经导管主动脉瓣置换术(TAVR)术后植入永久起搏器的术前影响因素

Preoperative Influencing Factors of Permanent Pacemaker Implantation after Transcatheter Aortic Valve Replacement (TAVR)

摘要: 目的：本研究通过描述分析，找到经导管主动脉瓣置换术术后植入永久起搏器的术前影响因素，以期对临床医师决定经导管主动脉瓣置换术的术前评估、手术操作或永久起搏器植入时机起到参考作用。方法：回顾性分析2017年9月至2021年4月在青岛大学附属医院心血管外科行经导管主动脉瓣置换术的73名患者，收集其病史资料、术前检验检查资料，使用独立样本t检验、卡方检验、二元Logistics回归检验各因素的独立影响作用。结果：在73例研究人群中，经导管主动脉瓣置换术术后起搏器植入率为20.5%；在起搏器植入组和非起搏器植入组两组人群中，术前完全性右束支传导阻滞(p < 0.001)、主动脉瓣重度钙化(p = 0.028)、瓣膜过大率(p = 0.002)、后扩张球囊大小(p = 0.037)、年龄(p = 0.037)因素存在统计学差异；通过二元Logistic回归分析显示术前完全性右束支传导阻滞(p = 0.014)、主动脉瓣重度钙化(p = 0.019)和瓣膜过大率(p = 0.021)为经导管主动脉瓣置换术术后植入永久起搏器的独立影响因素，且均为危险因素。结论：术前完全性右束支传导阻滞、主动脉瓣重度钙化和瓣膜过大率是经导管主动脉瓣置换术术后植入永久起搏器的独立危险因素。

Abstract: Objective: Through description and analysis, this study found the preoperative influencing factors of permanent pacemaker implantation after transcatheter aortic valve replacement, in order to play a reference role for clinicians to determine the preoperative evaluation, surgical operation or the timing of permanent pacemaker implantation of transcatheter aortic valve replacement. Meth-ods: 73 patients who underwent transcatheter aortic valve replacement in the Department of car-diovascular surgery of the Affiliated Hospital of Qingdao University from September 2017 to April 2021 were retrospectively analyzed. Their medical history and preoperative examination data were collected. The independent influence of various factors was tested by independent sample t-test, chi square test and binary logistic regression. Results: In the 73 study population, the pacemaker im-plantation rate after transcatheter aortic valve replacement was 20.5%; There were significant dif-ferences in preoperative complete right bundle branch block (p < 0.001), severe aortic valve calci-fication (p = 0.028), valve oversize rate (p = 0.002), post dilation balloon size (p = 0.037) and age (p = 0.037) between pacemaker implantation group and non pacemaker implantation group; Binary logistic regression analysis showed that preoperative complete right bundle branch block (p = 0.014), severe aortic valve calcification (p = 0.019) and valve oversize rate (p = 0.021) were inde-pendent influencing factors of permanent pacemaker implantation after transcatheter aortic valve replacement. Conclusion: Preoperative complete right bundle branch block, severe aortic valve cal-cification and valve oversize are independent risk factors for permanent pacemaker implantation after transcatheter aortic valve replacement.