王伟敏,孙玉喜,丁立成,王丽岚,许巧如,王斌

• 1:厦门大学附属心血管病医院急诊科
• 2:四川大学华西医院心脏内科

摘要(Abstract)：

目的 回顾性探究接受自膨胀式瓣膜（SEV）置入的经导管主动脉瓣置换术（TAVR）患者的基线临床特征、升主动脉根部解剖特点及术后新发传导障碍（NOCD）的相关因素。方法 回顾性研究自2014年12月至2022年11月于厦门大学附属心血管病医院接受TAVR手术的245例患者，根据纳排标准连续纳入167例术中置入SEV的患者，根据主动脉瓣形态分为三叶瓣组（TAV组，113例）和二叶瓣组（BAV组，54例），术后根据心电图特征将TAV组分为NOCD组（43例）和无NOCD组（70例）；BAV组分为NOCD组（16例）和无NOCD组（38例）。收集患者术前心电图、升主动脉根部CT血管造影等临床资料。结果 在TAV组中：与NOCD组相比，无NOCD组的右-无冠瓣钙化定量更大（P=0.005），而主动脉成角则较小（P=0.002），多因素分析结果提示右-无冠瓣钙化定量每增加10 mm~3,TAVR术后NOCD的发生风险降低2.6%(OR 0.974,P=0.039)，主动脉成角每增加1°，术后NOCD的风险提升将近7.3%(OR1.073,P=0.003)。在BAV组中：术前PR间期每增加1 ms,TAVR术后NOCD的发生风险提升将近3.3%(OR 1.033,P=0.041)，右冠瓣区的钙化定量每增加10m m~3，出现NOCD的风险降低6.6%(OR0.934,P=0.013)。结论 在TAV患者中，右-无冠瓣钙化定量可能对心脏传导系统具有保护作用，而主动脉成角则是NOCD发生的危险因素。在BAV患者中，术前PR间期是NOCD的危险因素，右冠瓣区钙化定量可能对心脏传导系统具有保护作用。

关键词(KeyWords)： 经导管主动脉瓣置换术;传导障碍;二叶式主动脉瓣

Abstract:

Keywords:

基金项目(Foundation): 厦门市联合支持医疗卫生重点项目（3502Z20209006）

作者(Author): 王伟敏,孙玉喜,丁立成,王丽岚,许巧如,王斌

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