Lauten Philipp, Costello-Boerrigter Lisa C, Goebel Björn, Gonzalez-Lopez David, Schreiber Matthias, Kuntze Thomas, Al Jassem Mahmoud, Lapp Harald
Department of Cardiology, Heart Center, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99437 Bad Berka, Germany.
J Cardiovasc Dev Dis. 2023 May 24;10(6):230. doi: 10.3390/jcdd10060230.
Transcatheter aortic valve implantation (TAVI) is now a commonly used therapy in patients with severe aortic stenosis, even in those patients at low surgical risk. The indications for TAVI have broadened as the therapy has proven to be safe and effective. Most challenges associated with TAVI after its initial introduction have been impressively reduced; however, the possible need for post-TAVI permanent pacemaker implantation (PPI) secondary to conduction disturbances continues to be on the radar. Conduction abnormalities post-TAVI are always of concern given that the aortic valve lies in close proximity to critical components of the cardiac conduction system. This review will present a summary of noteworthy pre-and post-procedural conduction blocks, the best use of telemetry and ambulatory device monitoring to avoid unnecessary PPI or to recognize the need for late PPI due to delayed high-grade conduction blocks, predictors to identify those patients at greatest risk of requiring PPI, important CT measurements and considerations to optimize TAVI planning, and the utility of the MInimizing Depth According to the membranous Septum (MIDAS) technique and the cusp-overlap technique. It is stressed that careful membranous septal (MS) length measurement by MDCT during pre-TAVI planning is necessary to establish the optimal implantation depth before the procedure to reduce the risk of compression of the MS and consequent damage to the cardiac conduction system.
经导管主动脉瓣植入术（TAVI）现已成为重度主动脉瓣狭窄患者常用的治疗方法，即使是手术风险较低的患者。随着该治疗方法被证明安全有效，TAVI的适应证不断扩大。TAVI最初应用后所面临的大多数挑战已显著减少；然而，TAVI术后因传导障碍可能需要植入永久性起搏器（PPI）这一问题仍备受关注。鉴于主动脉瓣紧邻心脏传导系统的关键组成部分，TAVI术后的传导异常一直令人担忧。本综述将总结术前和术后值得关注的传导阻滞情况、遥测和动态设备监测的最佳应用，以避免不必要的PPI或识别因延迟的高度传导阻滞而需要晚期PPI的情况、识别那些最有可能需要PPI的患者的预测因素、优化TAVI规划的重要CT测量和注意事项，以及根据膜周部间隔最小化深度（MIDAS）技术和瓣叶重叠技术的效用。强调在TAVI术前规划期间通过MDCT仔细测量膜周部间隔（MS）长度对于在手术前确定最佳植入深度以降低MS受压及随后心脏传导系统受损风险是必要的。
