Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-Shi, Saitama, 330-8503, Japan.
Department of Medical Informatics, Center for Information, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan.
J Artif Organs. 2022 Sep;25(3):238-244. doi: 10.1007/s10047-021-01301-4. Epub 2021 Nov 2.
Rapid deployment valve has expanded surgical indication for high-risk patients with aortic stenosis despite its accommodated risk for conduction disorder (CD). The purpose of this study was to evaluate the degree of oversizing in association with postoperative CD. During June 2019 to September 2021, 25 patients underwent aortic valve replacement with Edwards INTUITY. Device size selection was evaluated intraoperatively using provided sizers. Oversizing was evaluated retrospectively by measuring the difference of the dimension of the annulus and left ventricular outflow tract (LVOT) compared to the dimensions of the device used by preoperative-computed tomography. Although there was no incidence of pacemaker implantation, seven patients (28.0%) experienced CD after surgery. There was no difference in device area and annulus area (CD: - 37 ± 22.7 mm vs. no CD: - 56 ± 63.6 mm, p = 0.47), and device circumference and annulus circumference (CD: - 4.4 ± 2.77 mm vs. no CD: - 6.9 ± 5.60 mm, p = 0.26) in patients with and without CD. However, there was a significant difference in area of the device skirt and sub-annular area at the LVOT (CD: 114 ± 28.4 mm vs. no CD: - 8 ± 80.0 mm, p < 0.001), and circumference of device skirt and the LVOT (CD: 3.9 ± 2.08 mm vs. no CD: - 4.6 ± 5.24 mm, p < 0.001) between the two groups. Receiver operating characteristic curve analysis showed that an area difference of 77.7 mm and circumference difference of 0.91 mm at LVOT were associated with postoperative CD with specificities of 0.83, 0.78 and sensitivity of 1.0, 1.0, respectively. Preoperative measurement of the LVOT may be useful in evaluating the risk of postoperative CD in patients receiving rapid deployment valve.
尽管快速部署瓣膜会增加主动脉瓣狭窄高危患者的手术适应证，但也会带来传导障碍（CD）的风险。本研究旨在评估与术后 CD 相关的过度扩张程度。2019 年 6 月至 2021 年 9 月，25 例患者接受 Edwards INTUITY 主动脉瓣置换术。术中使用提供的扩张器评估器械尺寸选择。通过术前 CT 测量瓣环和左心室流出道（LVOT）的尺寸与使用的器械尺寸之间的差异，回顾性评估过度扩张。尽管没有植入起搏器的病例，但术后 7 例（28.0%）发生 CD。CD 组与无 CD 组的器械面积和瓣环面积（CD：-37±22.7mm 比无 CD：-56±63.6mm，p=0.47）、器械周长和瓣环周长（CD：-4.4±2.77mm 比无 CD：-6.9±5.60mm，p=0.26）无差异。然而，在有 CD 和无 CD 的患者中，器械裙边面积和 LVOT 亚瓣环面积（CD：114±28.4mm 比无 CD：-8±80.0mm，p<0.001）和器械裙边周长与 LVOT（CD：3.9±2.08mm 比无 CD：-4.6±5.24mm，p<0.001）有显著差异。受试者工作特征曲线分析显示，LVOT 处的面积差异 77.7mm 和周长差异 0.91mm 与术后 CD 相关，特异性分别为 0.83、0.78，灵敏度分别为 1.0、1.0。术前测量 LVOT 可能有助于评估接受快速部署瓣膜的患者术后 CD 的风险。
