Chua Aileen Paula, Myagmardorj Rinchyenkhand, Nabeta Takeru, Kuneman Jurrien H, van der Kley Frank, Bax Jeroen J, Ajmone Marsan Nina
Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands.
Department of Cardiology, Turku Heart Center, University of Turku and Turku University Hospital, Turku, Finland.
Struct Heart. 2025 Feb 17;9(5):100428. doi: 10.1016/j.shj.2025.100428. eCollection 2025 May.
Expanding indications for transcatheter aortic valve implantation (TAVI) highlighted the importance of complications such as new left bundle branch block (LBBB) or permanent pacemaker (PPM) implantation. However, studies on the long-term outcomes of these conduction abnormalities (CA) are limited. This study aims to examine the progression of CA within the first year after TAVI and their long-term prognostic value.
TAVI patients were divided into 1) PPM implantation within the first year, 2) post-TAVI LBBB persisting until 1 year (permanent LBBB), and 3) no-CA. Endpoint was all-cause mortality after 1 year.
Among 794 patients initially included, 30% developed new LBBB, which persisted in 17% until discharge; 12% received a PPM during the hospitalization. One-year follow-up was available in 502 patients: 11% were classified as permanent LBBB (n = 56), 18% as PPM (n = 89), and the rest as no-CA (n = 357). Baseline characteristics were comparable, except for valve type, with self-expanding more common among the PPM group. At 1-year follow-up, lower left ventricular ejection fraction and global longitudinal strain were observed in the PPM and permanent LBBB groups compared to the no-CA group (55% ± 9% and 15% ± 4% vs. 54% ± 11% and 15% ± 4% vs. 58% ± 9% and 17% ± 4%, respectively, < 0.001). At long-term follow-up (median: 4 [interquartile range: 3-6] years), higher mortality was observed in the PPM group (ꭓ = 10.168, = 0.006). In addition, PPM implantation (hazard ratio: 1.654, = 0.011) and global longitudinal strain at 1 year (hazard ratio: 0.950, = 0.027), as well as pre-TAVI EuroSCORE II and New York Heart Association III-IV at 1 year, were independently associated with the outcome.
Post-TAVI CAs are dynamic within the first year. Patients who needed PPM implantation did not show significant improvement in left ventricular function after TAVI and had higher long-term mortality.
经导管主动脉瓣植入术（TAVI）适应证的不断扩大凸显了诸如新发左束支传导阻滞（LBBB）或永久性起搏器（PPM）植入等并发症的重要性。然而，关于这些传导异常（CA）长期预后的研究有限。本研究旨在探讨TAVI术后第一年CA的进展情况及其长期预后价值。
将TAVI患者分为1）术后第一年内植入PPM；2）TAVI术后LBBB持续至1年（永久性LBBB）；3）无CA。观察终点为1年后的全因死亡率。
在最初纳入的794例患者中，30%出现新发LBBB，其中17%持续至出院；12%在住院期间接受了PPM植入。502例患者获得了1年随访：11%被归类为永久性LBBB（n = 56），18%为PPM（n = 89），其余为无CA（n = 357）。除瓣膜类型外，各组基线特征具有可比性，自膨胀瓣膜在PPM组中更为常见。在1年随访时，与无CA组相比，PPM组和永久性LBBB组的左心室射血分数和整体纵向应变较低（分别为55%±9%和15%±4%，54%±11%和15%±4%，58%±9%和17%±4%，P < 0.001）。在长期随访（中位数：4[四分位间距：3 - 6]年）中，PPM组的死亡率较高（χ² = 10.168，P = 0.006）。此外，PPM植入（风险比：1.654，P = 0.011）、1年时的整体纵向应变（风险比：0.950，P = 0.027）以及术前TAVI欧洲心脏手术风险评估系统II和1年时纽约心脏协会心功能III - IV级与预后独立相关。
TAVI术后CA在第一年具有动态变化。需要植入PPM的患者在TAVI术后左心室功能未显示出明显改善，且长期死亡率较高。
