Newlon Claire A, Niu Mary C, Binka Edem, Boucek Dana M, Ou Zhining, Etheridge Susan P, Pilcher Thomas A, Martin Mary Hunt, Gray Robert G, Asaki S Yukiko
Division of Pediatric Cardiology, Department of Pediatrics, UCLA Health System, Los Angeles, CA, USA.
Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA.
Pediatr Cardiol. 2025 May 13. doi: 10.1007/s00246-025-03889-3.
TAVR is an alternative to surgical aortic valve [AoV] replacement. In adults, rates of atrioventricular block [AVB] requiring permanent pacemaker [PPM] placement in the modern era are 4-24%. Post-TAVR conduction abnormality incidence and risk factors are unknown in children and young adults. Describe post-TAVR conduction abnormalities in children and young adults. Retrospective single-center review of patients undergoing TAVR (9/2014 to 6/2021). Patients with pre-existing complete AVB or PPM were excluded (N = 1). The relationship between described adult risk factors for AVB and primary outcome of new conduction abnormality was assessed. Of 28 cases (Ages 3.5-22 y), 50% were male and 43% had isolated AoV disease, and the remainder with multilevel obstructive left-sided heart disease (29%) or complex congenital heart disease (29%). Baseline conduction abnormality was present in 57% (16/28), with right bundle branch block the most prevalent (9, 56%). Post-TAVR, acute- and late-onset conduction abnormalities occurred in 9 and 2 patients, respectively, and resolved in 8/11 patients during follow-up. One patient required PPM for complete heart block. There was no association between new conduction abnormality and previously reported adult risk factors-baseline RBBB, membranous septum length, valve implantation depth, or degree of valve oversizing. There was no relationship between outcome and baseline conduction abnormality nor history of multiple AoV interventions. In our pediatric series, AVB requiring PPM was rare following TAVR, with an incidence 3.6%-lower than average rates reported in adult literature. We identified no association of conduction abnormality with described adult risk factors.
经导管主动脉瓣置换术（TAVR）是外科主动脉瓣置换术的一种替代方案。在成年人中，现代需要植入永久起搏器（PPM）的房室传导阻滞（AVB）发生率为4%-24%。儿童和年轻人TAVR术后传导异常的发生率及危险因素尚不清楚。描述儿童和年轻人TAVR术后的传导异常情况。对接受TAVR的患者进行回顾性单中心研究（2014年9月至2021年6月）。排除既往有完全性AVB或PPM的患者（N = 1）。评估已描述的成人AVB危险因素与新传导异常的主要结局之间的关系。28例患者（年龄3.5-22岁）中，50%为男性，43%患有孤立性主动脉瓣疾病，其余患者患有多级梗阻性左侧心脏病（29%）或复杂性先天性心脏病（29%）。57%（16/28）的患者存在基线传导异常，其中右束支传导阻滞最为常见（9例，56%）。TAVR术后，分别有9例和2例患者出现急性和迟发性传导异常，11例患者中有8例在随访期间传导异常得到缓解。1例患者因完全性心脏传导阻滞需要植入PPM。新传导异常与先前报道的成人危险因素——基线右束支传导阻滞、膜周部间隔长度、瓣膜植入深度或瓣膜过大程度之间无关联。结局与基线传导异常及多次主动脉瓣干预史之间无关系。在我们的儿科系列研究中，TAVR术后需要PPM的AVB很少见，发生率为3.6%，低于成人文献报道的平均发生率。我们未发现传导异常与已描述的成人危险因素之间存在关联。
