李瑞锋,韩克,张勇,王小可,吴岳,袁祖贻

• 1:西安交通大学第一附属医院心血管内科

摘要(Abstract)：

目的旨在系统性识别和总结经导管主动脉瓣置换术(TAVR)术后永久起搏器植入(PPI)的预测因素。方法对探讨TAVR术后PPI预测因素的研究进行系统检索,提取研究数据、患者特征、心电图特征、影像学特征及手术相关指标,分析总体及不同类型瓣膜TAVR术后PPI的比例,计算各预测因素的比值比(OR)和95%置信区间(CI),并进一步根据瓣膜类型进行分层分析,分别计算使用自膨胀瓣膜及球囊扩张瓣膜行TAVR术后PPI预测因素的OR和95%CI。结果最终纳入30项研究的数据,包含23 934例患者,其中PPI占比11.8%,自膨胀瓣膜PPI风险为25.9%,球囊扩张瓣膜术后PPI风险为7.5%。综合分析显示,完全性右束支传导阻滞(RBBB)(OR 5.39,95%CI4.73～6.14,P<0.001)、自膨胀瓣膜较球囊扩张瓣膜(OR3.86,95%CI3.38～4.40,P<0.001)与TAVR术PPI风险显著相关,一度房室传导阻滞(一度AVB)(OR 1.86,95%CI 1.54～2.24,P<0.001)、男性较女性(OR 1.17,95%CI 1.07～1.28,P<0.001)、PR间期较长(MD 12.13,95%CI 8.09～16.18,P<0.001)、QRS波较宽(MD 6.59,95%CI 5.40～7.77,P<0.001)、置入深度较深(MD 1.29,95%CI 0.99～1.58,P<0.001)与TAVR术后PPI风险相关。分层分析表明,使用自膨胀瓣膜:RBBB(OR5.53,95%CI3.37～8.11,P<0.001)、置入深度更深(MD1.60,95%CI 1.20～2.01,P<0.001)与TAVR术后PPI风险相关;使用球囊扩张瓣膜:RBBB(OR 7.08,95%CI 5.46～9.18,P<0.001)、一度AVB(OR 1.71,95%CI 1.38～2.12,P<0.001)、QRS波较宽(MD 15.45,95%CI 12.26～18.65,P<0.001)与TAVR术后PPI风险相关。结论 TAVR术后PPI的比例为11.8%。RBBB、瓣膜类型、一度AVB、性别、基础PR间期、QRS波宽度及瓣膜置入深度可作为TAVR术后PPI的预测因素。

关键词(KeyWords)： 经导管主动脉瓣置换术;永久起搏器植入;预测因子

Abstract:

Keywords:

基金项目(Foundation): 国家重点研发计划（2019YFA0802300）;; 国家自然科学基金项目（81822005、81970351）

作者(Author): 李瑞锋,韩克,张勇,王小可,吴岳,袁祖贻

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