Mantilla-Gutierrez Hugo, Cabrales Jaime, Herrera Víctor
Fundación Cardioinfantil Instituto de Cardiología Anesthesiology Department Bogotá Colombia Anesthesiology Department, Fundación Cardioinfantil - Instituto de Cardiología, Bogotá, Colombia.
Universidad Industrial de Santander Public Health Department Bucaramanga Colombia Public Health Department, Universidad Industrial de Santander, Bucaramanga, Colombia.
Braz J Cardiovasc Surg. 2025 Jul 2;40(4):e20240127. doi: 10.21470/1678-9741-2024-0127.
Transcatheter aortic valve replacement (TAVR) has revolutionized the management of patients with aortic valve disease. However, the need for pacemaker implantation remains a frequent complication. The objectives of this study were to estimate the incidence of permanent pacemaker implantation and to determine the associated risk factors.
This is a retrospective cohort study of adults who underwent TAVR, developed cardiac conduction disease, and required permanent pacemaker implantation during hospitalization. Groups were compared according to post procedure pacemaker implantation or not; and recognized preoperative and echocardiographically identified anatomic factors related to the procedure were evaluated. A predictive model was generated using multiple logistic regression.
A total of 234 patients were included. The pacemaker implantation rate was 14%, and risk factors associated with this procedure were age (odds ratio [OR] 1.10, 95% confidence interval [CI] 1.01 - 1.22), female sex (OR 0.11, 95% CI 0.01 - 0.61), body surface area > 1.51 m2 (OR 9.78, 95% CI 2.13 - 73.6), right bundle branch block (OR 22.5, 95% CI 2.62 - 242), first-degree atrioventricular block (OR 18.8, 95% CI 3.04 - 150), and implantation depth measured via echocardiography (OR 1.76, 95% CI 1.26 - 2.64). The model demonstrated good predictive capability with an area under the receiver operating characteristic curve of 0.934 (P < 0.001, 95% CI 0.878 - 0.988).
A well-performing predictive model was developed with six independent risk factors for the need for pacemaker implantation after TAVR, based on factors related to anatomic echocardiographic measurements associated with classic risk factors.
经导管主动脉瓣置换术（TAVR）彻底改变了主动脉瓣疾病患者的治疗方式。然而，起搏器植入需求仍然是一种常见的并发症。本研究的目的是估计永久起搏器植入的发生率，并确定相关危险因素。
这是一项对接受TAVR、发生心脏传导疾病且住院期间需要永久起搏器植入的成年人进行的回顾性队列研究。根据术后是否植入起搏器对各组进行比较；并评估已确认的术前和经超声心动图确定的与该手术相关的解剖学因素。使用多元逻辑回归生成预测模型。
共纳入234例患者。起搏器植入率为14%，与该手术相关的危险因素包括年龄（比值比[OR]1.10，95%置信区间[CI]1.01 - 1.22）、女性（OR 0.11，95%CI 0.01 - 0.61）、体表面积>1.51 m²（OR 9.78，95%CI 2.13 - 73.6）、右束支传导阻滞（OR 22.5，95%CI 2.62 - 242）、一度房室传导阻滞（OR 18.8，95%CI 3.04 - 150）以及通过超声心动图测量的植入深度（OR 1.76，95%CI 1.26 - 2.64）。该模型显示出良好的预测能力，受试者工作特征曲线下面积为0.934（P < 0.001，95%CI 0.878 - 0.988）。
基于与经典危险因素相关联的解剖学超声心动图测量因素，开发了一个性能良好的预测模型，该模型包含六个TAVR术后起搏器植入需求的独立危险因素。
