Lim Kevin, Ho Yan Kit, Chow Simon Chi Ying, Fujikawa Takuya, Lee Alex Pui-Wai, Wong Randolph Hung Leung
Division of Cardiothoracic Surgery, Prince of Wales Hospital, Shatin, Hong Kong.
Division of Cardiology, Department of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
Front Cardiovasc Med. 2021 Jul 15;8:690752. doi: 10.3389/fcvm.2021.690752. eCollection 2021.
The Edwards INTUITY rapid deployment valve was anchored on the left ventricular outflow tract (LVOT) by radial force akin to transcatheter balloon-expandable valves. This design feature facilitates minimally invasive and complex procedures but comes at the price of compressing the atrioventricular conduction bundle and potential requirement for pacemaker implantation. A retrospective observational study was conducted on 30 consecutive patients who received the INTUITY valve at our institution from August 2018 to January 2021. Demographical, clinical, and echocardiographic parameters were collected for 90 days post-operatively. The diameter of the native LVOT at the landing site of the sub-annular stent was retrospectively measured using archived trans-esophageal echocardiographic images. A line was drawn from the inner edge of the septal endocardium to the inner edge of the anterior mitral leaflet in mid-systole, parallel to the aortic annulus, 6-8 mm apical to the aortic annulus depending on the valve size and the corresponding stent length. Risk factors associated with new onset conduction disturbances, defined as the occurrence of bundle branch block or complete heart block, were analyzed. Operative mortality was 3.3%. Pre-operatively, permanent pacemakers were required for two patients who were excluded from the subsequent analysis. New onset conduction disturbances occurred in four of the remaining 28 patients (14.3%). This included two incidences of persistent left bundle branch block and two incidences of permanent pacemaker implantation due to complete heart block. Univariate analysis identified over-sizing of the native LVOT by 5 mm or more as a significant risk factor associated with conduction disturbance. During INTUITY vale implantation, in addition to the aortic annulus, the landing site of the sub-annular stent within the native LVOT should also be sized pre-bypass. Over-sizing the native LVOT by 5 mm or more was associated with an increased risk of new onset conduction disturbances and should be avoided.
爱德华兹INTUITY快速部署瓣膜通过类似于经导管球囊扩张瓣膜的径向力固定在左心室流出道（LVOT）上。这一设计特点便于进行微创和复杂手术，但代价是会压迫房室传导束，并可能需要植入起搏器。对2018年8月至2021年1月在我们机构接受INTUITY瓣膜的30例连续患者进行了一项回顾性观察研究。收集术后90天的人口统计学、临床和超声心动图参数。使用存档的经食管超声心动图图像回顾性测量瓣下支架着陆部位的原生LVOT直径。在收缩中期，从间隔心内膜的内边缘到二尖瓣前叶的内边缘画一条线，平行于主动脉瓣环，根据瓣膜大小和相应支架长度，在主动脉瓣环尖部6 - 8毫米处。分析与新发传导障碍相关的危险因素，新发传导障碍定义为束支传导阻滞或完全性心脏传导阻滞的发生。手术死亡率为3.3%。术前，两名患者需要植入永久性起搏器，这两名患者被排除在后续分析之外。其余28例患者中有4例（14.3%）出现新发传导障碍。这包括2例持续性左束支传导阻滞和2例因完全性心脏传导阻滞而植入永久性起搏器的情况。单因素分析确定原生LVOT尺寸过大5毫米或更多是与传导障碍相关的一个重要危险因素。在INTUITY瓣膜植入过程中，除了主动脉瓣环外，还应在体外循环前对原生LVOT内瓣下支架的着陆部位进行尺寸测量。原生LVOT尺寸过大5毫米或更多与新发传导障碍风险增加相关，应避免这种情况。
