Clinico San Carlos University Hospital IdISSC Madrid Spain.
J Am Heart Assoc. 2024 Oct;13(19):e034936. doi: 10.1161/JAHA.124.034936. Epub 2024 Sep 30.
Conduction disturbances represent one of the most common complications following transcatheter aortic valve replacement (TAVR). We sought to investigate the role of left ventricular outflow tract (LVOT) morphology in the development of conduction disturbances following TAVR.
Consecutive patients who underwent TAVR in our center were included. The ratio between the LVOT area and the aortic annulus area was calculated. Patients were then divided into 2 groups on the basis of this ratio: group 1, which included patients with an LVOT area/aortic annulus area ratio <0.9; and group 2, which included patients with an LVOT area/aortic annulus area ratio ≥0.9. The primary end point was to assess the relationship between LVOT shape and the rate of permanent pacemaker implantation following TAVR. A multivariable analysis was performed to identify predictors of permanent pacemaker implantation following TAVR. From January 2018 to December 2020, 276 patients were included. Ninety-one patients with tapered LVOT morphology were assigned to group 1 and the rest (n=185 patients), tubular LVOT or flared LVOT shape, to group 2. The mean age was 81.5±5.7 years and 57% were women. After adjusting by confounding factors, tapered morphology of the LVOT and prior right bundle-branch block were found to be independent predictors of permanent pacemaker implantation (hazard ratio [HR], 2.6 [95% CI, 1.2-5.7]; =0.014; and HR: 4.3 [95% CI 2.4-7.6], <0.001); at a median follow-up time of 15.5 (interquartile range, 15) months.
A tapered-LVOT morphology was associated with increased risk for permanent pacemaker implantation. LVOT morphology may be an additional factor to consider when choosing prosthesis size.
传导障碍是经导管主动脉瓣置换术（TAVR）后最常见的并发症之一。我们旨在研究左心室流出道（LVOT）形态在 TAVR 后传导障碍发展中的作用。
连续纳入在我们中心接受 TAVR 的患者。计算 LVOT 面积与主动脉瓣环面积的比值。然后根据该比值将患者分为两组：第 1 组，LVOT 面积/主动脉瓣环面积比<0.9；第 2 组，LVOT 面积/主动脉瓣环面积比≥0.9。主要终点是评估 LVOT 形状与 TAVR 后永久性起搏器植入率之间的关系。进行多变量分析以确定 TAVR 后永久性起搏器植入的预测因素。从 2018 年 1 月至 2020 年 12 月，共纳入 276 例患者。91 例 LVOT 形态呈锥形的患者被分配至第 1 组，其余（185 例）LVOT 形态呈管状或喇叭形的患者被分配至第 2 组。平均年龄为 81.5±5.7 岁，57%为女性。调整混杂因素后，LVOT 锥形形态和先前的右束支传导阻滞被发现是永久性起搏器植入的独立预测因素（风险比[HR]，2.6[95%CI，1.2-5.7]；=0.014；和 HR：4.3[95%CI 2.4-7.6]，<0.001）；中位随访时间为 15.5（四分位距，15）个月。
锥形 LVOT 形态与永久性起搏器植入风险增加相关。LVOT 形态可能是选择假体尺寸时需要考虑的附加因素。
