自膨胀式瓣膜经导管主动脉瓣置换术后新发传导障碍的相关因素分析

Analysis of related factors of new-onset conduction disturbance after transcatheter aortic valve replacement with self-expanding valve

目的回顾性探究接受自膨胀式瓣膜(SEV)置入的经导管主动脉瓣置换术(TAVR)患者的基线临床特征、升主动脉根部解剖特点及术后新发传导障碍(NOCD)的相关因素。方法回顾性研究自2014年12月至2022年11月于厦门大学附属心血管病医院接受TAVR手术的245例患者,根据纳排标准连续纳入167例术中置入SEV的患者,根据主动脉瓣形态分为三叶瓣组(TAV组,113例)和二叶瓣组(BAV组,54例),术后根据心电图特征将TAV组分为NOCD组(43例)和无NOCD组(70例);BAV组分为NOCD组(16例)和无NOCD组(38例)。收集患者术前心电图、升主动脉根部CT血管造影等临床资料。结果在TAV组中:与NOCD组相比,无NOCD组的右-无冠瓣钙化定量更大(P=0.005),而主动脉成角则较小(P=0.002),多因素分析结果提示右-无冠瓣钙化定量每增加10 mm^(3),TAVR术后NOCD的发生风险降低2.6%(OR 0.974,P=0.039),主动脉成角每增加1°,术后NOCD的风险提升将近7.3%(OR 1.073,P=0.003)。在BAV组中:术前PR间期每增加1 ms,TAVR术后NOCD的发生风险提升将近3.3%(OR 1.033,P=0.041),右冠瓣区的钙化定量每增加10 mm^(3),出现NOCD的风险降低6.6%(OR 0.934,P=0.013)。结论在TAV患者中,右-无冠瓣钙化定量可能对心脏传导系统具有保护作用,而主动脉成角则是NOCD发生的危险因素。在BAV患者中,术前PR间期是NOCD的危险因素,右冠瓣区钙化定量可能对心脏传导系统具有保护作用。

Objective To investigate the baseline clinical characteristics,ascending aortic root anatomical characteristics,and related factors of the surgical strategy of patients with new-onset conduction disturbance(NOCD)after transcatheter aortic valve replacement(TAVR)with self-expanding valve(SEV)implantation.Methods A retrospective study was conducted on 245 patients who underwent TAVR at the Xiamen Cardiovascular Hospital Xiamen University between December 2014 and November 2022.According to the inclusion and exclusion criteria,167 patients with SEV implantation during surgery were continuously included.They were divided into tricuspid aortic valve group(TAV group,113 cases)and bicuspid aortic valve group(BAV group,54 cases)according to aortic valve morphology.The TAV group was divided into NOCD group(43 cases)and non NOCD group(70 cases)according to postoperative electrocardiogram characteristics.The BAV group was divided into NOCD group(16 cases)and non NOCD group(38 cases).Collect clinical data such as preoperative electrocardiogram and ascending aortic root CT angiography from patients.Results The right-non valvular calcifi cation quantifi cation(P=0.005)in the non-NOCD group was signifi cantly greater than that in the NOCD group,but the aortic angle(P=0.002)was smaller in TAV patients.Multivariate analysis suggested that the risk of NOCD after TAVR is reduced by 2.6%for every 10 mm^(3)increase in right-non valvular calcifi cation in patients(OR 0.974,P=0.039),the risk of postoperative NOCD nearly 7.3%for every degree increase in aortic angulation(OR 1.073,P=0.003).In BAV patients the increase of the risk of NOCD after TAVR is nearly 3.3%for every 1 ms increase in preoperative PR interval(OR1.033,P=0.041),the risk of NOCD is reduced by 6.6%for every 10 mm^(3)increase in calcification quantifi cation in the right coronary valve area(OR 0.934,P=0.013).Conclusions In TAV patient,right-non valvular calcification may have a protective effect on the cardiac conduction system,but a larger aortic angle increases the risk of NOCD.In BAV patients,a longer preoperative PR interval is a risk factor for NOCD,and the right coronary valve area may protect the cardiac conduction system.