经导管主动脉瓣置换术后心脏传导阻滞发生与影响因素分析

Analysis of Heart Block and Its Influencing Factors after Aortic Valve Replacement

分析经导管主动脉瓣置换术(TAVI)后心脏传导阻滞的发生情况及影响因素.回顾性收集2019年1月至2021年10月云南省第一人民医院行TAVI术患者45例,其中,术后发生心脏传导阻滞组14例,未发生心脏传导阻滞组31例.比较两组临床特征、术前心脏超声,随访两组术后并发症情况,并采用多因素Logistic回归分析发生心脏传导阻滞的危险因素.结果显示,45例TAVI术后患者中,发生心脏传导阻滞患者14例,其中左束支传导阻滞11例.发生心脏传导阻滞组合并糖尿病(42.9%)、陈旧性心肌梗死(35.7%)、术前主动脉瓣重度钙化(28.6%)、术前右束支传导阻滞(57.1%)和术前QRS波增宽(50.0%)与未发生心脏传导阻滞组比较,差异具有统计学意义(P<0.05).多因素分析显示,主动脉瓣严重钙化(OR=2.837,95%CI 2.251~10.803,P=0.003),术前QRS波增宽(OR=1.425,95%CI 1.352~3.264,P=0.042)及合并糖尿病(OR=1.018,95%CI 1.053-6.514,P=0.010)是TAVI术后发生心脏传导阻滞的独立危险因素.术后平均随访3个月,两组患者心功能较术前均有改善,但两组间差异无统计学意义(P>0.05).

The occurrence and influencing factors of heart block after transcatheter aortic valve replacement(TAVI)were analyzed.Forty-five patients who underwent TAVI in the first people’s Hospital of Yunnan Province from January 2019 to October 2021 were retrospectively collected,including 14 cases in the group with postoperative heart block and 31 cases in the group without heart block.The clinical characteristics,preoperative echocardiography and postoperative complications of the two groups were compared,and the risk factors of heart block were analyzed by multivariate logistic regression.The results showed that among the 45 patients after TAVI,14 patients had heart block,including 11 patients with left bundle branch block.Compared with the group without heart block,the difference in the heart block group with diabetes(42.9%),old myocardial infarction(35.7%),severe preoperative aortic valve calcification(28.6%),preoperative right bundle branch block(57.1%),and preoperative QRS wave widening(50.0%)were statistically significant(P<0.05).Multivariate analysis showed that severe aortic valve calcification(OR=2.837,95%CI2.251-10.803,P=0.003),preoperative QRS wave widening(OR=1.425,95%CI 1.352-3.264,P=0.042)and diabetes(OR=1.018,95%CI 1.053-6.514,P=0.010)were independent risk factors for heart block after TAVI.After an average follow-up of 3 months,the cardiac function of the two groups was improved compared with that before operation,but there was no significant difference between the two groups(P>0.05).