应用Venus-A瓣膜行经导管主动脉瓣置换术后传导阻滞患者特征和心脏解剖结构分析

Analysis of characteristics and cardiac anatomy of patients with conduction block after transcatheter aortic valve replacement with Venus-A valve

目的分析应用Venus-A瓣膜行经导管主动脉瓣置换术后传导阻滞患者的特征和心脏解剖结构。方法选取2017年10月-2020年5月在陆军军医大学第二附属医院应用Venus-A瓣膜行经导管主动脉瓣置换术的60例重度主动脉瓣狭窄患者,对其临床资料进行回顾性分析。依据术后是否发生心脏传导阻滞,将入选患者分为阻滞组和未阻滞组,比较阻滞组与未阻滞组的特征和心脏解剖结构差异。结果49例主动脉瓣重度狭窄患者被纳入分析,阻滞组29例,未阻滞组20例。阻滞组患者术前心房颤动发生率高于未阻滞组(P=0.015),其余术前指标差异无统计学意义(P>0.05)。阻滞组和未阻滞组患者术后指标差异均无统计学意义(P>0.05)。二叶瓣患者中,阻滞组的左心室流出道椭圆率及瓣环椭圆率高于未阻滞组(P<0.05),未阻滞组的左心室流出道短径/瓣膜底径高于阻滞组(t=2.225,P=0.043),其余心脏解剖学指标差异无统计学意义(P>0.05)。三叶瓣患者中,阻滞组和未阻滞组的心脏解剖学指标差异均无统计学意义(P>0.05)。结论对于植入Venus-A人工瓣膜的二叶式重度主动脉瓣狭窄患者,术后出现心脏传导阻滞者具有瓣环及左心室流出道椭圆率大、左心室流出道短径与植入瓣膜底部直径比值小的解剖学特征,这些解剖形态或可作为潜在的预测术后传导阻滞的临床指标。

Objective To analyze the characteristics and cardiac anatomy of patients with conduction block after transcatheter aortic valve replacement(TAVR)with Venus-A valve.Methods Retrospective analysis was conducted on the clinical data of patients with severe aortic stenosis who underwent TAVR with Venus-A valve in the Second Affiliated Hospital of Army Military Medical University from October 2017 to May 2020.According to the occurrence of heart conduction block after TAVR,the patients were divided into the blocked group and the unblocked group,and the differences in characteristics and cardiac anatomy between the two groups were compared.Results Forty-nine patients with severe aortic stenosis were included in the analysis,including 29 in the blocked group and 20 in the unblocked group.The incidence of atrial fibrillation in the blocked group was higher than that in the unblocked group(P=0.015),and there was no statistically significant difference in other preoperative indicators(P>0.05).There was no statistically significant difference in postoperative indicators between the blocked group and the unblocked group(P>0.05).Among bicuspid aortic valve,the ellipticity of left ventricular outflow tract and annulus in the blocked group were higher than those in the unblocked group(P<0.05),and the ratio of the short diameter of the left ventricular outflow tract to the bottom diameter of the implanted valve was smaller than that of the unblocked group(t=2.225,P=0.043).There was no significant difference in other cardiac anatomical indicators(P>0.05).As to tricuspid aortic valve cases,there was no significant difference in cardiac anatomic parameters between the blocked group and the unblocked group(P>0.05).Conclusions For bicuspid aortic valve patients with severe aortic stenosis and implanted with Venus-A valve,larger elliptic rate of annulus or left ventricular outflow tract,smaller proportion of left ventricular outflow tract diameter to the bottom diameter of implanted valve are associated with conduction block after TAVR.These anatomical patterns might be used as potential clinical indicators to predict postoperative conduction block.