经导管主动脉瓣植入术后的膜性间隔形态与传导异常风险。
Membranous septum morphology and risk of conduction abnormalities after transcatheter aortic valve implantation.
机构信息
Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
出版信息
EuroIntervention. 2022 Jan 28;17(13):1061-1069. doi: 10.4244/EIJ-D-21-00363.
BACKGROUND
There are limited data on the association of membranous septum (MS) morphology and transcatheter heart valve (THV) implantation depth, and the development of new conduction abnormalities (CA) after transcatheter aortic valve implantation (TAVI).
AIMS
The aim of this study was to describe the morphology of the MS and predict the risk of new CA after TAVI based on the MS morphology and THV implantation depth.
METHODS
Based on preprocedural CT scans, the MS depth was measured for every 25% of the entire MS width in 272 TAVI patients without preprocedural bundle branch block (BBB) or pacemaker. Post-procedural CT scans for THV implantation depth assessment were available in 130 of these patients.
RESULTS
The MS depth was a median of 2.5 mm (IQR 1.4-3.8) deeper at the posterior edge when compared to the anterior edge of the MS. New CA developed in 7.1% of patients in whom the THV did not cross the lower MS border at its anterior edge (3.6% with new BBB and high degree CA, respectively), in 18.8% of patients (15.6% with new BBB and 3.1% with new high-degree CA) where the THV overlapped the lower MS border by <2.5 mm and in 47.1% of patients (24.3% with new BBB and 22.9% with new high-degree CA) with THV overlap of the lower MS border by ≥2.5 mm.
CONCLUSIONS
The difference of the MS depth and THV implantation depth measured at the anterior edge of the MS predicted new CA after TAVI.
背景
关于膜部间隔（MS）形态与经导管心脏瓣膜（THV）植入深度的关系，以及经导管主动脉瓣置换术（TAVI）后新传导异常（CA）的发展，目前数据有限。
目的
本研究旨在描述 MS 的形态，并根据 MS 形态和 THV 植入深度预测 TAVI 后新发 CA 的风险。
方法
在 272 例无术前束支传导阻滞（BBB）或起搏器的 TAVI 患者中，根据术前 CT 扫描测量 MS 宽度的每 25%处的 MS 深度。其中 130 例患者可获得术后 THV 植入深度评估的 CT 扫描。
结果
与 MS 前缘相比，MS 后缘的 MS 深度中位数深 2.5mm（IQR 1.4-3.8）。THV 前缘未穿过 MS 下缘的患者中，有 7.1%（分别为 3.6%出现新 BBB 和高度 CA）出现新发 CA；THV 与 MS 下缘重叠<2.5mm 的患者中，有 18.8%（分别为 15.6%出现新 BBB 和 3.1%出现新高度 CA）出现新发 CA；THV 与 MS 下缘重叠≥2.5mm 的患者中，有 47.1%（分别为 24.3%出现新 BBB 和 22.9%出现新高度 CA）出现新发 CA。
结论
MS 前缘处 MS 深度和 THV 植入深度的差异预测了 TAVI 后新发 CA。
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