纯主动脉瓣反流患者TAVR术后新发传导阻滞的危险因素分析  

Risk factors of new conduction block after TAVR in patients with pure aortic regurgitation

作　　者：张璇 查林涛 梁诚 左权 葛涛 汤圣兴 ZHANG Xuan;ZHA Lintao;LIANG Cheng;ZUO Quan;GE Tao;TANG Shengxing(Department of Cardiology,The First Affiliated Hospital of Wannan Medical College,Wuhu 241001,Anhui,China)

机构地区：[1]皖南医学院第一附属医院弋矶山医院心血管内科,安徽芜湖241001

出　　处：《皖南医学院学报》2024年第5期430-434,共5页Journal of Wannan Medical College

基　　金：安徽省高等学校科学研究项目重大项目(2023AH040258);安徽省重点研究与开发计划临床医学研究转化专项(202304295107020008)。

摘　　要：目的:探讨应用新一代自膨胀瓣膜对纯主动脉瓣反流(PAR)患者行经导管主动脉瓣置换术(TAVR)术后新发传导阻滞的危险因素。方法:选取2021年11月~2023年9月于弋矶山医院心脏中心因重度PAR而行TAVR的68名连续性患者进行回顾性队列研究,最终纳入58例,根据术后是否新发传导阻滞,分为传导阻滞组(23例)和非传导阻滞组(35例),通过Logistic回归分析PAR患者TAVR术后新发传导阻滞的危险因素。结果:传导阻滞组糖尿病患病率更高、瓣膜植入深度更深、主动脉根部角度更大(P<0.05)。多因素Logistic回归分析显示,主动脉根部角度更大(OR=1.166,95%CI:1.029~1.321,P=0.016)及瓣膜植入深度更深(OR=1.504,95%CI:1.055~2.144,P=0.024)为PAR患者TAVR术后新发传导阻滞的危险因素。结论:本研究显示主动脉根部角度及瓣膜植入深度均与PAR患者TAVR术后新发传导阻滞独立相关,提示术者术前应充分结合主动脉根部角度制定手术方案,评估最佳的术中瓣膜植入深度,尽量减少术后新发传导阻滞的风险。Objective:To investigate the risk factors of new conduction block after transcatheter aortic valve replacement(TAVR)with a new generation self-expanding valve in patients with pure aortic regurgitation.Methods:Sixty eight consecutive patients undergoing TAVR due to severe pure aortic regurgitation in the Heart Center of Yijishan Hospital of Wannan Medical College were initially recruited from November 2021 to September 2023 for cohort analysis.Finally,58 cases were included,and divided into conduction block group(n=23)and non-conduction block group(n=35)according to the occurrence of new conduction block after TAVR.Clinical data were collected and risk factors of new conduction block after TAVR in PNAR patients were analyzed by logistic regression.Results:The prevalence rate of diabetes was higher,the valve implantation depth was deeper,and the aortic root angle was larger in the conduction block group(all P<0.05).Multivariate logistic analysis showed that greater aortic root angle(OR=1.166;95%CI:1.029-1.321)and deeper valve implantation depth(OR=1.504;95%CI:1.055-2.144)were the risks associated with new onset conduction block after TAVR.Conclusion:This study shows that aortic root angle and valve implantation depth are associated with the new conduction block independently in patients with PAR undergoing TAVR.It is suggested that the interventional operative plan should be fully combined with the angle of aortic root before operation to evaluate the best depth of valve implantation during operation and minimize the risk of new conduction block after TAVR.

关 键 词：经导管主动脉瓣置换术 纯主动脉瓣反流 传导阻滞 主动脉根部角度 瓣膜植入深度 

分 类 号：R654.2[医药卫生—外科学]