Marie Claes, Francesco Pollari, Hazem Mamdooh, Theodor Fischlein
{"title":"AVR术后房室传导阻滞的基线ct危险因素。","authors":"Marie Claes, Francesco Pollari, Hazem Mamdooh, Theodor Fischlein","doi":"10.1055/a-2052-8848","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong> We aimed to evaluate the impact of membranous interventricular septum (MIS) length and calcifications of the native aortic valve (AV), via preoperative multidetector computed tomography (MDCT) scan, on postoperative atrioventricular block III (AVB/AVB III) and permanent pacemaker implantation in surgical aortic valve replacement (SAVR).</p><p><strong>Methods: </strong> We retrospectively analyzed preoperative contrast-enhanced MDCT scans and procedural outcomes of patients affected by AV stenosis who underwent SAVR at our center (June 2016-December 2019). The study population was divided into two groups (AVB and non-AVB), and variables were compared with a Mann-Whitney's <i>U</i>-test or chi-square test. Data were further analyzed using point biserial correlation and logistic regression.</p><p><strong>Results: </strong> A total of 155 (38% female) patients (mean age of 71.2 ± 6 years) were enrolled in our study: conventional stented bioprosthesis (<i>N</i> = 99) and sutureless prosthesis (<i>N</i> = 56) were implanted. A postoperative AVB III was observed in 11 patients (7.1%). AVB patients had significant greater calcifications in left coronary cusp (LCC) -AV (non-AVB = 181.0 mm<sup>3</sup> [82.7-316.9] vs. AVB = 424.8 mm<sup>3</sup> [115.9-563.2], <i>p</i> = 0.044), LCC left ventricular outflow tract (LVOT) (non-AVB = 2.1 mm<sup>3</sup> [0-20.1] vs. AVB = 26.0 mm<sup>3</sup> [0.1-138.0], <i>p</i> = 0.048), right coronary cusp (RCC) -LVOT (non-AVB = 0 mm<sup>3</sup> [0-3.5] vs. AVB = 2.8 mm<sup>3</sup> [0-29.0], <i>p</i> = 0.039), and consequently in total LVOT (non-AVB = 2.1 mm<sup>3</sup> [0-20.1] vs. AVB = 26.0 mm<sup>3</sup> [0.1-138.0], <i>p</i> = 0.02), while their MIS was significantly shorter than in non-AVB patients (non-AVB = 11.3 mm [9.9-13.4] vs. AVB = 9.44 mm [6.98-10.5]; <i>p</i>=0.014)). Partially, these group differences correlated positively (LCC -AV, <i>r</i> = 0.201, <i>p</i> = 0.012; RCC -LVOT, <i>r</i> = 0.283, <i>p</i> ≤ 0.001) or negatively (MIS length, <i>r</i> = -0.202, <i>p</i> = 0.008) with new-onset AVB III.</p><p><strong>Conclusion: </strong> We recommend including an MDCT in preoperative diagnostic testing for all patients undergoing surgical AVR for further risk stratification.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"117-125"},"PeriodicalIF":1.3000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Baseline CT-Based Risk Factors for Atrioventricular Block after Surgical AVR.\",\"authors\":\"Marie Claes, Francesco Pollari, Hazem Mamdooh, Theodor Fischlein\",\"doi\":\"10.1055/a-2052-8848\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong> We aimed to evaluate the impact of membranous interventricular septum (MIS) length and calcifications of the native aortic valve (AV), via preoperative multidetector computed tomography (MDCT) scan, on postoperative atrioventricular block III (AVB/AVB III) and permanent pacemaker implantation in surgical aortic valve replacement (SAVR).</p><p><strong>Methods: </strong> We retrospectively analyzed preoperative contrast-enhanced MDCT scans and procedural outcomes of patients affected by AV stenosis who underwent SAVR at our center (June 2016-December 2019). The study population was divided into two groups (AVB and non-AVB), and variables were compared with a Mann-Whitney's <i>U</i>-test or chi-square test. Data were further analyzed using point biserial correlation and logistic regression.</p><p><strong>Results: </strong> A total of 155 (38% female) patients (mean age of 71.2 ± 6 years) were enrolled in our study: conventional stented bioprosthesis (<i>N</i> = 99) and sutureless prosthesis (<i>N</i> = 56) were implanted. A postoperative AVB III was observed in 11 patients (7.1%). AVB patients had significant greater calcifications in left coronary cusp (LCC) -AV (non-AVB = 181.0 mm<sup>3</sup> [82.7-316.9] vs. AVB = 424.8 mm<sup>3</sup> [115.9-563.2], <i>p</i> = 0.044), LCC left ventricular outflow tract (LVOT) (non-AVB = 2.1 mm<sup>3</sup> [0-20.1] vs. AVB = 26.0 mm<sup>3</sup> [0.1-138.0], <i>p</i> = 0.048), right coronary cusp (RCC) -LVOT (non-AVB = 0 mm<sup>3</sup> [0-3.5] vs. AVB = 2.8 mm<sup>3</sup> [0-29.0], <i>p</i> = 0.039), and consequently in total LVOT (non-AVB = 2.1 mm<sup>3</sup> [0-20.1] vs. AVB = 26.0 mm<sup>3</sup> [0.1-138.0], <i>p</i> = 0.02), while their MIS was significantly shorter than in non-AVB patients (non-AVB = 11.3 mm [9.9-13.4] vs. AVB = 9.44 mm [6.98-10.5]; <i>p</i>=0.014)). Partially, these group differences correlated positively (LCC -AV, <i>r</i> = 0.201, <i>p</i> = 0.012; RCC -LVOT, <i>r</i> = 0.283, <i>p</i> ≤ 0.001) or negatively (MIS length, <i>r</i> = -0.202, <i>p</i> = 0.008) with new-onset AVB III.</p><p><strong>Conclusion: </strong> We recommend including an MDCT in preoperative diagnostic testing for all patients undergoing surgical AVR for further risk stratification.</p>\",\"PeriodicalId\":23057,\"journal\":{\"name\":\"Thoracic and Cardiovascular Surgeon\",\"volume\":\" \",\"pages\":\"117-125\"},\"PeriodicalIF\":1.3000,\"publicationDate\":\"2025-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Thoracic and Cardiovascular Surgeon\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1055/a-2052-8848\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/3/13 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Thoracic and Cardiovascular Surgeon","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1055/a-2052-8848","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/3/13 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
背景:我们旨在通过术前多探测器计算机断层扫描(MDCT)评估膜性室间隔(MIS)长度和原生主动脉瓣(AV)钙化对手术主动脉瓣置换术(SAVR)中术后房室传导阻滞(AVB/AVB III)和永久起搏器植入的影响。方法:回顾性分析2016年6月- 2019年12月在我中心行SAVR的房室狭窄患者术前增强MDCT扫描和手术结果。研究人群分为两组(AVB组和非AVB组)，变量采用Mann-Whitney u检验或卡方检验进行比较。数据进一步分析采用点双列相关和逻辑回归。结果:共入组患者155例(女性38%)，平均年龄71.2±6岁，植入常规支架生物假体99例(N = 99)和无缝线假体56例(N = 56)。11例(7.1%)患者术后AVB为III型。真空断路患者显著更大的钙化左冠状尖端(LCC) av (non-AVB = 181.0 mm3[82.7 - -316.9]与真空断路mm3 (115.9 - -563.2) = 424.8, p = 0.044), LCC左心室流出道(LVOT) (non-AVB = 2.1 mm3[0 - 20.1]与真空断路mm3 (0.1 - -138.0) = 26.0, p = 0.048),右冠状尖端(RCC) -LVOT (non-AVB = 0 mm3[0 - 3.5]与真空断路mm3 [0 - 29.0) = 2.8, p = 0.039),因此总共LVOT (non-AVB = 2.1 mm3[0 - 20.1]与真空断路mm3 (0.1 - -138.0) = 26.0, p = 0.02),非AVB = 11.3 mm [9.9 ~ 13.4] vs. AVB = 9.44 mm [6.98 ~ 10.5];p = 0.014)。部分组间差异正相关(LCC -AV, r = 0.201, p = 0.012;RCC -LVOT, r = 0.283, p≤0.001)或阴性(MIS长度，r = -0.202, p = 0.008)伴新发AVB III。结论:我们建议在所有接受外科AVR的患者的术前诊断检查中包括多层螺旋ct检查，以进一步进行风险分层。
Baseline CT-Based Risk Factors for Atrioventricular Block after Surgical AVR.
Background: We aimed to evaluate the impact of membranous interventricular septum (MIS) length and calcifications of the native aortic valve (AV), via preoperative multidetector computed tomography (MDCT) scan, on postoperative atrioventricular block III (AVB/AVB III) and permanent pacemaker implantation in surgical aortic valve replacement (SAVR).
Methods: We retrospectively analyzed preoperative contrast-enhanced MDCT scans and procedural outcomes of patients affected by AV stenosis who underwent SAVR at our center (June 2016-December 2019). The study population was divided into two groups (AVB and non-AVB), and variables were compared with a Mann-Whitney's U-test or chi-square test. Data were further analyzed using point biserial correlation and logistic regression.
Results: A total of 155 (38% female) patients (mean age of 71.2 ± 6 years) were enrolled in our study: conventional stented bioprosthesis (N = 99) and sutureless prosthesis (N = 56) were implanted. A postoperative AVB III was observed in 11 patients (7.1%). AVB patients had significant greater calcifications in left coronary cusp (LCC) -AV (non-AVB = 181.0 mm3 [82.7-316.9] vs. AVB = 424.8 mm3 [115.9-563.2], p = 0.044), LCC left ventricular outflow tract (LVOT) (non-AVB = 2.1 mm3 [0-20.1] vs. AVB = 26.0 mm3 [0.1-138.0], p = 0.048), right coronary cusp (RCC) -LVOT (non-AVB = 0 mm3 [0-3.5] vs. AVB = 2.8 mm3 [0-29.0], p = 0.039), and consequently in total LVOT (non-AVB = 2.1 mm3 [0-20.1] vs. AVB = 26.0 mm3 [0.1-138.0], p = 0.02), while their MIS was significantly shorter than in non-AVB patients (non-AVB = 11.3 mm [9.9-13.4] vs. AVB = 9.44 mm [6.98-10.5]; p=0.014)). Partially, these group differences correlated positively (LCC -AV, r = 0.201, p = 0.012; RCC -LVOT, r = 0.283, p ≤ 0.001) or negatively (MIS length, r = -0.202, p = 0.008) with new-onset AVB III.
Conclusion: We recommend including an MDCT in preoperative diagnostic testing for all patients undergoing surgical AVR for further risk stratification.
期刊介绍：
The Thoracic and Cardiovascular Surgeon publishes articles of the highest standard from internationally recognized thoracic and cardiovascular surgeons, cardiologists, anesthesiologists, physiologists, and pathologists. This journal is an essential resource for anyone working in this field.
Original articles, short communications, reviews and important meeting announcements keep you abreast of key clinical advances, as well as providing the theoretical background of cardiovascular and thoracic surgery. Case reports are published in our Open Access companion journal The Thoracic and Cardiovascular Surgeon Reports.
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