PDF(Pubmed)
Abstract：
OBJECTIVE: Permanent pacemaker implantation (PPI) risk is higher following transcatheter aortic valve implantation (TAVI) than surgical valve replacement. Native aortic leaflets are retained in patients undergoing TAVI, unlike in surgical valve replacement. Whether the retained leaflets influence PPI risk because of their proximity to the conduction system is unknown. The study sought to determine the association between infra-annular extension of native right coronary cusp/noncoronary cusp (RCC/NCC) post balloon-expandable TAVI and PPI risk.
METHODS: We performed a retrospective analysis of 190 patients undergoing balloon-expandable TAVI at a single center. Manifestation of infra-annular extension of RCC/NCC was considered to be present when part of leaflet extended below aortic-annular plane on post-implantation aortic-root angiography.
RESULTS: Infra-annular extension of RCC/NCC was observed in 33 patients (17.37%). PPI incidence post-TAVI was higher in patients with infra-annular extension of RCC/NCC than in those without (36.36% versus 8.92%, relative-risk: 4.08, p˂0.0001). On logistic-regression analysis, preexisting right bundle-branch block (RBBB) (odds-ratio: 12.73, 95% confidence-interval: 2.16-74.93, p = 0.005), and infra-annular extension of RCC/NCC (odds-ratio: 5.63, 95% confidence-interval: 2.17-14.58, p < 0.0001) were independently associated with PPI risk. Preexisting RBBB (φ = +0.25, p = 0.001) and infra-annular extension of RCC/NCC (φ = +0.30, p < 0.0001) showed a positive-correlation with PPI risk. Infra-annular extension of RCC/NCC was a significant predictor of PPI risk on receiver-operating-characteristic curve analysis (area under-the-curve 0.67; 95% confidence-interval: 0.54-0.79, p = 0.006).
CONCLUSIONS: The retained native aortic leaflets play a significant role in PPI risk following balloon-expandable TAVI. Infra-annular extension of RCC/NCC is a novel predictor, and is associated with a four-fold higher risk of PPI.
METHODS: We performed a retrospective analysis of 190 patients undergoing balloon-expandable TAVI at a single center. Manifestation of infra-annular extension of RCC/NCC was considered to be present when part of leaflet extended below aortic-annular plane on post-implantation aortic-root angiography.
RESULTS: Infra-annular extension of RCC/NCC was observed in 33 patients (17.37%). PPI incidence post-TAVI was higher in patients with infra-annular extension of RCC/NCC than in those without (36.36% versus 8.92%, relative-risk: 4.08, p˂0.0001). On logistic-regression analysis, preexisting right bundle-branch block (RBBB) (odds-ratio: 12.73, 95% confidence-interval: 2.16-74.93, p = 0.005), and infra-annular extension of RCC/NCC (odds-ratio: 5.63, 95% confidence-interval: 2.17-14.58, p < 0.0001) were independently associated with PPI risk. Preexisting RBBB (φ = +0.25, p = 0.001) and infra-annular extension of RCC/NCC (φ = +0.30, p < 0.0001) showed a positive-correlation with PPI risk. Infra-annular extension of RCC/NCC was a significant predictor of PPI risk on receiver-operating-characteristic curve analysis (area under-the-curve 0.67; 95% confidence-interval: 0.54-0.79, p = 0.006).
CONCLUSIONS: The retained native aortic leaflets play a significant role in PPI risk following balloon-expandable TAVI. Infra-annular extension of RCC/NCC is a novel predictor, and is associated with a four-fold higher risk of PPI.
摘要：
目的：经导管主动脉瓣植入术（TAVI）后，永久性起搏器植入术（PPI）的风险高于外科瓣膜置换术。接受TAVI的患者保留了天然的主动脉小叶，与手术瓣膜置换不同。保留的小叶是否因其接近传导系统而影响PPI风险尚不清楚。该研究试图确定球囊扩张TAVI后天然右冠状动脉尖/非冠状动脉尖（RCC/NCC）的环形扩张与PPI风险之间的关联。
方法：我们对190例单中心球囊扩张TAVI患者进行了回顾性分析。在植入后的主动脉根血管造影术中，当小叶的一部分延伸到主动脉环形平面以下时，认为存在RCC/NCC的环形延伸表现。
结果：在33例患者（17.37%）中观察到RCC/NCC的环状扩张。有肾癌/NCC环下扩张的患者在TAVI后的PPI发生率高于无（36.36％对8.92％，相对风险：4.08，p<0.0001）。在逻辑回归分析中，先前存在的右束支传导阻滞（RBBB）（比值比：12.73，95％置信区间：2.16-74.93，p=0.005），RCC/NCC(比值比:5.63,95%置信区间:2.17-14.58,p<0.0001)与PPI风险独立相关.先前存在的RBBB（φ=0.25，p=0.001）和RCC/NCC的环下延伸（φ=0.30，p<0.0001）与PPI风险呈正相关。在受试者工作特征曲线分析中，RCC/NCC的环形延伸是PPI风险的重要预测因子（曲线下面积0.67；95％置信区间：0.54-0.79，p=0.006）。
结论：保留的天然主动脉小叶在球囊扩张TAVI后的PPI风险中起重要作用。RCC/NCC的环形延伸是一种新的预测因子，并且与PPI的风险高四倍有关。
方法：我们对190例单中心球囊扩张TAVI患者进行了回顾性分析。在植入后的主动脉根血管造影术中，当小叶的一部分延伸到主动脉环形平面以下时，认为存在RCC/NCC的环形延伸表现。
结果：在33例患者（17.37%）中观察到RCC/NCC的环状扩张。有肾癌/NCC环下扩张的患者在TAVI后的PPI发生率高于无（36.36％对8.92％，相对风险：4.08，p<0.0001）。在逻辑回归分析中，先前存在的右束支传导阻滞（RBBB）（比值比：12.73，95％置信区间：2.16-74.93，p=0.005），RCC/NCC(比值比:5.63,95%置信区间:2.17-14.58,p<0.0001)与PPI风险独立相关.先前存在的RBBB（φ=0.25，p=0.001）和RCC/NCC的环下延伸（φ=0.30，p<0.0001）与PPI风险呈正相关。在受试者工作特征曲线分析中，RCC/NCC的环形延伸是PPI风险的重要预测因子（曲线下面积0.67；95％置信区间：0.54-0.79，p=0.006）。
结论：保留的天然主动脉小叶在球囊扩张TAVI后的PPI风险中起重要作用。RCC/NCC的环形延伸是一种新的预测因子，并且与PPI的风险高四倍有关。
