Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
Int J Cardiol. 2021 Jun 15;333:152-158. doi: 10.1016/j.ijcard.2021.02.080. Epub 2021 Mar 3.
Background The need for new permanent pacemaker implantation (PPI) after Transcatheter Aortic Valve Implantation (TAVI) remains a critical issue. Membranous Septum (MS) length is associated with PPI after TAVI. The aim of this study was to identify different MS thresholds for the contemporary THV-platforms. Methods This retrospective, case-control study enrolled all patients who underwent a successful TAVI procedure with contemporary THV-platforms in the Erasmus University Medical Center between January 2016 and March 2020. The follow-up period for new PPI was 30 days. MS-length was determined by Computed Tomography. Results The study consisted 653 TAVI patients with median age 80.6 years (IQR 74.7-84.8). New PPI occurred in 120 patients (18.4%). Patients with new PPI had a shorter MS-length (2.9 mm (IQR 2.3-4.3) vs. 4.2 mm (IQR 2.9-5.7), p < 0.001). MS-length < 3 mm identified a high-risk phenotype with 30.3% PPI-rate (OR 6.5 [95%CI 2.9-14.9]), MS-length 3-6 mm an intermediate-risk phenotype with 15.4% PPI-rate (OR 2.7 [95%CI 1.2-6.2]) and MS > 6 mm a low-risk phenotype with a 6.3% PPI-rate (reference). For the Lotus valve, there was no significant difference in PPI-rates between the high-risk (45.8%, OR 3.5 [95%CI 0.8-15.1]) and low-risk group (20%). By multivariate analysis MS-length, Agatston-score, use of Lotus valve, and ECG with first-degree AV block, RBBB or bifascular block were independent predictors for new PPI. Conclusion MS-length was an independent predictor for new PPI post-TAVI. Three phenotypes were found based on MS-length. MS < 3 mm was universally associated with a high risk for new PPI (>30%). MS > 6 mm represented a low-risk phenotype with PPI-rate < 10%. PPI-rate varied per THV type in the intermediate phenotype. PPI-rate with Lotus was high regardless of MS-length.
经导管主动脉瓣置换术（TAVI）后需要新的永久性起搏器植入（PPI）仍然是一个关键问题。膜间隔（MS）长度与 TAVI 后 PPI 相关。本研究旨在为当代 THV 平台确定不同的 MS 阈值。
本回顾性病例对照研究纳入了 2016 年 1 月至 2020 年 3 月期间在伊拉斯谟大学医学中心成功接受当代 THV 平台 TAVI 手术的所有患者。新 PPI 的随访时间为 30 天。MS 长度通过计算机断层扫描确定。
该研究纳入了 653 名 TAVI 患者，中位年龄 80.6 岁（IQR 74.7-84.8）。120 名患者（18.4%）发生新的 PPI。新 PPI 患者的 MS 长度更短（2.9mm（IQR 2.3-4.3）比 4.2mm（IQR 2.9-5.7），p<0.001）。MS 长度<3mm 确定为高风险表型，PPI 发生率为 30.3%（OR 6.5[95%CI 2.9-14.9]），MS 长度 3-6mm 为中风险表型，PPI 发生率为 15.4%（OR 2.7[95%CI 1.2-6.2]），MS>6mm 为低风险表型，PPI 发生率为 6.3%（参考）。对于 Lotus 瓣膜，高危组（45.8%，OR 3.5[95%CI 0.8-15.1]）和低危组（20%）之间的 PPI 发生率无显著差异。多变量分析显示，MS 长度、Agatston 评分、使用 Lotus 瓣膜以及伴有一度房室传导阻滞、右束支阻滞或双支阻滞的心电图是新 PPI 的独立预测因子。
MS 长度是 TAVI 后新发 PPI 的独立预测因子。根据 MS 长度发现了三种表型。MS<3mm 普遍与新发 PPI 风险增加（>30%）相关。MS>6mm 代表 PPI 发生率<10%的低风险表型。中危表型中每个 THV 类型的 PPI 发生率不同。Lotus 瓣膜的 PPI 发生率无论 MS 长度如何均较高。
