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.
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 vs 3.27（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。
Keywords: annulus size; aortic valve disease; computed tomography; conduction block; transcatheter aortic valve replacement.