(1)背景:传统上,经导管主动脉瓣植入术(TAVI)后需要新的永久性起搏器(PPM)的传导障碍是常见的并发症。据报道,具有自膨胀平台的新植入技术降低了PPM的发生率。我们试图使用EvolutR/PRO/PRO+调查TAVI后30天PPM的预测因素;(2)方法:2019年10月至2022年8月在戈尔韦大学医院连续使用Evolut平台接受TAVI的患者,爱尔兰,包括在内。既往有PPM的患者(n=10),不包括瓣膜-瓣膜程序(n=8)或在索引程序期间接受>1个瓣膜(n=3)。基线临床,心电图(ECG),分析超声心动图和多层螺旋CT(MSCT)参数。TAVI前MSCT分析包括膜间隔(MS)长度,主动脉瓣小叶的半定量钙化分析,左心室流出道,和二尖瓣环.此外,植入深度(ID)由最终主动脉造影测量.多变量二元逻辑分析和受试者工作特征(ROC)曲线分析用于识别独立的预测因子以及最佳MS和ID截止值,以预测新的PPM需求。结果:共纳入129例TAVI患者(年龄=81.3±5.3岁;36%为女性;中位EuroSCOREII3.2[2.0,5.4])。15例患者(11.6%)在30天后需要PPM。30天需要新PPM的患者更可能有较低的欧洲心脏手术风险评估系统II。基线心电图右束支传导阻滞(RBBB)患病率增加,有较高的二尖瓣环钙化严重程度和有较短的MS术前MSCT分析,并且有一个身份证,如最终主动脉造影图所示。从多变量分析来看,TAVI前RBBB,MS长度,和ID被证明是新PPM的预测因子。MS长度<2.85mm(AUC=0.85,95CI:(0.77,0.93))和ID>3.99mm(曲线下面积(AUC)=0.79,(95%置信区间(CI):(0.68,0.90))被发现是预测新PPM需求的最佳截止值;(4)结论:发现隔膜长度和植入深度是新PPTAVI平台后体积的独立预测因子。患者特定的植入深度可用于减轻对新PPM的需求。
(1) Background: Conduction disturbance requiring a new permanent pacemaker (PPM) after transcatheter aortic valve implantation (TAVI) has traditionally been a common complication. New implantation techniques with self-expanding platforms have reportedly reduced the incidence of PPM. We sought to investigate the predictors of PPM at 30 days after TAVI using Evolut R/PRO/PRO+; (2) Methods: Consecutive patients who underwent TAVI with the Evolut platform between October 2019 and August 2022 at University Hospital Galway, Ireland, were included. Patients who had a prior PPM (n = 10), valve-in-valve procedures (n = 8) or received >1 valve during the index procedure (n = 3) were excluded. Baseline clinical, electrocardiographic (ECG), echocardiographic and multislice computed tomography (MSCT) parameters were analyzed. Pre-TAVI MSCT analysis included membranous septum (MS) length, a semi-quantitative calcification analysis of the aortic valve leaflets, left ventricular outflow tract, and mitral annulus. Furthermore, the implantation depth (ID) was measured from the final aortography. Multivariate binary logistic analysis and receiver operating characteristic (ROC) curve analysis were used to identify independent predictors and the optimal MS and ID cutoff values to predict new PPM requirements, respectively; (3) Results: A total of 129 TAVI patients were included (age = 81.3 ± 5.3 years; 36% female; median EuroSCORE II 3.2 [2.0, 5.4]). Fifteen patients (11.6%) required PPM after 30 days. The patients requiring new PPM at 30 days were more likely to have a lower European System for Cardiac Operative Risk Evaluation II, increased prevalence of right bundle branch block (RBBB) at baseline ECG, have a higher mitral annular calcification severity and have a shorter MS on preprocedural MSCT analysis, and have a ID, as shown on the final aortogram. From the multivariate analysis, pre-TAVI RBBB, MS length, and ID were shown to be predictors of new PPM. An MS length of <2.85 mm (AUC = 0.85, 95%CI: (0.77, 0.93)) and ID of >3.99 mm (area under the curve (AUC) = 0.79, (95% confidence interval (CI): (0.68, 0.90)) were found to be the optimal cut-offs for predicting new PPM requirements; (4) Conclusions: Membranous septum length and implantation depth were found to be independent predictors of new PPM post-TAVI with the Evolut platform. Patient-specific implantation depth could be used to mitigate the requirement for new PPM.