第二军医大学学报  2019, Vol. 40 Issue (8): 902-908   PDF    
引用本文
潘佳君, 唐小军, 乔帆, 陆方林, 徐志云, 李白翎. 经导管主动脉瓣置换术后心脏传导阻滞情况分析[J]. 第二军医大学学报, 2019, 40(8): 902-908  
PAN Jia-jun, TANG Xiao-jun, QIAO Fan, LU Fang-lin, XU Zhi-yun, LI Bai-ling. Cardiac conduction block after transcatheter aortic valve replacement[J]. Academic Journal of Second Military Medical University, 2019, 40(8): 902-908 (in Chinese with English abstract)  
经导管主动脉瓣置换术后心脏传导阻滞情况分析
潘佳君, 唐小军, 乔帆, 陆方林, 徐志云, 李白翎     
海军军医大学(第二军医大学)长海医院心血管外科, 上海 200433
收稿日期: 2018-10-15    接受日期: 2018-11-22
基金项目: 国家重点研发计划（2016YFC1100900）.
作者简介: 潘佳君, 硕士, 主治医师.E-mail:panjiajun82@163.com
通信作者(Corresponding author): 李白翎, Tel:021-31161761, E-mail:smmu_libailing@163.com
摘要: 目的 探讨应用国产瓣膜的经导管主动脉瓣置换（TAVR）疗效和患者术后心脏传导阻滞发生情况及其对患者预后的影响。方法 选择2017年9月至2018年1月在我科行TAVR术的重度主动脉瓣狭窄或反流患者作为研究对象。应用国产的J-Valve或Venus-A瓣膜进行TAVR术，评估TAVR术后疗效和并发症发生情况，观察TAVR术中和术后新发心脏传导阻滞发生情况及住院期间心律失常恢复情况。根据出院时是否存在心脏传导阻滞，将患者分为心律正常组和传导阻滞组，比较两组患者的基线资料、术后情况和左心室结构与功能。结果 共入组16例患者，心律正常组12例、传导阻滞组4例。TAVR术后脑钠肽[（1 114.87±802.32）pg/mL vs（530.39±276.26）pg/mL，P=0.026]、主动脉瓣跨瓣压差[（83.06±37.76）mmHg vs（24.14±9.73）mmHg，P < 0.001；1 mmHg=0.133 kPa]和主动脉瓣最大跨瓣流速[（466.00±82.30）cm/s vs（249.30±43.98）cm/s，P < 0.001]降低，左心室舒张末期内径缩小[（5.41±0.83）cm vs（4.93±0.52）cm，P=0.010]。术后无或仅有微量至少量主动脉瓣反流，2例有肾功能不全基础疾病的患者出现肾功能恶化，其中1例予以血液透析治疗。所有患者住院期间均无死亡、急性心肌梗死、脑卒中、严重血管并发症等不良事件发生。共有4例（25.00%）患者出现新发心脏传导阻滞，其中1例为完全性房室传导阻滞，住院期间恢复为完全性左束支传导阻滞；1例为室内传导阻滞，住院期间发展为完全性左束支传导阻滞；另2例为完全性左束支传导阻滞。这4例患者出院时完全性左束支传导阻滞均未恢复。无住院期间需要置入永久性心脏起搏器的患者。心律正常组和传导阻滞患者术后肝肾功能、血红蛋白水平、脑钠肽水平及左心室结构与功能上的差异均无统计学意义（P均>0.05）。结论 应用国产介入瓣膜的TAVR术能有效降低患者主动脉瓣跨瓣压差且并发症少，术后可能发生完全性左束支传导阻滞等心脏传导阻滞，但此类传导阻滞在术后短期对心脏不良事件的发生和心功能无明显影响。
关键词: 经导管主动脉瓣置换术    完全性左束支传导阻滞    起搏器置入术    左心室射血分数    
Cardiac conduction block after transcatheter aortic valve replacement
PAN Jia-jun, TANG Xiao-jun, QIAO Fan, LU Fang-lin, XU Zhi-yun, LI Bai-ling     
Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China
Supported by National Key Research and Development Plan (2016YFC1100900).
Abstract: Objective To evaluate the effectiveness of transcatheter aortic valve replacement (TAVR) using domestic valves for treating aortic valve stenosis or regurgitation, and to explore the incidence of cardiac conduction block after surgery and its influence on the prognosis of the patients. Methods The patients with severe aortic valve stenosis or regurgitation receiving TAVR surgery in our department from Sep. 2017 to Jan. 2018 were enrolled in this study. The TAVR surgery was performed with domestic valves (J-Valve or Venus-A), and the outcomes and incidence of complications were assessed after surgery. The patients were observed for the incidence of new-onset cardiac conduction block during and after TAVR and the recovery of arrhythmia during hospitalization. According to the presence of cardiac conduction block at discharge, the patients were divided into normal rhythm group and conduction block group. The baseline and postoperative characteristics, and left ventricular structure and function were compared between the two groups. Results Sixteen patients were enrolled in this study, including 12 in the normal rhythm group and 4 in the conduction block group. Brain natriuretic peptide ([1 114.87±802.32] pg/mL vs[530.39±276.26] pg/mL, P=0.026), aortic transvalvular pressure difference ([83.06±37.76] mmHg vs[24.14±9.73] mmHg, P < 0.001; 1 mmHg=0.133 kPa), maximum transvalvular velocity of aortic valve ([466.00±82.30] cm/s vs[249.30±43.98] cm/s, P < 0.001) and left ventricular end-diastolic diameters ([5.41±0.83] cm vs[4.93±0.52] cm, P=0.010) were significantly decreased after TAVR. After TAVR, there was no or only mild aortic valve regurgitation. Two patients with renal insufficiency developed deterioration of renal function, and one of whom received hemodialysis treatment. There were no death, acute myocardial infarction, stroke, or severe vascular complications during the hospitalization. A total of 4 patients (25.00%) had new-onset cardiac conduction block, including 1 patient with complete atrioventricular block who recovered to complete left bundle branch block, 1 patient with intraventricular block who progressed to complete left bundle branch block, and 2 patients with complete left bundle branch block during hospitalization. At discharge, the 4 patients still had complete left bundle branch block. There were no patients requiring permanent pacemaker implantation during the hospitalization. There were no significant differences in the postoperative liver function, renal function, hemoglobin, brain natriuretic peptide, or cardiac structure and function between normal rhythm group and conduction block group (all P>0.05). Conclusion TAVR with domestic valves can effectively reduce the aortic transvalvular pressure difference with fewer complications. It may cause complete left bundle branch block, which has no significant influence on the short-term adverse cardiac events and cardiac function after operation.
Key words: transcatheter aortic valve replacement    complete left bundle branch block    pacemaker implantation    left ventricular ejection fraction    

随着经导管主动脉瓣置换（transcatheter aortic valve replacement，TAVR）技术的成熟，TAVR术已成为越来越多不适合外科手术或高风险的主动脉瓣病变患者的选择。通过对TAVR术后的研究分析发现，房室传导阻滞（atrioventricular block，AVB）、左束支传导阻滞（center bundle branch block，LBBB）等缓慢性心律失常是TAVR术常见的并发症之一，而且有部分患者需要置入永久性心脏起搏器[1-9]。国外TAVR术中应用的人工瓣膜多为美国美敦力公司生产的CoreValve瓣膜和美国爱德华公司生产的Sapien瓣膜，近些年也有新型瓣膜研究应用被报道，但国产瓣膜资料较少。本研究旨在了解应用国产瓣膜的TAVR术的疗效和并发症情况，重点探讨术后心脏传导阻滞的发生情况及其对患者预后的影响。

1 资料和方法 1.1 研究对象

连续纳入2017年9月至2018年1月有常规外科换瓣手术禁忌证或经美国胸外科医师学会（Society of Thoracic Surgeon，STS）评分评估为高危而在我科行TAVR术的重度主动脉瓣狭窄或反流患者（术中均常规经静脉于右心室置入心脏临时起搏电极导线）。排除术前有永久性心脏起搏器置入史患者。术中应用的瓣膜为国产J-Valve瓣膜（经心尖途径，苏州杰成医疗科技有限公司生产）或Venus-A瓣膜（经动脉途径，杭州启明医疗器械股份有限公司生产）。

1.2 观察指标与分组

对行TAVR术的患者于术前、术后次日及出院前检测血常规、肝肾功能、脑钠肽水平和常规12导联心电图。在患者术前和出院前行超声心动图检查，测定心腔大小、左心室射血分数（center ventricular ejection fraction，LVEF）、主动脉瓣跨瓣压差和主动脉瓣最大跨瓣血流速度等。记录术后死亡、急性心肌梗死、脑卒中、肾功能不全、血管严重并发症等事件的发生情况。观察TAVR术中和术后新发心脏传导阻滞（包括AVB、束支传导阻滞或室内传导阻滞）发生情况及住院期间心律失常恢复情况，并根据出院时是否存在此类心脏传导阻滞将患者分为心律正常组和传导异常组，比较两组患者的基线资料、术后情况和左心室结构与功能。

1.3 统计学处理

应用SPSS 25.0软件进行统计学分析。符合正态分布的计量资料以x±s表示，非正态分布的计量资料以中位数（最小值，最大值）表示，计数资料以例数和百分数表示。计量资料的组间比较采用独立样本t检验或秩和检验，组内手术前后的比较采用配对t检验；计数资料的比较采用Fisher确切概率法。检验水准（α）为0.05。

2 结果 2.1 患者基线资料

行TAVR术患者共17例，排除1例术前有永久性心脏起搏器置入史的女性患者，共16例患者入选，其中男12例、女4例。患者基线资料见表 1。

表 1 行TAVR术患者基线资料

2.2 患者围手术期情况

16例患者中，4例经心尖置入J-Valve瓣膜，1例经颈动脉置入Venus-A瓣膜，11例经股动脉置入Venus-A瓣膜。术后共有4例（25.0%，4/16）患者出现新发心脏传导阻滞，其中1例（6.3%，1/16）于术中出现完全性AVB，术后第2天恢复，留有完全性LBBB；1例于术中出现完全性LBBB，出院时未恢复；1例于术后第5天出现完全性LBBB，出院时未恢复；1例于术中出现室内传导阻滞，后发展为完全性LBBB，出院时未恢复。无一例患者需要置入永久性心脏起搏器。

心律正常组患者应用的瓣膜为2例25 mm J-Valve、1例29 mm J-Valve、1例20 mm Venus-A、1例23 mm Venus-A、3例26 mm Venus-A和4例29 mm Venus-A，心律失常组患者应用的瓣膜为1例27 mm J-Valve、2例29 mm Venus-A和1例26 mm Venus-A。住院期间，2例有肾功能不全基础疾病的患者出现肾功能恶化，其中1例行血液透析治疗，另1例经保守治疗后好转。16例患者住院期间无死亡、急性心肌梗死、脑卒中、严重血管并发症等不良事件发生。患者围手术期肾功能及左心室结构与功能变化见表 2。与术前相比，患者术后脑钠肽水平下降[（1 114.87±802.32）pg/mL vs（530.39±276.26）pg/mL，P＝0.026]、左心室舒张末期内径缩小[（5.41±0.83）cm vs（4.93±0.52）cm，P＝0.010]、主动脉瓣跨瓣压差降低[（83.06±37.76）mmHg vs（24.14±9.73）mmHg，P＜0.001；1 mmHg＝0.133 kPa]、主动脉瓣最大流速下降[（466.00±82.30）cm/s vs（249.30±43.98）cm/s，P＜0.001]。术后患者均无主动脉瓣反流，或仅有微量至少量反流。术后患者血清肌酐无明显改变（P＝0.268）。虽然患者术后患者LVEF改善、左心室舒张末期容积减小，但与术前相比差异均无统计学意义（P均＞0.05）。

表 2 行TAVR术患者围手术期肾功能及左心室结构与功能变化

2.3 两组患者TAVR术后情况和左心室结构与功能比较

TAVR术后，心律正常组和传导异常组患者的肝、肾功能和血红蛋白水平的差异均无统计学意义（P均＞0.05），两组术后脑钠肽水平的差异也无统计学意义（P＞0.05）。在心脏超声参数方面，两组术后LVEF、左心室舒张末期内径、左心室舒张末期容积、主动脉瓣跨瓣压差、主动脉瓣最大跨瓣流速的差异均无统计学意义（P均＞0.05）。见表 3。

表 3 两组患者TAVR术后情况及左心室结构与功能比较

3 讨论

AVB、LBBB等缓慢性心律失常是TAVR术后常见并发症之一。TAVR术后LBBB新发率为11%~65%，其中置入Sapien瓣膜的患者术后LBBB新发率为4%~30.2%，而置入CoreValve瓣膜的患者则为22%~65%[1-6]。Gutiérrez等[7]发现TAVR术后LBBB从术前的9%上升为27%，在术后1个月时回落至13%。TAVR术后永久性心脏起搏器置入比例为6%~34%[8-9]。心脏起搏器的适应证主要为完全性AVB（79%），其次为病态窦房结综合征（17.3%）[10]。本研究中，TAVR术中出现1例完全性AVB（6.3%，1/16），在术后第2天恢复，留有LBBB；新发心脏传导阻滞共4例（25.0%，4/16）；无住院期间因缓慢性心律失常需要置入永久性心脏起搏器的患者。

既往研究提示TAVR术后缓慢性心律失常的出现主要与患者自身因素、手术因素和装置相关因素有关。（1）患者自身因素：患者基础情况差，为手术高危患者[11]；基础QRS波增宽[5]，尤其是合并右束支传导阻滞[12-15]；左心室流出道（center ventricular outflow tract，LVOT）内径较小[1, 16]、主动脉瓣环较小[17]等。（2）手术因素：瓣膜置入LVOT深度过深[1, 5]；低LVOT/主动脉瓣环比（＜0.89）导致置入瓣膜过大[16]；球囊预扩张[4]等。CoreValve瓣膜在LVOT中的深度与新置入心脏起搏器有关，临界值为10.1 mm（灵敏度为87.5%，特异度为74%）[15]。Sapien瓣膜心室端位置在左房室瓣前叶铰链点或铰链点以上（2.9±1.7）mm，无新发LBBB；而在铰链点以下（3.5±1.8）mm的患者，有35%出现新发LBBB[7]。（3）装置相关因素：CoreValve瓣膜术后缓慢性心律失常发生率显著高于Sapien瓣膜[12-13]，这至少部分与瓣膜的设计有关。Sapien瓣膜需要球囊膨胀，其产生的径向力主要依赖于主动脉根部组织的几何形状和硬度；CoreValve瓣膜是自膨胀瓣膜，其在LVOT的水平上产生一个连续、依赖于LVOT直径的径向力。本研究所应用的国产J-Valve瓣膜由安装在镍钛合金支架（有3个U形定位件环绕）的猪动脉瓣组成，是自膨胀瓣膜，支架和瓣膜之间有可活动的连接，当定位件已被置于主动脉窦时，瓣膜仍可调整位置。因此，瓣膜能在LVOT最合适的部位释放。且由于定位件的锚定作用，无需应用过大的瓣膜减少瓣膜脱位的风险[18-19]。这些原因共同减少了术后心律失常的发生。既往研究中，因主动脉瓣狭窄置入J-Valve瓣膜患者的永久性心脏起搏器的置入率几乎为0[18-19]，完全性LBBB发生率约为11.1%，因主动脉瓣反流置入J-Valve瓣膜患者的永久性心脏起搏器的置入率为0~9.1%[18, 20]，完全性LBBB发生率为16.7%~36.4%[18, 20]。本研究中4例置入J-Valve瓣膜的患者均无需在术后置入永久性心脏起搏器，1例（25.0%，1/4）发生完全性LBBB（患者因主动脉瓣反流而行TAVR）。Venus-A瓣膜也是一款自膨式瓣膜，其术后永久性心脏起搏器置入率为7.4%~18.8%[21-22]，而与之对照的CoreValve瓣膜术后永久性心脏起搏器置入率为37%[21]。Venus-A瓣膜较低的起搏器置入率可能与其设计有关，其锥形的流入端可以减少传导组织的受压，此外影像学上的标定点也可以促进瓣膜的精准释放。本研究中置入Venus-A瓣膜的12例患者中无永久性心脏起搏器置入，3例（25.0%，3/12）出现完全性LBBB（其中1例有一过性的完全性AVB）。

TAVR术后缓慢性心律失常对生存率的影响存有一定争议。但大部分研究发现TAVR术后新发LBBB并不影响全因或心血管死亡[2, 5-6]。TAVR术后新置入永久性心脏起搏器并不增加住院期间及术后30 d[23-24]、1年[24-26]、2年[3]的死亡率。本组患者在住院期间无死亡事件发生，远期结果有待进一步随访。

TAVR术后缓慢性心律失常对LVEF存在不良影响。TAVR术后住院期间和随访期间，无传导阻滞的患者LVEF升高，新发传导阻滞的患者LVEF降低[27]。TAVR术后新发LBBB的患者，出院后1年内LVEF降低[5]或未见明显升高[6]。TAVR术后永久性心脏起搏器的置入对患者LVEF可能也有影响[25]。U. K. TAVI（United Kingdom Transcatheter Aortic Valve Implantation）注册研究发现接受TAVR手术的患者中约36%术前存在心功能不全，其心功能多数在TAVR术后得到改善[28]。新起搏器的置入虽然不会增加因心力衰竭导致的再次住院率，但这些患者LVEF的改善低于未置入永久性心脏起搏器患者[29]，且预示了术后6个月和12个月中LVEF的降低[5, 23, 26]。从临床表现来说，心脏起搏器对左心室功能的不利影响并不影响美国纽约心脏协会（New York Heart Association，NYHA）心功能分级，可能由于大部分患者基础LVEF正常，心脏起搏器置入后患者LVEF虽轻度下降，但由于更换了主动脉瓣，对血流动力学存在有利影响。而对那些存在可能导致TAVR术后传导异常的基础情况的患者，尤其合并左心室收缩功能不全的情况下，需要仔细评估TAVR术的获益与风险。本研究中在TAVR术后无一例患者需置入永久性心脏起搏器，对传导阻滞患者和心律正常患者进行比较后发现，住院期间两组患者的术后脑钠肽水平、术后LVEF的差异均无统计学意义（P均＞0.05）。心律正常患者LVEF的升高有大于传导阻滞患者的趋势，但差异也无统计学意义（P＞0.05）。传导阻滞对心功能的影响仍需要远期随访来明确。

目前研究发现TAVR术后缓慢性心律失常多数可逆。37%~50%的LBBB患者可在术后1个月内恢复[5]。而对那些因完全性AVB置入永久性心脏起搏器的患者，分别随访79、234.2和435 d的研究均发现，大部分患者的房室结传导功能可恢复[14, 30-31]。本研究中患者LBBB在远期能否恢复有待进一步随访。

综上所述，本研究结果表明应用国产J-Valve或Venus-A瓣膜的TAVR术能有效降低主动脉瓣跨瓣压差、并发症少，术后可能导致完全性LBBB等心脏传导阻滞，但需要置入永久性心脏起搏器的比例低，安全性较好。LBBB在术后短期对心脏不良事件和心功能未见明显影响。但本研究样本量小，应用国产瓣膜行TAVR术的短期和远期疗效还有待术后长期随访。

参考文献
[1]
BAAN J Jr, YONG Z Y, KOCH K T, HENRIQUES J P, BOUMA B J, VIS M M, et al. Factors associated with cardiac conduction disorders and permanent pacemaker implantation after percutaneous aortic valve implantation with the CoreValve prosthesis[J]. Am Heart J, 2010, 159: 497-503. DOI:10.1016/j.ahj.2009.12.009
[2]
FRANZONI I, LATIB A, MAISANO F, COSTOPOULOS C, TESTA L, FIGINI F, et al. Comparison of incidence and predictors of left bundle branch block after transcatheter aortic valve implantation using the CoreValve versus the Edwards valve[J]. Am J Cardiol, 2013, 112: 554-559. DOI:10.1016/j.amjcard.2013.04.026
[3]
HOUTHUIZEN P, VAN GARSSE L A, POELS T T, DE JAEGERE P, VAN DER BOON R M, SWINKELS B M, et al. Left bundle-branch block induced by transcatheter aortic valve implantation increases risk of death[J]. Circulation, 2012, 126: 720-728. DOI:10.1161/CIRCULATIONAHA.112.101055
[4]
NUIS R J, VAN MIEGHEM N M, SCHULTZ C J, TZIKAS A, VAN DER BOON R M, MAUGENEST A M, et al. Timing and potential mechanisms of new conduction abnormalities during the implantation of the Medtronic CoreValve System in patients with aortic stenosis[J]. Eur Heart J, 2011, 32: 2067-2074. DOI:10.1093/eurheartj/ehr110
[5]
URENA M, MOK M, SERRA V, DUMONT E, NOMBELA-FRANCO L, DELAROCHELLIÈRE R, et al. Predictive factors and long-term clinical consequences of persistent left bundle branch block following transcatheter aortic valve implantation with a balloon-expandable valve[J]. J Am Coll Cardiol, 2012, 60: 1743-1752. DOI:10.1016/j.jacc.2012.07.035
[6]
NAZIF T M, WILLIAMS M R, HAHN R T, KAPADIA S, BABALIAROS V, RODÉS-CABAU J, et al. Clinical implications of new-onset left bundle branch block after transcatheter aortic valve replacement:analysis of the PARTNER experience[J]. Eur Heart J, 2014, 35: 1599-1607. DOI:10.1093/eurheartj/eht376
[7]
GUTIÉRREZ M, RODÉS-CABAU J, BAGUR R, DOYLE D, DELAROCHELLIÈRE R, BERGERON S, et al. Electrocardiographic changes and clinical outcomes after transapical aortic valve implantation[J]. Am Heart J, 2009, 158: 302-308. DOI:10.1016/j.ahj.2009.05.029
[8]
SIONTIS G C, JÜNI P, PILGRIM T, STORTECKY S, BÜLLESFELD L, MEIER B, et al. Predictors of permanent pacemaker implantation in patients with severe aortic stenosis undergoing TAVR:a meta-analysis[J]. J Am Coll Cardiol, 2014, 64: 129-140. DOI:10.1016/j.jacc.2014.04.033
[9]
GAEDE L, BLUMENSTEIN J, LIEBETRAU C, DÖRR O, KIM W K, NEF H, et al. Outcome after transvascular transcatheter aortic valve implantation in 2016[J]. Eur Heart J, 2018, 39: 667-675. DOI:10.1093/eurheartj/ehx688
[10]
NAZIF T M, DIZON J M, HAHN R T, XU K, BABALIAROS V, DOUGLAS P S, et al. Predictors and clinical outcomes of permanent pacemaker implantation after transcatheter aortic valve replacement:the PARTNER (Placement of AoRtic TraNscathetER Valves) trial and registry[J]. JACC Cardiovasc Interv, 2015, 8: 60-69.
[11]
KALAVROUZIOTIS D, LI D, BUTH K J, LÉGARÉ J F. The European System for Cardiac Operative Risk Evaluation (EuroSCORE) is not appropriate for withholding surgery in high-risk patients with aortic stenosis: a retrospective cohort study[J/OL]. J Cardiothorac Surg, 2009, 4: 32. doi: 10.1186/1749-8090-4-32.
[12]
KOOS R, MAHNKEN A H, AKTUG O, DOHMEN G, AUTSCHBACH R, MARX N, et al. Electrocardiographic and imaging predictors for permanent pacemaker requirement after transcatheter aortic valve implantation[J]. J Heart Valve Dis, 2011, 20: 83-90.
[13]
LIANG M, DEVLIN G, PASUPATI S. The incidence of transcatheter aortic valve implantation-related heart block in self-expandable Medtronic CoreValve and balloon-expandable Edwards valves[J]. J Invasive Cardiol, 2012, 24: 173-176.
[14]
ROTEN L, WENAWESER P, DELACRÉTAZ E, HELLIGE G, STORTECKY S, TANNER H, et al. Incidence and predictors of atrioventricular conduction impairment after transcatheter aortic valve implantation[J]. Am J Cardiol, 2010, 106: 1473-1480. DOI:10.1016/j.amjcard.2010.07.012
[15]
FERREIRA N D, CAEIRO D, ADÃO L, OLIVEIRA M, GONÇALVES H, RIBEIRO J, et al. Incidence and predictors of permanent pacemaker requirement after transcatheter aortic valve implantation with a self-expanding bioprosthesis[J]. Pacing Clin Electrophysiol, 2010, 33: 1364-1372. DOI:10.1111/j.1540-8159.2010.02870.x
[16]
TOUTOUZAS K, SYNETOS A, TOUSOULIS D, LATSIOS G, BRILI S, MASTROKOSTOPOULOS A, et al. Predictors for permanent pacemaker implantation after core valve implantation in patients without preexisting ECG conduction disturbances:the role of a new echocardiographic index[J]. Int J Cardiol, 2014, 172: 601-603. DOI:10.1016/j.ijcard.2014.01.091
[17]
TZAMTZIS S, VIQUERAT J, YAP J, MULLEN M J, BURRIESCI G. Numerical analysis of the radial force produced by the Medtronic-CoreValve and Edwards-SAPIEN after transcatheter aortic valve implantation (TAVI)[J]. Med Eng Phys, 2013, 35: 125-130. DOI:10.1016/j.medengphy.2012.04.009
[18]
ZHU D, CHEN Y, GUO Y, HU J, ZHANG J, WEI X, et al. Transapical transcatheter aortic valve implantation using a new second-generation TAVI system-J-ValveTM for high-risk patients with aortic valve diseases:initial results with 90-day follow-up[J]. Int J Cardiol, 2015, 199: 155-162. DOI:10.1016/j.ijcard.2015.07.037
[19]
FEI X, ELHMIDI Y, ZHANG B, TANG H, ZHU D, CHEN Y, et al. Transapical transcatheter aortic valve implantation using a new tavi system for high-risk patients with severe aortic stenosis[J/OL]. Heart Lung Circ, 2017: e67-e69. doi: 10.1016/j.hlc.2017.07.007.
[20]
WEI L, LIU H, ZHU L, YANG Y, ZHENG J, GUO K, et al. A new transcatheter aortic valve replacement system for predominant aortic regurgitation implantation of the J-Valve and early outcome[J]. JACC Cardiovasc Interv, 2015, 8: 1831-1841. DOI:10.1016/j.jcin.2015.08.021
[21]
LIAO Y B, ZHAO Z G, WEI X, XU Y N, ZUO Z L, LI Y J, et al. Transcatheter aortic valve implantation with the self-expandable Venus A-Valve and CoreValve devices:preliminary experiences in China[J]. Catheter Cardiovasc Interv, 2017, 89(S1): 528-533. DOI:10.1002/ccd.26912
[22]
宋光远, 王墨扬, 王媛, 刘先宝, 冯沅, 孔祥清, 等. Venus-A主动脉瓣膜介入治疗重度主动脉瓣狭窄的效果[J]. 中华心血管病杂志, 2017, 45: 843-847. DOI:10.3760/cma.j.issn.0253-3758.2017.10.006
[23]
URENA M, WEBB J G, TAMBURINO C, MUÑOZ-GARCÍA A J, CHEEMA A, DAGER A E, et al. Permanent pacemaker implantation after transcatheter aortic valve implantation:impact on late clinical outcomes and left ventricular function[J]. Circulation, 2014, 129: 1233-1243. DOI:10.1161/CIRCULATIONAHA.113.005479
[24]
BLACKMAN D J, BAXTER P D, GALE C P, MOAT N E, MACCARTHY P A, HILDICK-SMITH D, et al. Do outcomes from transcatheter aortic valve implantation vary according to access route and valve type? The UK TAVI Registry[J]. J Interv Cardiol, 2014, 27: 86-95. DOI:10.1111/joic.12084
[25]
BUELLESFELD L, STORTECKY S, HEG D, HAUSEN S, MUELLER R, WENAWESER P, et al. Impact of permanent pacemaker implantation on clinical outcome among patients undergoing transcatheter aortic valve implantation[J]. J Am Coll Cardiol, 2012, 60: 493-501. DOI:10.1016/j.jacc.2012.03.054
[26]
MONTEIRO C, FERRARI A D L, CARAMORI P R A, CARVALHO L A F, SIQUEIRA D A A, THIAGO L E K S, et al. Permanent pacing after transcatheter aortic valve implantation:incidence, predictors and evolution of left ventricular function[J]. Arq Bras Cardiol, 2017, 109: 550-559.
[27]
TZIKAS A, VAN DALEN B M, VAN MIEGHEM N M, GUTIERREZ-CHICO J L, NUIS R J, KAUER F, et al. Frequency of conduction abnormalities after transcatheter aortic valve implantation with the Medtronic-CoreValve and the effect on left ventricular ejection fraction[J]. Am J Cardiol, 2011, 107: 285-289. DOI:10.1016/j.amjcard.2010.09.015
[28]
MOAT N E, LUDMAN P, DE BELDER M A, BRIDGEWATER B, CUNNINGHAM A D, YOUNG C P, et al. Long-term outcomes after transcatheter aortic valve implantation in high-risk patients with severe aortic stenosis:the U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) Registry[J]. J Am Coll Cardiol, 2011, 58: 2130-2138. DOI:10.1016/j.jacc.2011.08.050
[29]
ELMARIAH S, PALACIOS I F, MCANDREW T, HUETER I, INGLESSIS I, BAKER J N, et al. Outcomes of transcatheter and surgical aortic valve replacement in high-risk patients with aortic stenosis and left ventricular dysfunction:results from the Placement of Aortic Transcatheter Valves (PARTNER) trial (cohort A)[J]. Circ Cardiovasc Interv, 2013, 6: 604-614. DOI:10.1161/CIRCINTERVENTIONS.113.000650
[30]
ERDOGAN H B, KAYALAR N, ARDAL H, OMEROGLU S N, KIRALI K, GULER M, et al. Risk factors for requirement of permanent pacemaker implantation after aortic valve replacement[J]. J Card Surg, 2006, 21: 211-215. DOI:10.1111/j.1540-8191.2006.00216.x
[31]
RUBÍN J, AVANZAS P, DEL VALLE R, MORÍS C. Long-term follow up of atrioventricular block in transcatheter aortic valve implantation[J]. Am J Cardiol, 2011, 107: 641-642.