Nuis Rutger-Jan, van den Dorpel Mark, Adrichem Rik, Daemen Joost, Van Mieghem Nicolas
Department of Cardiology, Thoraxcenter, Erasmus University Medical Center Rotterdam, the Netherlands.
Interv Cardiol. 2024 Aug 13;19:e12. doi: 10.15420/icr.2024.11. eCollection 2024.
The demonstrated safety and effectiveness of transcatheter aortic valve implantation (TAVI) among low surgical risk patients opened the road to its application in younger low-risk patients. However, the occurrence of conduction abnormalities and need for permanent pacemaker implantation remains a frequent problem associated with adverse outcomes. The clinical implications may become greater when TAVI shifts towards younger populations, highlighting the need for comprehensive strategies to address this issue. Beyond currently available clinical and electrocardiographic predictors, patient-specific anatomical assessment of the aortic root using multi-sliced CT (MSCT) imaging can refine risk stratification. Moreover, leveraging MSCT data for computational 3D simulations to predict device-anatomy interactions may help guide procedural strategy to mitigate conduction abnormalities. The aims of this review are to summarise the incidence and clinical impact of new left bundle branch block and permanent pacemaker implantation post-TAVI using contemporary transcatheter heart valves; and highlight the value of MSCT data interpretation to improve the management of this complication.
经导管主动脉瓣植入术（TAVI）在低手术风险患者中已证实的安全性和有效性为其在年轻低风险患者中的应用开辟了道路。然而，传导异常的发生以及永久起搏器植入的需求仍然是与不良结局相关的常见问题。当TAVI转向更年轻的人群时，临床意义可能会更大，这突出了需要采取综合策略来解决这一问题。除了目前可用的临床和心电图预测指标外，使用多层螺旋CT（MSCT）成像对主动脉根部进行患者特异性解剖评估可以优化风险分层。此外，利用MSCT数据进行计算3D模拟以预测器械与解剖结构的相互作用可能有助于指导手术策略以减轻传导异常。本综述的目的是总结使用当代经导管心脏瓣膜在TAVI后新的左束支传导阻滞和永久起搏器植入的发生率及临床影响；并强调MSCT数据解读对改善这一并发症管理的价值。
