膜性间隔长度对不同经导管主动脉瓣置换系统起搏器需求的影响：INTERSECT注册研究
Impact of membranous septum length on pacemaker need with different transcatheter aortic valve replacement systems: The INTERSECT registry.
作者信息
Hokken Thijmen W, Muhemin Mohammed, Okuno Taishi, Veulemans Verena, Lopes Bernardo B, Beneduce Alessandro, Vittorio Romano, Ooms Joris F, Adrichem Rik, Neleman Tara, Kardys Isabella, Daemen Joost, Chieffo Alaide, Montorfano Matteo, Cavalcante Joao, Zeus Tobias, Pilgrim Thomas, Toggweiler Stefan, Van Mieghem Nicolas M
机构信息
Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
Heart Center Lucerne, Lucerner Kantonsspital, Lucerne, Switzerland.
出版信息
J Cardiovasc Comput Tomogr. 2022 Nov-Dec;16(6):524-530. doi: 10.1016/j.jcct.2022.07.003. Epub 2022 Jul 13.
BACKGROUND
New permanent pacemaker implantation (new-PPI) remains a compelling issue after Transcatheter Aortic Valve Replacement (TAVR). Previous studies reported the relationship between a short MS length and the new-PPI post-TAVR with a self-expanding THV. However, this relationship has not been investigated in different currently available THV. Therefore, the aim of this study was to investigate the association between membranous septum (MS)-length and new-PPI after TAVR with different Transcatheter Heart Valve (THV)-platforms.
METHODS
We included patients with a successful TAVR-procedure and an analyzable pre-procedural multi-slice computed tomography. MS-length was measured using a standardized methodology. The primary endpoint was the need for new-PPI within 30 days after TAVR.
RESULTS
In total, 1811 patients were enrolled (median age 81.9 years [IQR 77.2-85.4], 54% male). PPI was required in 275 patients (15.2%) and included respectively 14.2%, 20.7% and 6.3% for Sapien3, Evolut and ACURATE-THV(p < 0.01). Median MS-length was significantly shorter in patients with a new-PPI (3.7 mm [IQR 2.2-5.1] vs. 4.1 mm [IQR 2.8-6.0], p = <0.01). Shorter MS-length was a predictor for PPI in patients receiving a Sapien3 (OR 0.87 [95% CI 0.79-0.96], p = <0.01) and an Evolut-THV (OR 0.91 [95% CI 0.84-0.98], p = 0.03), but not for an ACURATE-THV (OR 0.99 [95% CI 0.79-1.21], p = 0.91). By multivariable analysis, first-degree atrioventricular-block (OR 2.01 [95% CI 1.35-3.00], p = <0.01), right bundle branch block (OR 8.33 [95% CI 5.21-13.33], p = <0.01), short MS-length (OR 0.89 [95% CI 0.83-0.97], p < 0.01), annulus area (OR 1.003 [95% CI 1.001-1.005], p = 0.04), NCC implantation depth (OR 1.13 [95% CI 1.07-1.19] and use of Evolut-THV(OR 1.54 [95% CI 1.03-2.27], p = 0.04) were associated with new-PPI.
CONCLUSION
MS length was an independent predictor for PPI across different THV platforms, except for the ACURATE-THV. Based on our study observations within the total cohort, we identified 3 risk groups by MS length: MS length ≤3 mm defined a high-risk group for PPI (>20%), MS length 3-7 mm intermediate risk for PPI (10-20%) and MS length > 7 mm defined a low risk for PPI (<10%). Anatomy-tailored-THV-selection may mitigate the need for new-PPI in patients undergoing TAVR.
背景
经导管主动脉瓣置换术（TAVR）后，新的永久性起搏器植入（new-PPI）仍是一个备受关注的问题。既往研究报道了短膜性间隔（MS）长度与经导管主动脉瓣置换术后使用自膨胀经导管心脏瓣膜（THV）进行new-PPI之间的关系。然而，目前尚未在不同的现有THV中研究这种关系。因此，本研究的目的是探讨不同经导管心脏瓣膜（THV）平台的TAVR术后膜性间隔（MS）长度与new-PPI之间的关联。
方法
我们纳入了TAVR手术成功且术前多层螺旋CT可分析的患者。使用标准化方法测量MS长度。主要终点是TAVR术后30天内是否需要进行new-PPI。
结果
共纳入1811例患者（中位年龄81.9岁[四分位间距77.2 - 85.4]，54%为男性）。275例患者（15.2%）需要进行PPI，其中Sapien3、Evolut和ACURATE-THV分别为14.2%、20.7%和6.3%（p < 0.01）。new-PPI患者的中位MS长度明显较短（3.7 mm[四分位间距2.2 - 5.1] vs. 4.1 mm[四分位间距2.8 - 6.0]，p = <0.01）。较短的MS长度是接受Sapien3（OR 0.87[95%置信区间0.79 - 0.96]，p = <0.01）和Evolut-THV（OR 0.91[95%置信区间0.84 - 0.98]，p = 0.03）患者发生PPI的预测因素，但不是ACURATE-THV患者的预测因素（OR 0.99[95%置信区间0.79 - 1.21]，p = 0.91）。通过多变量分析，一度房室传导阻滞（OR 2.01[95%置信区间1.35 - 3.00]，p = <0.01）、右束支传导阻滞（OR 8.33[95%置信区间5.21 - 13.33]，p = <0.01）、短MS长度（OR 0.89[95%置信区间0.83 - 0.97]，p < 0.01）、瓣环面积（OR 1.003[95%置信区间1.001 - 1.005]，p = 0.04）、无冠窦植入深度（OR 1.13[95%置信区间1.07 - 1.19]）以及使用Evolut-THV（OR 1.54[95%置信区间1.03 - 2.27]，p = 0.04）与new-PPI相关。
结论
除ACURATE-THV外，MS长度是不同THV平台中PPI的独立预测因素。根据我们在整个队列中的研究观察结果，我们根据MS长度确定了3个风险组：MS长度≤3 mm定义为PPI的高风险组（>20%），MS长度3 - 7 mm为PPI的中度风险组（10 - 20%），MS长度>7 mm定义为PPI的低风险组（<10%）。根据解剖结构选择合适的THV可能会减少接受TAVR患者进行new-PPI的需求。
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