南方医科大学学报

南方医科大学学报 ›› 2023, Vol. 43 ›› Issue (11): 1901-1908.doi: 10.12122/j.issn.1673-4254.2023.11.10

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主动脉瓣复合体钙化分布密度是国产自膨式瓣膜TAVR术后传导障碍的危险因素

王蔚然，孙泽瑜，辛 然，丁熠璞，刘子暖，王 玺，王 晶，单冬凯，刘长福   

  1. 中国人民解放军总医院第一医学中心心内科，北京 100853；中国人民解放军总医院第六医学中心心血管病医学部，北京 100048；南开大学医学院，天津 300071
  • 出版日期:2023-11-20 发布日期:2023-12-08

Calcification distributional density of the aortic-valvular complex is an independent risk factor for conduction block following self-expanding transcatheter aortic valve replacement

WANG Weiran, SUN Zeyu, XIN Ran, DING Yipu, LIU Zinuan, WANG Xi, WANG Jing, SHAN Dongkai, LIU Changfu   

  1. Department of Cardiology, First Medical Center, Chinese PLA General Hospital, Beijing 100853, China; Senior Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, Beijing 100048, China; School of Medicine, Nankai University, Tianjin 300071, China
  • Online:2023-11-20 Published:2023-12-08

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摘要： 目的 评估主动脉瓣复合体（AVC）不同区域钙化分布密度对应用国产自膨式瓣膜（SEV）行经导管主动脉瓣置换（TAVR）术后新发传导障碍（CB）的影响。方法 纳入2016年1月~2022年12月接受国产Venus-A人工瓣膜置换术的重度主动脉瓣狭窄患者共73例，根据术后是否出现新发CB分为CB组和无CB组，比较两组基线数据、影像资料和手术数据情况。单因素、多因素Logistic回归分析TAVR术后新发CB的独立危险因素。应用受试者工作特征（ROC）曲线及DeLong检验，分析各危险因素及联合指标预测效能。结果 73例TAVR患者中，18例（24.7%）术后新发CB。CB组具有更大的植入深度（6.77±2.45 mm vs 5.11±3.28 mm，P=0.027），且室间隔膜部长度与植入深度差值（MSID）明显小于无CB组（0.68±3.49 mm vs 2.82±3.88 mm，P=0.036）。钙化分布方面，CB组设备着陆区（DLZ）左冠窦（LCS）的钙化分布密度明显高于无CB组[10.34（2.50，48.35）×102 mm3/mm2 vs3.27（0.00，13.79）×102 mm3/mm2，P=0.026]。多因素Logistic分析发现，DLZ-LCS钙化分布密度、MSID是TAVR术后新发CB的独立危险（保护）因素。ROC曲线显示，MSID、DLZ-LCS钙化分布密度预测CB的曲线下面积（AUC）分别为0.775和0.716，联合指标预测具有最大的AUC（0.890），与单独指标比较差异均有统计学意义（P=0.041 vs MSID；P=0.027 vs DLZ-LCS钙化分布密度）。结论 DLZ-LCS钙化分布密度是国产SEV的TAVR术后新发CB的独立危险因素，联合MSID可以有效预测TAVR术后的传导并发症。

关键词: 主动脉瓣膜病；经导管主动脉瓣置换术；传导障碍；计算机断层扫描；瓣环大小

Abstract: Objective To evaluate the effect of calcification distributional density in different regions of aortic-valvular complex (AVC) on postoperative new-onset conduction block (CB) following transcatheter aortic valve replacement (TAVR) using self-expandable valves (SEV) made in China. Methods From January, 2016 to December, 2022, 73 patients with severe aortic valve stenosis received Venus-A prosthetic valve replacement using SEV made in China, and postoperative new-onset CB occurred in 18 (24.7% ) of the patients. The baseline data, imaging and intervention- related data were compared were between the patients with CB and those without CB. Univariate and multivariate logistic regression analysis was used for investigating the independent risk factors for new- onset CB after TAVR, and the predictive performance of these risk factors was evaluated using receiver operating characteristic (ROC) curve and DeLong test. Results Compared with those with CB, the patients experiencing postoperative new-onset CB had a greater implantation depth (6.77±2.45 mm vs 5.11±3.28 mm, P=0.027), a smaller difference between the membranous septum length and the implantation depth (MSID) (0.68±3.49 mm vs 2.82±3.88 mm, P=0.036), and a higher calcification distributional density of the left coronary sinus (LCS) in the device landing zone (DLZ) (P=0.026). Multivariate logistic analysis revealed that DLZ-LCS calcification distributional density and MSID were independent risk (protective) factors for new-onset CB following TAVR. ROC curve analysis showed that the AUC of MSID and DLZ-LCS calcification distributional density was 0.775 and 0.716, respectively, and their combination had had a significantly higher AUC of 0.890 (P=0.041 and 0.027, respectively). Conclusion The DLZ-LCS calcification distributional density is an independent risk factor for new-onset CB following TAVR using SEV. The conduction complications following TAVR can be effectively predicted using this calcification indicator combined with MSID.

Key words: aortic valve disease; transcatheter aortic valve replacement; conduction block; computed tomography; annulus size