Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital, Helsinki, Finland.
Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan.
J Cardiovasc Electrophysiol. 2022 Jul;33(7):1576-1586. doi: 10.1111/jce.15525. Epub 2022 May 22.
Implantation depth and membranous septum (MS) length have been established as the predictors of new-onset conduction disturbance (CD) after transcatheter aortic valve replacement (TAVR) for tricuspid aortic valve (TAV) stenosis. However, little is known about the predictors with bicuspid aortic valve (BAV). This study investigated the role of MS length and implantation depth in predicting CD following TAVR with a balloon-expandable valve in patients with BAV.
This retrospective study analyzed 169 patients who underwent TAVR for BAV with balloon-expandable valve, and TAV cohort was established as a control group using propensity score (PS) matching. The primary endpoints were in-hospital new permanent pacemaker implantation (PPI) and new-onset CD (the composite outcome of new-onset left bundle branch block and new PPI).
PPI developed in 14 patients (8.3%) and new-onset CD in 37 patients (21.9%) in the BAV cohort. Multivariate analysis revealed severe left ventricle outflow tract (LVOT) calcification (odds ratio [OR]: 5.83, 95% confidence interval [CI]: 1.08-31.5, p = .0407) and implantation depth-MS length (OR: 1.30, 95% CI: 1.12-1.51, p = .0005) as the predictors of new-onset CD within the BAV cohort. The matched comparison between BAV and TAV groups showed similar MS length (3.0 vs. 3.2 mm, p = .5307), but valves were implanted more deeply in the BAV group than in the TAV group (3.9 vs. 3.0 mm, p < .0001). New-onset CD was more frequent in patients who had BAV (22.3% vs. 13.9%, p = .0458).
The implantation depth-MS length, and severe LVOT calcification predicted new-onset CD following TAVR in BAV with balloon-expandable valve. Among BAV patients, valves were implanted more deeply compared to TAV patients. High deployment technique could be considered to avoid new-onset CD in BAV anatomy.
在经导管主动脉瓣置换术（TAVR）治疗三尖瓣主动脉瓣（TAV）狭窄后，植入深度和膜间隔（MS）长度已被确定为新发传导障碍（CD）的预测因子。然而，对于二叶式主动脉瓣（BAV），关于预测因子的了解甚少。本研究旨在探讨 MS 长度和植入深度在使用球囊扩张瓣行 TAVR 后预测 BAV 患者新发 CD 的作用。
本回顾性研究纳入了 169 例接受球囊扩张瓣 TAVR 治疗的 BAV 患者，采用倾向评分（PS）匹配法设立 TAV 队列作为对照组。主要终点为住院期间新植入永久性起搏器（PPI）和新发 CD（新发左束支传导阻滞和新 PPI 的复合结局）。
BAV 队列中有 14 例（8.3%）患者发生 PPI，37 例（21.9%）患者新发 CD。多变量分析显示严重左心室流出道（LVOT）钙化（比值比 [OR]：5.83，95%置信区间 [CI]：1.08-31.5，p=0.0407）和植入深度-MS 长度（OR：1.30，95%CI：1.12-1.51，p=0.0005）是 BAV 队列中新发 CD 的预测因子。BAV 组与 TAV 组的匹配比较显示 MS 长度相似（3.0 与 3.2mm，p=0.5307），但 BAV 组的瓣膜植入深度较 TAV 组深（3.9 与 3.0mm，p<0.0001）。BAV 患者新发 CD 更为常见（22.3%与 13.9%，p=0.0458）。
在使用球囊扩张瓣的 BAV 行 TAVR 后，植入深度-MS 长度和严重的 LVOT 钙化可预测新发 CD。与 TAV 患者相比，BAV 患者的瓣膜植入深度更深。在 BAV 解剖结构中，可考虑采用高植入技术以避免新发 CD。
