经导管主动脉瓣置换术后永久起搏器植入研究进展

Research Progress of Permanent Pacemaker Implantation after Transcatheter Aortic Valve Replacement

摘要: 目的：随着人口老龄化的加剧，主动脉瓣狭窄(AS, Aortic Stenosis)患者的发病率逐年增加。经导管主动脉瓣置换术(TAVR, Transcatheter Aortic Valve Replacement)经过20年的发展，目前已被开发为不可手术、高风险外科手术严重主动脉瓣狭窄患者的有效替代和较为安全的治疗方法，并且随着技术的不断发展，如今符合TAVR手术指征的患者已经扩大到风险更低和/或更年轻的患者。但是与TAVR相关的并发症：术后永久性起搏器植入问题仍令人担忧。虽然最新的中国专家共识已经明确了TAVR术后永久起搏器(PPM, Permanent Pacemaker)植入的适应症，且随着介入技术的不断改进，TAVR术后并发症的整体发生率不断降低，但是TAVR术后起搏器的植入发生率并未明显下降，并且是TAVR术后最常见的并发症；因此关于TAVR手术后出现起搏器植入适应症的发生及预测因素，仍是目前关注的焦点。TAVR相关的传导异常预防和管理仍然是明显的临床挑战。在这篇文章中，我们回顾了近些年关于TAVR相关PPM的研究进展，为临床TAVR并发症的研究提供参考。

Abstract: Objective: With the aging of population, the incidence of patients with aortic stenosis is increasing year by year. After 20 years’ development, TAVR transcatheter aortic valve replacement has been developed as an effective alternative and safer treatment for patients with severe aortic stenosis who are inoperable and have high-risk surgery, and with the continuous development of technology, the patients who meet the indications of TAVR surgery have now expanded to patients with lower risk and/or younger. However, the complication related to TAVR: the problem of permanent pace-maker implantation after operation is still worrying. Although the latest expert consensus in China has defined the indication of permanent pacemaker implantation after TAVR, and with the contin-uous improvement of interventional technology, the overall incidence of complications after TAVR has been decreasing, but the incidence of pacemaker implantation after TAVR has not decreased significantly, and it is the most common complication after TAVR; Therefore, the occurrence and predictive factors of pacemaker implantation indications after TAVR surgery are still the focus of attention at present. The prevention and management of TAVR-related conduction abnormalities remains an obvious clinical challenge. In this article, we review the research progress of TAVR-related PPM in recent years, and provide reference for the study of clinical TAVR complica-tions.