通过计算机断层扫描预测经导管主动脉瓣置换术后起搏器的需求。

Sarah Verhemel, Rutger-Jan Nuis, Mark van den Dorpel, Rik Adrichem, Mauricio Felippi de Sá Marchi, Alexander Hirsch, Joost Daemen, Ricardo P J Budde, Nicolas M Van Mieghem
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引用次数: 0

摘要

经导管主动脉瓣置换术(TAVR)是重度主动脉瓣狭窄(AS)老年患者的首选治疗方法,并越来越多地用于年轻患者,具有良好的安全性和有效性。然而,心脏传导异常仍是 TAVR 术后的常见并发症,从相对良性的室间传导延迟到预后相关的左束支传导阻滞和需要植入永久起搏器(PPI)的完全性房室传导阻滞。虽然临床、手术和心电图因素已被确定为这一并发症的预测因素,但仍需要先进的策略来控制传导缺陷的负担,尤其是在 TAVR 向年轻人群转移的过程中。这篇最新技术综述强调了对主动脉根部进行心电图同步计算机断层扫描(CTA)评估的价值,以更好地了解和处理 TAVR 术后的传导问题。本文提供了与传导问题相关的 CTA 衍生解剖特征的最新信息,并辅以计算框架建模。这种由 CTA 导出的三维解剖重建工具可生成针对特定患者的 TAVR 模拟,使操作人员能够调整手术策略和植入技术,以降低传导异常风险。
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Computed tomography to predict pacemaker need after transcatheter aortic valve replacement.

Transcatheter aortic valve replacement (TAVR) is preferred therapy for elderly patients with severe aortic stenosis (AS) and increasingly used in younger patient populations with good safety and efficacy outcomes. However, cardiac conduction abnormalities remain a frequent complication after TAVR ranging from relative benign interventriculair conduction delays to prognostically relevant left bundle branch block and complete atrio-ventricular (AV) block requiring permanent pacemaker implantation (PPI). Although clinical, procedural and electrocardiographic factors have been identified as predictors of this complication, there is a need for advanced strategies to control the burden of conduction defects particularly as TAVR shifts towards younger populations. This state of the art review highlights the value of ECG-synchronized computed tomographic angiography (CTA) evaluation of the aortic root to better understand and manage conduction problems post-TAVR. An update on CTA derived anatomic features related to conduction issues is provided and complemented with computational framework modelling. This CTA-derived 3-dimensional anatomical reconstruction tool generates patient-specific TAVR simulations enabling operators to adapt procedural strategy and implantation technique to mitigate conduction abnormality risks.

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