コアバルブトランスキャテーターによる大動脈弁の埋め込み後の永久ペースメーカーの挿入:発生率と要因 (UKのCoreValve Collaborative)
M Z Khawaja1, R Rajani, A Cook
1UK CoreValve Collaborative, Sussex Cardiac Centre, Brighton & Sussex University Hospital Trust, Eastern Road, Brighton, East Sussex, BN2 5BE, UK.
Circulation
|February 23, 2011
まとめ
患者の有意な3分の1は,CoreValveトランスキャテーター大動脈弁の植入後に永久ペースメーカー (PPM) を必要とします. ハートブロックや気球の先行膨張などの要因は,このリスクを高めます.
科学分野:
- 心臓病学 心臓病学
- 介入性心臓病学 介入性心臓病学
- 医療機器 医療機器について
背景:
- 永久ペースメーカー (PPM) の必要性は,トランスキャテータ大動脈弁の埋め込み (TAVI) の後の既知の合併症です.
- コアバルブTAVI後のPPMの発生率と予測要因の評価は,患者管理において極めて重要です.
研究 の 目的:
- 英国におけるCoreValveの植入から30日以内にPPMの発生率を決定する.
- TAVI後のPPMの必要性を予測する解剖学的および電気生理学的モデルを開発する.
主な方法:
- イギリスの10のセンターでCoreValve TAVIを受けた270人の患者の遡及的分析.
- QRSの持続時間とバンドル・ブランチ・ブロックの発生率を含む,ベースラインと処置後のEKGパラメータの評価.
- PPMの要件に関する独立した予測要因を特定するための多変量分析.
主要な成果:
- 33.3%の患者は,処置後30日以内にPPMが必要になりました.
- QRSの持続時間 (105〜135 ms) とLBBB発生率 (13%〜61%) の有意な増加が観察されました.
- PPMの独立予測因子には,周術 AV ブロック,気球の先延ばし,より大きな義肢サイズ,セプトの直径の増加,およびQRSの持続期間が長くなります.
結論:
- CoreValve TAVIを受ける患者の3分の1は30日以内にPPMを必要とします.
- 術後の AV ブロック,気球の先延ばし,より大きな義肢,心室間隔膜の直径の増加,および長時間の QRS 持続は,PPM の必要性に関連しています.
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