经导管主动脉瓣置换术后新发持续完全性左束支传导阻滞的危险因素及短期预后分析  

Risk factors and prognosis of new continuous complete left bundle branch block in elderly patients undergoing transcatheter aortic valve replacement

作　　者：杜招娜 姜文博 牟俊宇 俞成云 夏伟[3] DU Zhaona;JIANG Wenbo;MOU Junyu;YU Chengyun;XIA Wei(School of Clinical Medicine,Shandong Second Medical University,Weifang 261053,China;Department of Neurosurgery,Qinigdao Hospital,University of Health and Rehabilitation Sciences(Qingdao Municipal Hospital),Qingdao 266071,China;Department of Cardiology,Qinigdao Hospital,University of Health and Rehabilitation Sciences(Qingdao Municipal Hospital),Qingdao 266071,China)

机构地区：[1]山东第二医科大学临床医学院,山东省潍坊市261053 [2]康复大学青岛医院(青岛市市立医院)神经外科,山东省青岛市266071 [3]康复大学青岛医院(青岛市市立医院)心内一科,山东省青岛市266071

出　　处：《实用老年医学》2024年第5期500-504,共5页Practical Geriatrics

基　　金：青岛市医药卫生科技项目(2021-WJZD004)。

摘　　要：目的 分析经导管主动脉瓣置换术(transcatheter aortic valve replacement, TAVR)术后新发持续完全性左束支传导阻滞(complete left bundle branch block, cLBBB)的相关危险因素及cLBBB对短期预后的影响。方法 选取2019年1月至2022年8月在青岛市市立医院心脏中心经股动脉行TAVR的78例主动脉瓣膜狭窄病人为研究对象,根据TAVR术后至出院时是否发生cLBBB分为新发持续性cLBBB组(n=26)和非左束支传导阻滞(LBBB)组(n=52)。收集并比较2组病人的基线资料、生化检查指标、CT等影像检查结果、瓣膜和手术相关数据,以及6个月后病人的预后情况。采用多因素Logistic回归分析TAVR术后新发持续性cLBBB的危险因素。结果 78例病人中,26例(33.3%)在TAVR术后出现持续性cLBBB。Logistic回归分析显示,术前存在的不完全性LBBB(OR=7.609, 95%CI:1.051~55.066)、植入瓣膜过大率≥17.25%(OR=1.096, 95%CI:1.017~1.181)及无窦侧瓣膜植入深度≥4.96 mm(OR=3.633, 95%CI:1.363~9.686)是TAVR术后新发持续性cLBBB的独立危险因素。术后第6个月随访时,新发持续性cLBBB组有更高的心力衰竭再住院率(16.0%比1.9%,P=0.02)。结论 术前不完全性LBBB、较高的植入瓣膜过大率及冠脉无窦侧瓣膜植入过深是影响TAVR术后持续性cLBBB发生的危险因素。新发cLBBB病人有更高的心力衰竭再住院风险。Objective To analyze the risk factors associated with new-onset persistent complete left bundle branch block(cLBBB)in the elderly patients with aortic stenosis undergoing transcatheter aortic valve replacement(TAVR)and the impact of cLBBB on short-term prognosis.Methods The clinical data of 78 elderly patients who underwent TAVR via femoral artery at the Heart Center of Qingdao Municipal Hospital from January 2019 to August 2022 were retrospectively analyzed,and the patients were divided into the new-onset persistent cLBBB group(n=26)and the non-LBBB group(n=52)according to whether cLBBB occurred after TAVR during the hospitalization.The baseline data,the levels of biochemical indexes,CT and cardiac ultrasonography imaging,valve-related and surgery-related data and the prognosis during 6 months of follow-up were compared between the two groups.A multiple Logistic regression model was used to analyze the risk factors of new-onset persistent cLBBB after TAVR.Results Of the 78 patients,26 patients(33.3%)presented with persistent cLBBB after TAVR.Logistic regression analysis showed that preoperative presence of incomplete LBBB(OR=7.609,95%CI:1.051-55.066),oversize rate of implanted valve≥17.25%(OR=1.096,95%CI:1.017-1.181)and valve implantation depth≥4.96 mm at sinus-free side(OR=3.633,95%CI:1.363-9.686)were the independent risk factors for new-onset persistent cLBBB after TAVR.During 6 months of follow-up,the new persistent cLBBB group had a higher rate of heart failure rehospitalization(16.0%vs 1.9%,P=0.02)compared to the non-LBBB group.Conclusions Preoperative incomplete LBBB,implantation of large-size valves and deep implantation of coronary sinusless lateral valves are the risk factors of persistent cLBBB after TAVR,and the patients with new-onset cLBBB have a higher risk of rehospitalization due to heart failure.

关 键 词：经导管主动脉瓣置换术 左束支传导阻滞 影响因素 预后 

分 类 号：R654.2[医药卫生—外科学]