Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.
Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
J Cardiovasc Comput Tomogr. 2024 Nov-Dec;18(6):597-608. doi: 10.1016/j.jcct.2024.08.009. Epub 2024 Sep 19.
Transcatheter aortic valve replacement (TAVR) is preferred therapy for elderly patients with severe aortic stenosis (AS) and increasingly used in younger patient populations with good safety and efficacy outcomes. However, cardiac conduction abnormalities remain a frequent complication after TAVR ranging from relative benign interventriculair conduction delays to prognostically relevant left bundle branch block and complete atrio-ventricular (AV) block requiring permanent pacemaker implantation (PPI). Although clinical, procedural and electrocardiographic factors have been identified as predictors of this complication, there is a need for advanced strategies to control the burden of conduction defects particularly as TAVR shifts towards younger populations. This state of the art review highlights the value of ECG-synchronized computed tomographic angiography (CTA) evaluation of the aortic root to better understand and manage conduction problems post-TAVR. An update on CTA derived anatomic features related to conduction issues is provided and complemented with computational framework modelling. This CTA-derived 3-dimensional anatomical reconstruction tool generates patient-specific TAVR simulations enabling operators to adapt procedural strategy and implantation technique to mitigate conduction abnormality risks.
经导管主动脉瓣置换术（TAVR）是老年重度主动脉瓣狭窄（AS）患者的首选治疗方法，并且在具有良好安全性和疗效的年轻患者人群中越来越多地使用。然而，心脏传导异常仍然是 TAVR 后的常见并发症，从相对良性的室间传导延迟到具有预后相关性的左束支传导阻滞和完全房室（AV）传导阻滞，需要植入永久性起搏器（PPI）。尽管已经确定了临床、程序和心电图因素是该并发症的预测因素，但需要采用先进的策略来控制传导缺陷的负担，特别是随着 TAVR 向年轻人群转移。这篇最新技术综述强调了心电图同步计算机断层血管造影（CTA）评估主动脉根部在更好地理解和管理 TAVR 后传导问题方面的价值。提供了与传导问题相关的 CTA 衍生解剖特征的最新信息，并补充了计算框架模型。该 CTA 衍生的三维解剖重建工具可生成患者特定的 TAVR 模拟，使操作人员能够调整手术策略和植入技术，以降低传导异常风险。
