory 风险评分最近被开发出来，以帮助对接受 SAPIEN 3 瓣膜的 TAVR 患者进行 PPM 插入的需求进行风险分层。我们的目的是评估该风险评分在我们患者人群中的有效性，以及其在接受自膨式瓣膜的患者中的适用性。
我们对 2016 年 11 月至 2018 年 12 月期间 479 例无术前起搏器的 TAVR 患者进行了回顾性研究。为每位患者收集了 Emory 风险评分中的术前风险因素：术前 QRS、术前右束支传导阻滞（RBBB）、术前晕厥和瓣膜过度扩张程度。对评分系统中的单个变量进行多变量分析，以确定 PPM 放置的预测因素。使用受试者工作特征曲线下面积（AUC）评估风险评分对 TAVR 后 PPM 放置风险的预测区分能力。
我们的结果表明，在分析的 479 例患者中，236 例（49.3%）接受了球囊扩张瓣膜，243 例（50.7%）接受了自膨式瓣膜。接受自膨式瓣膜的患者比接受球囊扩张瓣膜的患者更需要起搏器（25.1%比 16.1%，=0.018）。Emory 风险评分与两种瓣膜类型的患者起搏器需求有中度相关性，球囊扩张瓣膜和自膨式瓣膜的 AUC 分别为 0.657 和 0.645。在四个风险评分组成部分中，术前 RBBB 是起搏器需求的唯一预测因素，球囊扩张瓣膜和自膨式瓣膜的 AUC 分别为 0.615。在接受球囊扩张和自膨式 TAVR 的患者中，Emory 风险评分对 PPM 植入有适度的预测作用。风险评分没有比术前 RBBB 单独提供更好的鉴别能力。了解 TAVR 后 PPM 插入的决定因素可以更好地指导患者教育和术后管理。
