The incidence and predictors of high-degree atrioventricular block in patients with bicuspid aortic valve receiving self-expandable transcatheter aortic valve implantation
经导管自膨式主动脉瓣植入术的二叶式主动脉瓣患者发生高度房室传导阻滞的发生率及预测因素
自己拡張型経カテーテル大動脈弁移植を受けた二尖大動脈弁患者における高度房室ブロックの発生率と予測因子
자가 확장형 경동맥 판막 이식술을 받은 이첨 대동맥판막 환자에서 고도 방실 차단의 발생률과 예측인자
Incidencia y predictores de bloqueo auriculoventricular de alto grado en pacientes con válvula aórtica bicúspide que reciben un implante percutáneo de válvula aórtica autoexpandible
L'incidence et les facteurs prédictifs du bloc auriculo-ventriculaire de haut degré chez les patients présentant une valve aortique bicuspide recevant une implantation de valve aortique transcathéter auto-extensible
Частота и предикторы атриовентрикулярной блокады высокой степени у пациентов с двустворчатым аортальным клапаном, которым имплантировали саморасширяющийся транскатетерный аортальный клапан
Yuan-Weixiang OU 欧袁伟翔 ¹ ², Jing-Jing HE 何婧婧 ², Xuan ZHOU 周轩 ¹ ³, Guo-Yong LI ², Yan-Biao LIAO 廖延标 ², Xin WEI 魏薪 ², Yong PENG 彭勇 ¹ ², Yuan FENG 冯沅 ¹ ², Mao CHEN 陈茂 ¹ ²
¹ Department of Cardiac Catheterization Laboratory, West China Hospital, Sichuan University, Sichuan, China
中国 四川 四川大学 华西医院 心导管室
² Department of Cardiology, West China Hospital, Sichuan University, Sichuan, China
中国 四川 四川大学 华西医院 心脏内科
³ Department of Radiology, West China Hospital, Sichuan University, Sichuan, China
中国 四川 四川大学 华西医院 放射科
The high-degree atrioventricular block (HAVB) in patients with bicuspid aortic valve (BAV) treated with transcatheter aortic valve implantation (TAVI) remains high. The study aims to explore this poorly understood subject of mechanisms and predictors for HAVB in BAV self-expandable TAVI patients.
METHODS
We retrospectively included 181 BAV patients for analysis. Using computed tomography data, the curvature of ascending aorta (AAo) was quantified by the angle (AAo angle) between annulus and the cross-section at 35 mm above annulus (where the stent interacts with AAo the most). The valvular anatomy and leaflet calcification were also characterized.
RESULTS
The 30-day HAVB rate was 16.0% (median time to HAVB was three days). Type-1 morphology was found in 79 patients (43.6%) (left- and right-coronary cusps fusion comprised 79.7%). Besides implantation below membrane septum, large AAo angle [odds ratio (OR) = 1.08, P = 0.016] and type-1 morphology (OR = 4.97, P = 0.001) were found as the independent predictors for HAVB. Together with baseline right bundle branch block, these predictors showed strong predictability for HAVB with area under the cure of 0.84 (sensitivity = 62.1%, specificity = 92.8%). Bent AAo and calcified raphe had a synergistic effect in facilitating high implantation, though the former is associated with at-risk deployment (device implanted above annulus + prothesis pop-out, versus straight AAo: 9.9% vs. 2.2%, P = 0.031).
CONCLUSIONS
AAo curvature and type-1 morphology are novel predictors for HAVB in BAV patients following self-expandable TAVI. For patients with bent AAo or calcified raphe, a progressive approach to implant the device above the lower edge of membrane septum is favored, though should be done cautiously to avoid pop-out.
