Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan.
Department of Cardiology, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu, Fukuoka, 802-8555, Japan.
Heart Vessels. 2022 Jun;37(6):1055-1065. doi: 10.1007/s00380-021-01999-5. Epub 2022 Jan 7.
Mechanical compression of left ventricular outflow tract (LVOT) was reported to be a leading cause of conduction impairment requiring permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR). However, the association between tapered-shape LVOT and PPI after TAVR has not been elucidated. Of 272 consecutive patients treated with SAPIEN 3 in our institute, we retrospectively analyzed the clinical data of 256 patients without previous PPI or bicuspid valve. In-hospital PPI was performed in 20 (7.8%) patients at 8.2 ± 2.9 days after TAVR. Patients requiring PPI had smaller LVOT area (356.3 vs. 399.4 mm, p ≤ 0.011). Moreover, receiver operating characteristic statistics showed that LVOT area /annulus area possessed significantly higher predictive ability than LVOT area (c-statistic: 0.91 [95% confidence interval [CI]: 0.84-0.95] vs. 0.67 [95% CI: 0.57-0.77], p < 0.001). Multivariable analysis revealed that LVOT area /annulus area (odds ratio [OR]: 1.93 [95% CI: 1.38-2.71]; p < 0.001 per % of decreasing), the difference between membranous septum length and implantation depth (ΔMSID) (OR: 6.82 [95% CI 2.39-19.48]; p < 0.001 per mm of decreasing) and pre-existing complete right bundle branch block (CRBBB) (OR: 32.38 [95% CI2.30-455.63]; p ≤ 0.002) were independently associated with PPI. In our study, tapered-shape LVOT as well as short ΔMSID and pre-existing CRBBB were identified as independent predictors for PPI after TAVR. Higher valve implantation is required to minimize the risk of post-procedural PPI especially for patients with short MS length, pre-procedural CRBBB, or tapered-shape LVOT.
经导管主动脉瓣置换术（TAVR）后，左心室流出道（LVOT）机械性压迫被报道为导致传导障碍并需要植入永久性起搏器（PPI）的主要原因。然而，TAVR 后锥形 LVOT 与 PPI 之间的关联尚未阐明。在我院接受 SAPIEN 3 治疗的 272 例连续患者中，我们回顾性分析了 256 例无既往 PPI 或二叶瓣的患者的临床资料。TAVR 后 8.2±2.9 天，20 例（7.8%）患者行院内 PPI。需要 PPI 的患者的 LVOT 面积较小（356.3 比 399.4 mm，p≤0.011）。此外，受试者工作特征统计显示，LVOT 面积/瓣环面积比 LVOT 面积具有更高的预测能力（C 统计量：0.91 [95%置信区间 [CI]：0.84-0.95] 比 0.67 [95% CI：0.57-0.77]，p<0.001）。多变量分析显示，LVOT 面积/瓣环面积（优势比 [OR]：1.93 [95% CI：1.38-2.71]；每降低 1%，p<0.001）、膜部间隔长度与植入深度的差值（ΔMSID）（OR：6.82 [95% CI 2.39-19.48]；每降低 1mm，p<0.001）和术前完全性右束支传导阻滞（CRBBB）（OR：32.38 [95% CI2.30-455.63]；p≤0.002）与 PPI 独立相关。在我们的研究中，锥形 LVOT 以及较短的 ΔMSID 和术前 CRBBB 被确定为 TAVR 后 PPI 的独立预测因素。为了最大限度地降低术后 PPI 的风险，需要更高的瓣膜植入，特别是对于 MS 长度较短、术前存在 CRBBB 或锥形 LVOT 的患者。
