Predictors for New-Onset Complete Heart Block After Transcatheter Aortic Valve Implantation
Predictors for New-Onset Complete Heart Block After Transcatheter Aortic Valve Implantation
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DOI：
10.1016/j.jcin.2010.01.017
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发表时间：
2010-05-01
影响因子：
11.3
通讯作者：
Lange, Ruediger
中科院分区：
文献类型：
--
作者：
Bleiziffer, Sabine;Ruge, Hendrik;Lange, Ruediger
目的本研究的目的是确定经导管主动脉瓣植入术（TAVI）后需要植入起搏器（PM）的新发房室（AV）传导阻滞的危险因素。背景高度房室阻滞和连续PM植入是TAVI术后常见的并发症。方法进行logistic回归分析，我们纳入了2007年6月至2009年1月间接受TAVI治疗的159例患者（平均年龄：81±6岁，EuroSCORE: 22±13%）（116例经股动脉，4例经锁骨下动脉，37例经根尖，2例经主动脉），且之前未植入PM。结果术后新发房室传导阻滞35例（22%），需行PM植入。逻辑回归显示，在小环内植入大瓣膜（起搏器植入32%，优势比[OR]: 2.378, p = NS）的患者中，新发房室传导阻滞的风险增加了2倍，植入Core瓣膜（Medtronic, Minneapolis, Minnesota）比植入Edwards Sapien瓣膜（Edwards Lifesciences, Irvine, California）（起搏器植入27%，OR）的风险增加了4倍。3.781, p = NS)，在植入过程中立即出现房室传导阻滞发作的患者风险增加5倍（49%的起搏器植入，OR: 4.819, p = 0.001）。预先存在的心电图改变未被确定为经导管主动脉瓣植入术后房室传导阻滞的危险因素。结论：我们认为传导组织损伤是由大型假体在较小的环空或覆盖流出道的较大面积的核心瓣膜的机械压迫引起的，并可能在植入过程中立即出现。所有接受TAVI手术的患者术后应持续进行至少3天的心电图监测，直到该并发症风险增加的患者出院。[J]中华医学会心脏病杂志2010；3:524-30 .
Objectives The aim of this study was to identify risk factors for new-onset atrioventricular (AV) block requiring pacemaker (PM) implantation after transcatheter aortic valve implantation (TAVI).Background High-grade AV block and consecutive PM implantation are frequent complications following TAVI.Methods For logistic regression analysis, we included 159 patients (mean age: 81 +/- 6 years, EuroSCORE: 22 +/- 13%) who underwent TAVI (n = 116 transfemoral, n = 4 via subclavian artery, n = 37 transapical, n = 2 transaortic) between June 2007 and January 2009 and who had no previously implanted PM.Results Thirty-five patients (22%) developed new-onset post-operative AV block with the need of PM implantation. Logistic regression revealed a 2-fold increased risk for new-onset AV block in patients in whom a large valve is implanted in a small annulus (32% pacemaker implantations, odds ratio [OR]: 2.378, p = NS), a 4-fold increased risk with the implantation of the Core Valve (Medtronic, Minneapolis, Minnesota) versus the Edwards Sapien valve (Edwards Lifesciences, Irvine, California) (27% pacemaker implantations, OR: 3.781, p = NS), and a 5-fold increased risk for patients who exhibit an AV block episode instantly during the implantation procedure (49% pacemaker implantations, OR: 4.819, p = 0.001). Pre-existing ECG alterations were not identified as risk factors for AV block after transcatheter aortic valve implantation.Conclusions We assume that conduction tissue impairment is provoked by mechanical compression with large prostheses in smaller annuli or in the larger area of the Core Valve covering the outflow tract and may appear instantly during the implantation procedure. Continuous post-operative electrocardiogram monitoring should be performed for at least 3 days in all patients after TAVI procedures and until discharge in patients with increased risk for this complication. (J Am Coll Cardiol Intv 2010;3:524-30) (C) 2010 by the American College of Cardiology Foundation