主动脉瓣复合体钙化分布密度是国产自膨式瓣膜TAVR术后传导障碍的危险因素

Calcification distributional density of the aortic-valvular complex is an independent risk factor for conduction block following self-expanding transcatheter aortic valve replacement

目的评估主动脉瓣复合体(AVC)不同区域钙化分布密度对应用国产自膨式瓣膜(SEV)行经导管主动脉瓣置换(TAVR)术后新发传导障碍(CB)的影响。方法纳入2016年1月~2022年12月接受国产Venus-A人工瓣膜置换术的重度主动脉瓣狭窄患者共73例,根据术后是否出现新发CB分为CB组和无CB组,比较两组基线数据、影像资料和手术数据情况。单因素、多因素Logistic回归分析TAVR术后新发CB的独立危险因素。应用受试者工作特征(ROC)曲线及DeLong检验,分析各危险因素及联合指标预测效能。结果73例TAVR患者中,18例(24.7%)术后新发CB。CB组具有更大的植入深度(6.77±2.45 mm vs 5.11±3.28 mm,P=0.027),且室间隔膜部长度与植入深度差值(MSID)明显小于无CB组(0.68±3.49 mm vs 2.82±3.88 mm,P=0.036)。钙化分布方面,CB组设备着陆区(DLZ)左冠窦(LCS)的钙化分布密度明显高于无CB组[10.34(2.50,48.35)×102 mm^(3)/mm^(2)vs 3.27(0.00,13.79)×102 mm^(3)/mm^(2),P=0.026]。多因素Logistic分析发现,DLZ-LCS钙化分布密度、MSID是TAVR术后新发CB的独立危险(保护)因素。ROC曲线显示,MSID、DLZ-LCS钙化分布密度预测CB的曲线下面积(AUC)分别为0.775和0.716,联合指标预测具有最大的AUC(0.890),与单独指标比较差异均有统计学意义(P=0.041 vs MSID;P=0.027 vs DLZ-LCS钙化分布密度)。结论DLZ-LCS钙化分布密度是国产SEV的TAVR术后新发CB的独立危险因素,联合MSID可以有效预测TAVR术后的传导并发症。

Objective To evaluate the effect of calcification distributional density in different regions of aortic-valvular complex(AVC)on postoperative new-onset conduction block(CB)following transcatheter aortic valve replacement(TAVR)using self expandable valves(SEV)made in China.Methods From January,2016 to December,2022,73 patients with severe aortic valve stenosis received Venus-A prosthetic valve replacement using SEV made in China,and postoperative new-onset CB occurred in 18(24.7%)of the patients.The baseline data,imaging and intervention-related data were compared were between the patients with CB and those without CB.Univariate and multivariate logistic regression analysis was used for investigating the independent risk factors for new-onset CB after TAVR,and the predictive performance of these risk factors was evaluated using receiver operating characteristic(ROC)curve and DeLong test.Results Compared with those with CB,the patients experiencing postoperative new-onset CB had a greater implantation depth(6.77±2.45 mm vs 5.11±3.28 mm,P=0.027),a smaller difference between the membranous septum length and the implantation depth(MSID)(0.68±3.49 mm vs 2.82±3.88 mm,P=0.036),and a higher calcification distributional density of the left coronary sinus(LCS)in the device landing zone(DLZ)(P=0.026).Multivariate logistic analysis revealed that DLZ-LCS calcification distributional density and MSID were independent risk(protective)factors for new-onset CB following TAVR.ROC curve analysis showed that the AUC of MSID and DLZ-LCS calcification distributional density was 0.775 and 0.716,respectively,and their combination had had a significantly higher AUC of 0.890(P=0.041 and 0.027,respectively).Conclusion The DLZ-LCS calcification distributional density is an independent risk factor for new-onset CB following TAVR using SEV.The conduction complications following TAVR can be effectively predicted using this calcification indicator combined with MSID.