经导管主动脉瓣植入术后新发传导阻滞的危险因素及预后分析  

Risk factors and prognosis of new-onset conduction block following transcatheter aortic valve implantation

作　　者：林文宝 郑可儿 陈海宇[2] 郑富臻[2] 翁国星[2] 陈新敬[2] LIN Wenbao;ZHENG Ke’er;CHEN Haiyu;ZHENG Fuzhen;WENG Guoxing;CHEN Xinjing(Shengli Clinical Medical College of Fujian Medical University,Fuzhou,350001,P.R.China;Cardiovascular Disease Research Center,Fujian Provincial Hospital,Fuzhou,350001,P.R.China)

机构地区：[1]福建医科大学省立临床医学院,福州350001 [2]福建省立医院心血管病研究中心,福州350001

出　　处：《中国胸心血管外科临床杂志》2022年第8期977-985,共9页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的分析经导管主动脉瓣植入术(transcatheter aortic valve implantation,TAVI)术后新发传导阻滞的相关危险因素及对患者预后的影响。方法回顾性分析2019—2021年在福建省立医院行经股动脉TAVI 86例患者的临床资料,其中男59例、女27例,平均年龄(72.9±8.0)岁。根据术后有无新发传导阻滞将患者分为正常组(47例)和新发传导阻滞组(39例),再将新发传导阻滞组分为左束支传导阻滞(left bundle branch block,LBBB)组(28例)和完全性传导阻滞(complete atrioventricular block,CAVB)组(11例)。比较术后及随访早期血流动力学和并发症发生情况,并采用多因素logistic回归模型分析TAVI术后发生传导阻滞的危险因素。结果所有患者术前中位EuroSCORE评分为8(2)分。术后及随访早期,新发传导阻滞组患者的血流动力学改变、并发症发生情况均与正常组差异无统计学意义(P>0.05)。CAVB组术后30 d内永久起搏器植入发生率(81.8%,9/11)及因心源性疾病的死亡率(18.1%,2/11)高于正常组和LBBB组,差异有统计学意义(P<0.05)。多因素分析显示,女性、主动脉瓣严重钙化、瓣膜尺寸选择过大、瓣膜植入过深是TAVI术后发生传导阻滞的危险因素。结论TAVI术后LBBB及CAVB的发生率较高,但对患者的血流动力学影响不显著。CAVB增加了TAVI术后永久起搏器植入率,并影响患者再住院率及因心源性疾病的死亡率。女性、主动脉瓣严重钙化、瓣膜尺寸选择过大、瓣膜植入过深是术后新发传导阻滞的危险因素。Objective To analyze predictive factors,clinical implications and prognosis effects of newonset conduction block after transcatheter aortic valve implantation(TAVI).Methods The clinical data of 86 patients who underwent TAVI through transfemoral approach from 2019 to 2021 in Fujian Provincial Hospital were retrospectively analyzed,including 59 males and 27 females with an average age of 72.9±8.0 years.The patients were divided into a normal group and a new-onset conduction block group according to whether there was new-onset conduction block after operation,and then the new-onset conduction block group was subdivided into a left bundle branch block(LBBB)group(28 patients)and a complete atrioventricular block(CAVB)group(11 patients).We compared the hemodynamics and TAVI-related complications between the postoperative and early follow-up periods,and used the multivariate logistic regression models to identify risk factors for the new-onset conduction block.Results The median EuroSCORE of all patients were 8(2)points before the operation.In the postoperative and early follow-up periods,the hemodynamics and TAVI-related complications had no statistical difference between the new-onset conduction block group and the normal group(P>0.05).The incidence of permanent pacemaker implantation(81.8%,9/11)and mortality due to cardiac causes(18.1%,2/11)in the CAVB group were significantly higher than those in the normal group and theLBBB group(P<0.05).Female,severe calcification of the aortic valve,too large valve size and deep valve implants were the risk factors for new-onset conduction block after TAVI.Conclusion The incidence of LBBB and CAVB is high after TAVI,however,both of them do not significantly effect the hemodynamics of the patients.Higher incidence of permanent pacemaker implantation is found in the CAVB group which affects the rate of rehospitalization and mortality.Female patients,severe calcification of the aortic valve,too large valve size and deep valve implants are the risk factors for the new-onset conduct

关 键 词：经导管主动脉瓣植入术 左束支传导阻滞 完全性房室传导阻滞 永久起搏器植入 

分 类 号：R654.2[医药卫生—外科学]