经导管主动脉瓣置换术后新发传导阻滞的单中心回顾性分析  

New-onset conduction block after transcatheter aortic valve replacement:A retrospective analysis in a single center

作　　者：张航[1] 王华君 石凤梧[1] 刘苏[1] 马千里[1] 安景辉[1] ZHANG Hang;WANG Huajun;SHI Fengwu;LIU Su;MA Qianli;AN Jinghui(Department of Cardiac Surgery,The Second Hospital of Hebei Medical University,Shijiazhuang,050000,P.R.China)

机构地区：[1]河北医科大学第二医院心脏外科,石家庄050000

出　　处：《中国胸心血管外科临床杂志》2025年第3期372-376,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：2023年度河北省医学科学研究课题(20230440)。

摘　　要：目的探讨经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)后新发传导阻滞情况并总结相关经验。方法收集2016年1月—2023年2月河北医科大学第二医院行TAVR患者的临床资料,回顾性分析TAVR术后患者新发传导阻滞的情况。结果纳入患者352例,其中男225例、女127例,平均年龄(67.2±5.1)岁。采用瓣膜Venus-A 256例、Vita-Flow 69例、J-Valve 27例。术后新发传导阻滞38例(10.8%),其中术后新发Ⅲ度房室传导阻滞6例(1.7%)[Venus-A 5例(2.0%)、Vita-Flow 1例(1.4%)],2例术后14 d内恢复传导功能,4例术后传导功能未能恢复,于心脏内科植入永久起搏器。术后新发左束支传导阻滞27例(7.7%)[Venus-A 22例(8.6%)、Vita-Flow 4例(5.8%)、J-Valve 1例(3.7%)],23例术后7 d内恢复传导功能。术后新发右束支传导阻滞5例(1.4%)[Venus-A 4例(1.5%)、Vita-Flow 1例(1.4%)]。结论新发传导阻滞是TAVR术后常见的并发症,术后左束支传导阻滞新发率最高,其次为术后Ⅲ度房室传导阻滞。掌握合理方法、运用适宜策略可有效降低术后传导阻滞新发率,提高TAVR整体成功率。Objective To investigate the new-onset conduction block after transcatheter aortic valve replacement(TAVR)and summarize the relevant experience.Methods The perioperative data of TAVR patients in the Second Hospital of Hebei Medical University from January 2016 to February 2023 were collected,and the new-onset incidence of conduction block after TAVR was analyzed retrospectively.Results Finally 352 patients were included,including 225 males and 127 females,with an average age of(67.2±5.1)years,among whom 256 patients were treated with Venus-A valves,69 patients with Vita-Flow valves,and 27 patients with J-Valve valves.There were 38(10.8%)patients of new-onset postoperative block.There were 6(1.7%)patients of new-onset postoperative gradeⅢatrioventricular block,including 5(2.0%)patients of Venus-A and 1(1.4%)patient of Vita-Flow.Conduction function was restored in 2 patients within 14 days after surgery,and failed to be restored in 4 patients,who then received permanent pacemaker implantation in the Department of Cardiology.There were 27(7.7%)patients of new left bundle branch block after surgery,including 22(8.6%)patients of Venus-A,4(5.8%)patients of Vita-Flow and 1(3.7%)patient of J-Valve;and conduction function was restored within 7 days after surgery in 23 patients,and 5(1.4%)patients developed new right bundle branch blocks after surgery including 4(1.5%)patients of Venus-A and 1(1.4%)patient of Vita-Flow.Conclusion New-onset conduction block is a common complication after TAVR,and the new-onset rate of left bundle branch block is the highest,followed by the gradeⅢatrioventricular block.Mastering reasonable methods and applying appropriate strategies can effectively reduce the new-onset rate of postoperative conduction block and improve the overall success rate of TAVR surgery.

关 键 词：经导管主动脉瓣置换术 传导阻滞 永久起搏器植入 

分 类 号：R65[医药卫生—外科学]