Keller Lukas S, Nuche Jorge, Mesnier Jules, Farjat-Pasos Julio, Paradis Jean-Michel, De Larochellière Robert, Mohammadi Siamak, Kalavrouziotis Dimitri, Dumont Eric, Philippon François, Rodés-Cabau Josep
Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada.
Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada.
Can J Cardiol. 2023 Jul;39(7):901-908. doi: 10.1016/j.cjca.2023.02.012. Epub 2023 Feb 18.
No data exist on the clinical and prognostic significance of syncope in patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis.
A total of 1705 consecutive patients with severe aortic stenosis undergoing TAVR in a tertiary university centre between 2007 and 2021 were included and classified according to the presence of syncope before the TAVR procedure. Baseline, procedural, and follow-up data were collected prospectively in a dedicated database.
A total of 115 patients (7%) presented with syncope before the TAVR procedure. Of these, 15 patients (13%) showed arrhythmic episodes as the probable cause of the syncope, and all of them had pacemakers implanted at a median of 13 (6 to 53) days before the TAVR procedure. Patients with syncope were older (82 ± 8 years vs 80 ± 8 years, P = 0.001) and had a higher rate of pacemaker implantation before the TAVR procedure (27% vs 14%, P < 0.001), with no differences between groups regarding the severity of aortic stenosis (transvalvular gradient, valve area). There were no differences between groups in 30-day (adjusted hazard ratio [HR], 1.28; 95% confidence interval [CI], 0.46-3.60) and 1-year (adjusted HR, 0.71; 95% CI, 0.0.35-1.45) mortality following TAVR.
Syncope was not associated with a more advanced valvular disease and had no significant prognostic impact on patients undergoing TAVR. However, arrhythmias and conduction-system disturbances were more common in patients with previous syncope and might play a relevant role in the pathogenesis of syncope in patients with aortic stenosis.
对于因严重主动脉瓣狭窄接受经导管主动脉瓣置换术（TAVR）的患者，晕厥的临床及预后意义尚无相关数据。
纳入2007年至2021年期间在一所三级大学中心连续接受TAVR的1705例严重主动脉瓣狭窄患者，并根据TAVR手术前是否存在晕厥进行分类。基线、手术及随访数据前瞻性收集于一个专用数据库。
共有115例患者（7%）在TAVR手术前出现晕厥。其中，15例患者（13%）的晕厥可能原因是心律失常发作，所有这些患者均在TAVR手术前中位数为13（6至53）天植入了起搏器。晕厥患者年龄更大（82±8岁 vs 80±8岁，P = 0.001），且在TAVR手术前起搏器植入率更高（27% vs 14%，P < 0.001），两组在主动脉瓣狭窄严重程度（跨瓣压差、瓣口面积）方面无差异。TAVR术后30天（校正风险比[HR]，1.28；95%置信区间[CI]，0.46 - 3.60）和1年（校正HR，0.71；95%CI，0.35 - 1.45）死亡率在两组间无差异。
晕厥与更严重的瓣膜疾病无关，对接受TAVR的患者无显著预后影响。然而，既往有晕厥的患者心律失常和传导系统紊乱更为常见，可能在主动脉瓣狭窄患者晕厥的发病机制中起相关作用。
