Department of Cardiology, The First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, No. 2, Zheshan West Road, Jinghu District, Wuhu City, Anhui Province, China.
Department of Ultrasound Medicine, The First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu, Anhui, China.
BMC Cardiovasc Disord. 2024 Jan 28;24(1):77. doi: 10.1186/s12872-024-03735-z.
New-generation self-expanding valves can improve the success rate of transcatheter aortic valve replacement (TAVR) for severe pure native aortic regurgitation (PNAR). However, predictors of new-onset conduction block post-TAVR using new-generation self-expanding valves in patients with PNAR remain to be established. Therefore, this study aimed to identify predictors of new-onset conduction block post-TAVR using new-generation self-expanding valves (VitaFlow Liberty™) in patients with PNAR.
In this retrospective cohort study, patients were categorized into pacemaker and non-pacemaker groups based on their need for new postoperative permanent pacemaker implantation (PPI). Based on the postoperative presence of either new-onset complete left bundle branch block (cLBBB) or high-grade atrioventricular block (AVB), patients were further classified into conduction disorder and non-conduction disorder groups. Laboratory, echocardiographic, computed tomography, preoperative and postoperative electrocardiography, and procedural and clinical data were collected immediately after TAVR and during hospitalization and compared between the groups. Multivariate logistic regression analysis was performed incorporating the significant variables from the univariate analyses.
This study examined 68 consecutive patients with severe PNAR who underwent TAVR. In 20 patients, a permanent pacemaker was fitted postoperatively. Multivariate logistic regression analysis revealed an association between the need for postoperative PPI and preoperative complete right bundle branch block (cRBBB) or first-degree AVB, as well as a non-tubular left ventricular outflow tract (LVOT). In addition, valve implantation depth and angle of aortic root were independent predictors of new-onset cLBBB or high-grade AVB developing post-TAVR. The predictive value of valve implantation depth and angle of aortic root was further supported by receiver operating characteristic curve analysis results.
In patients with PNAR undergoing TAVR using self-expanding valves, preoperative cRBBB or first-degree AVB and a non-tubular LVOT were indicators of a higher likelihood of PPI requirement. Moreover, deeper valve implantation depth and greater angle of aortic root may be independent risk factors for new-onset cLBBB or high-grade AVB post-TAVR. Valve implantation depth and angle of aortic root values may be used to predict the possibility of new cLBBB or high-grade AVB post-TAVR.
新一代自膨式瓣膜可提高严重原发性主动脉瓣反流（PNAR）患者经导管主动脉瓣置换术（TAVR）的成功率。然而，对于使用新一代自膨式瓣膜（VitaFlow Liberty™）的 PNAR 患者 TAVR 后新发传导阻滞的预测因素仍有待确定。因此，本研究旨在确定使用新一代自膨式瓣膜（VitaFlow Liberty™）的 PNAR 患者 TAVR 后新发传导阻滞的预测因素。
在这项回顾性队列研究中，根据术后是否需要新植入永久性起搏器（PPI），将患者分为起搏器组和非起搏器组。根据术后新发完全左束支传导阻滞（cLBBB）或高度房室传导阻滞（AVB）的存在，将患者进一步分为传导障碍组和非传导障碍组。收集 TAVR 后即刻及住院期间的实验室、超声心动图、计算机断层扫描、术前和术后心电图以及手术和临床资料，并进行组间比较。多变量逻辑回归分析纳入单变量分析中有意义的变量。
本研究纳入了 68 例严重 PNAR 行 TAVR 的连续患者。在 20 例患者中，术后需要植入永久性起搏器。多变量逻辑回归分析显示，术后需要 PPI 与术前完全右束支传导阻滞（cRBBB）或一度房室传导阻滞以及非管状左心室流出道（LVOT）相关。此外，瓣膜植入深度和主动脉根部角度是 TAVR 后新发 cLBBB 或高度 AVB 的独立预测因素。瓣膜植入深度和主动脉根部角度的预测价值也得到了受试者工作特征曲线分析结果的支持。
在使用自膨式瓣膜行 TAVR 的 PNAR 患者中，术前 cRBBB 或一度 AVB 和非管状 LVOT 是需要 PPI 的更高可能性的指标。此外，更深的瓣膜植入深度和更大的主动脉根部角度可能是 TAVR 后新发 cLBBB 或高度 AVB 的独立危险因素。瓣膜植入深度和主动脉根部角度值可用于预测 TAVR 后新发 cLBBB 或高度 AVB 的可能性。
