Abdelshafy Mahmoud, Elkoumy Ahmed, Elzomor Hesham, Abdelghani Mohammad, Campbell Ruth, Kennedy Ciara, Kenny Gibson William, Fezzi Simone, Nolan Philip, Wagener Max, Arsang-Jang Shahram, Mohamed Sameh K, Mostafa Mansour, Shawky Islam, MacNeill Briain, McInerney Angela, Mylotte Darren, Soliman Osama
Discipline of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Health Service Executive, H91 YR71 Galway, Ireland.
CORRIB Core Lab, University of Galway, H91 V4AY Galway, Ireland.
J Clin Med. 2023 Jul 22;12(14):4835. doi: 10.3390/jcm12144835.
(1) Background: Conduction disturbance requiring a new permanent pacemaker (PPM) after transcatheter aortic valve implantation (TAVI) has traditionally been a common complication. New implantation techniques with self-expanding platforms have reportedly reduced the incidence of PPM. We sought to investigate the predictors of PPM at 30 days after TAVI using Evolut R/PRO/PRO+; (2) Methods: Consecutive patients who underwent TAVI with the Evolut platform between October 2019 and August 2022 at University Hospital Galway, Ireland, were included. Patients who had a prior PPM ( = 10), valve-in-valve procedures ( = 8) or received >1 valve during the index procedure ( = 3) were excluded. Baseline clinical, electrocardiographic (ECG), echocardiographic and multislice computed tomography (MSCT) parameters were analyzed. Pre-TAVI MSCT analysis included membranous septum (MS) length, a semi-quantitative calcification analysis of the aortic valve leaflets, left ventricular outflow tract, and mitral annulus. Furthermore, the implantation depth (ID) was measured from the final aortography. Multivariate binary logistic analysis and receiver operating characteristic (ROC) curve analysis were used to identify independent predictors and the optimal MS and ID cutoff values to predict new PPM requirements, respectively; (3) Results: A total of 129 TAVI patients were included (age = 81.3 ± 5.3 years; 36% female; median EuroSCORE II 3.2 [2.0, 5.4]). Fifteen patients (11.6%) required PPM after 30 days. The patients requiring new PPM at 30 days were more likely to have a lower European System for Cardiac Operative Risk Evaluation II, increased prevalence of right bundle branch block (RBBB) at baseline ECG, have a higher mitral annular calcification severity and have a shorter MS on preprocedural MSCT analysis, and have a ID, as shown on the final aortogram. From the multivariate analysis, pre-TAVI RBBB, MS length, and ID were shown to be predictors of new PPM. An MS length of <2.85 mm (AUC = 0.85, 95%CI: (0.77, 0.93)) and ID of >3.99 mm (area under the curve (AUC) = 0.79, (95% confidence interval (CI): (0.68, 0.90)) were found to be the optimal cut-offs for predicting new PPM requirements; (4) Conclusions: Membranous septum length and implantation depth were found to be independent predictors of new PPM post-TAVI with the Evolut platform. Patient-specific implantation depth could be used to mitigate the requirement for new PPM.
(1) 背景：经导管主动脉瓣植入术（TAVI）后需要植入新的永久性起搏器（PPM）的传导障碍传统上一直是一种常见并发症。据报道，采用自膨胀平台的新植入技术降低了PPM的发生率。我们试图使用Evolut R/PRO/PRO+研究TAVI术后30天PPM的预测因素；(2) 方法：纳入2019年10月至2022年8月在爱尔兰戈尔韦大学医院接受Evolut平台TAVI的连续患者。排除既往有PPM（n = 10）、瓣中瓣手术（n = 8）或在索引手术期间接受>1个瓣膜（n = 3）的患者。分析基线临床、心电图（ECG）、超声心动图和多层计算机断层扫描（MSCT）参数。TAVI前MSCT分析包括膜性间隔（MS）长度、主动脉瓣叶、左心室流出道和二尖瓣环的半定量钙化分析。此外，从最终主动脉造影测量植入深度（ID）。采用多变量二元逻辑分析和受试者操作特征（ROC）曲线分析分别确定独立预测因素以及预测新PPM需求的最佳MS和ID临界值；(3) 结果：共纳入129例TAVI患者（年龄 = 81.3 ± 5.3岁；36%为女性；欧洲心脏手术风险评估II中位数3.2 [2.0, 5.4]）。15例患者（11.6%）在30天后需要PPM。30天需要新PPM的患者更可能有较低的欧洲心脏手术风险评估系统II、基线ECG时右束支传导阻滞（RBBB）患病率增加、二尖瓣环钙化严重程度较高、术前MSCT分析时MS较短以及最终主动脉造影片上显示的ID。多变量分析显示，TAVI前RBBB、MS长度和ID是新PPM的预测因素。发现MS长度<2.85 mm（曲线下面积（AUC） = 0.85，95%置信区间（CI）：(0.77, 0.93)）和ID>3.99 mm（AUC = 0.79，(95%CI：(0.68, 0.90))）是预测新PPM需求的最佳临界值；(4) 结论：发现膜性间隔长度和植入深度是Evolut平台TAVI术后新PPM的独立预测因素。针对患者的植入深度可用于减少新PPM的需求。
