コアバルブリバルビングシステムによるトランスキャテーター大動脈弁のインプラント化後の持続的な左バンドル・ブランチ・ブロックの臨床的影響
Luca Testa1, Azeem Latib, Federico De Marco
1Department of Interventional Cardiology, Clinical Institute S. Ambrogio, IRCCS San Donato, 20149 Milan, Italy. luctes@gmail.com
Circulation
|February 28, 2013
まとめ
トランスキャテーターによる大動脈弁の埋め込み後の新発症左束枝ブロック (LBBB) は,長期的な死亡率に影響を与えませんでした. しかし,LBBBは,ペースメーカーへの短期的な需要がより高いことと関連していました.
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
- 心臓電気生理学 心臓電気生理学
背景:
- トランスカテーター大動脈弁の埋め込み (TAVI) の後,伝導障害は一般的です.
- 手術による大動脈弁置換後の持続的な左束枝ブロック (LBBB) は,有害な結果と関連しています.
- TAVI後の新発症LBBBの予後効果は不明である.
研究 の 目的:
- 新発性持続性LBBBとTAVI後の予後との関連を調査する.
- LBBBの死亡率と心不全のLBBBの効果を評価するために,TAVI後の入院を評価する.
主な方法:
- コアバルブリヴァルビングシステムでTAVIを受けた818人の患者の分析.
- 患者は,持続的なLBBB (n=224) とLBBBなし (n=594) の2つのグループに分けられました.
- 臨床的特徴,インプラントの詳細,および長期的な結果 (死亡率,入院) を比較した.
主要な成果:
- 持続的なLBBBは,全因死亡率,心臓死亡率,または30日または1年の心不全入院の増加と関連しませんでした.
- LBBBグループでは30日後にペースメーカーインプラントの割合が高く見られたが,1年後にそうではなかった.
- 低インプランテーションは,LBBBグループでより頻繁でした.
結論:
- CoreValveシステムを使用したTAVI後の持続的なLBBBは,硬質の臨床エンドポイントに悪影響を及ぼしません.
- LBBBは,ペースメーカーインプラントの短期的な需要の増加と関連しています.
- また,TAVI後のLBBB患者におけるペースメーカーの依存を軽減する戦略を探求する研究も行われます.
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