Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
Faculty of Medicine Siriraj Hospital, Her Majesty's Cardiac Center, Mahidol University, Bangkok, Thailand.
BMC Cardiovasc Disord. 2022 Mar 31;22(1):135. doi: 10.1186/s12872-022-02576-y.
Conduction disturbances are a common complication after transcatheter aortic valve replacement (TAVR). The aim of this study was to investigate the preprocedural and procedural variables that predict new-onset conduction disturbances post-TAVR (hereafter CD/CDs).
Consecutive patients who underwent TAVR during December 2009-March 2021 at the Faculty of Medicine Siriraj Hospital, Mahidol University-Thailand's largest national tertiary referral center-were enrolled. Patients with prior implantation of a cardiac device, periprocedural death, or unsuccessful procedure were excluded. Clinical and electrocardiographic data, preprocedural imaging, including membranous septum (MS) length, and procedural variables, including implantation depth (ID), were analyzed. CD was defined as new left or right bundle branch block, significant intraventricular conduction disturbance with QRS interval ≥ 120 ms, new high-grade atrioventricular block, or complete heart block. Multivariate binary logistic analysis and receiver operating characteristic (ROC) curve analysis were used to identify independent predictors and the optimal ∆MSID (difference between the MS length and ID) cutoff value, respectively.
A total of 124 TAVR patients (mean age: 84.3 ± 6.3 years, 62.1% female) were included. The mean Society of Thoracic Surgeons score was 7.3%, and 85% of patients received a balloon expandable transcatheter heart valve. Thirty-five patients (28.2%) experienced a CD, and one-third of those required pacemaker implantation. The significant preprocedural and procedural factors identified from univariate analysis included intraventricular conduction delay, mitral annular calcification, MS length ≤ 6.43 mm, self-expanding device, small left ventricular cavity, and ID ≥ 6 mm. Multivariate analysis revealed MS length ≤ 6.43 mm (adjusted odds ratio [aOR] 9.54; 95% CI 2.56-35.47; p = 0.001) and ∆MSID < 0 mm (adjusted odds ratio [aOR] 10.77; 95% CI 2.86-40.62; p = < 0.001) to be independent predictors of CD. The optimal ∆MSID cutoff value for predicting conduction disturbances was less than 0 mm (area under the receiver operating characteristic curve [AuROC]: 0.896).
This study identified MS length ≤ 6.43 mm and ∆MSID < 0 mm as independent predictors of CDs. ∆MSID < 0 was the strongest and only modifiable predictor. Importantly, we expanded the CD criteria to cover all spectrum of TAVR-related conduction injury to lower the threshold of this sole modifiable risk. The optimal ∆MSID cutoff value was < 0 mm.
TCTR, TCTR20210818002. Registered 17 August 2021-Retrospectively registered, http://www.thaiclinicaltrials.org/show/TCTR 20210818002.
传导障碍是经导管主动脉瓣置换术（TAVR）后的常见并发症。本研究旨在探讨预测 TAVR 后新发传导障碍（以下简称 CD/CDs）的术前和术中变量。
连续纳入 2009 年 12 月至 2021 年 3 月在泰国玛希隆大学 Siriraj 医院接受 TAVR 的患者。排除了既往植入心脏装置、围手术期死亡或手术不成功的患者。分析了临床和心电图数据、术前影像学资料，包括膜间隔（MS）长度，以及术中变量，包括植入深度（ID）。CD 定义为新发左或右束支传导阻滞、QRS 间隔≥120ms 的显著室内传导障碍、新发高度房室传导阻滞或完全性心脏阻滞。采用多变量二元逻辑分析和接收者操作特征（ROC）曲线分析分别确定独立预测因子和最佳 ∆MSID（MS 长度与 ID 之间的差异）截断值。
共纳入 124 例 TAVR 患者（平均年龄：84.3±6.3 岁，62.1%为女性）。平均胸外科医生协会评分 7.3%，85%的患者接受了球囊扩张式经导管心脏瓣膜。35 例（28.2%）患者发生 CD，其中三分之一需要植入起搏器。单变量分析确定的显著术前和术中因素包括室内传导延迟、二尖瓣环钙化、MS 长度≤6.43mm、自膨式装置、左心室腔小和 ID≥6mm。多变量分析显示 MS 长度≤6.43mm（调整后优势比[aOR]9.54；95%CI 2.56-35.47；p=0.001）和 ∆MSID＜0mm（调整后优势比[aOR]10.77；95%CI 2.86-40.62；p＜0.001）是 CD 的独立预测因子。预测传导障碍的最佳 ∆MSID 截断值小于 0mm（受试者工作特征曲线下面积[AuROC]：0.896）。
本研究确定 MS 长度≤6.43mm 和 ∆MSID＜0mm 是 CD 的独立预测因子。∆MSID＜0 是最强且唯一可改变的预测因子。重要的是，我们扩大了 CD 标准以涵盖所有 TAVR 相关的传导损伤谱，以降低这一唯一可改变的风险的阈值。最佳 ∆MSID 截断值为＜0mm。
TCTR，TCTR20210818002。2021 年 8 月 17 日注册-回顾性注册，http://www.thaiclinicaltrials.org/show/TCTR 20210818002。
