Investigating The Preoperative Factors Affecting The Need For Permanent Pacemaker After Transcatheter Aortic Valve Replacement (TAVR)

Background:Aortic valve disease is a heart valve disease that seriously affects the quality of life and life expectancy of patients.In the past,for severe aortic valve disease,drug conservative treatment could not significantly improve the symptoms of heart failure and quality of life.Aortic valve replacement has become the gold standard for the treatment of aortic valve disease,but for elderly patients with high-risk poor cardiac function,the surgical trauma is large,the postoperative recovery is slow,and the surgical mortality is high.After improvement and development,transcatheter aortic valve replacement has become a new choice for high-risk aortic valve surgery in the elderly.However,as a surgical treatment,the problem of atrioventricular block or the need for permanent pacemaker after TAVR is significantly higher than that of surgical aortic valve replacement.The preoperative predictors of the need for permanent pacemaker after transcatheter aortic valve replacement are only studied abroad,but rarely reported in China.Objective : By describing the patients with TAVR surgery completed by the cardiovascular surgery department of the Affiliated Hospital of Qingdao University in recent years,analyzing the influence of the patient’s previous medical history,preoperative examination and examination on the need for permanent pacemaker after TAVR,we found the preoperative predictors of the need for permanent pacemaker after TAVR,so as to provide a reference for clinicians to formulate the operation plan,determine whether permanent pacemaker is needed after TAVR and the implantation time of permanent pacemaker,In order to reduce the implantation rate of permanent pacemaker after TAVR,so as to further develop TAVR surgery.Methods:Through a retrospective case-control study,73 patients who underwent TAVR in the Department of cardiovascular surgery of the Affiliated Hospital of Qingdao University from September 2017 to April 2021 were included.Their medical history,preoperative examination and examination data,whether there was permanent pacemaker implantation during hospitalization,and the time and reason of implantation were collected,Through the follow-up data in the electronic medical record system or telephone follow-up,we can understand whether the patient has permanent pacemaker implantation and the reason and time of pacemaker implantation after discharge,and establish a database.Using SPSS statistical software,after the normality test of the measurement data,use the independent sample t-test or Mann Whitney U-test,and use the chi square test for the counting data to conduct binary logistic regression analysis to test the independent influence of each factor.For meaningful measurement data,ROC curve can be established,and the best intercept value can be selected according to yoden index.Results:In the 73 study population,the pacemaker implantation rate after TAVR was20.5%;86.7% of patients implanted permanent pacemaker within 1 week after operation.In the pacemaker implantation group and the non pacemaker implantation group,By univariate analysis,age(76.93 ± 3.56 vs 74.26 ± 6.34,p=0.037),valve oversize rate(p=0.002),balloon size(p=0.037),preoperative complete right bundle branch block(40.0% vs 5.2%,p=0.001)and aortic valve calcification(p=0.008)were significantly different.Binary logistic regression analysis showed that preoperative complete right bundle branch block(or 16.598,95% CI [1.765156.07],P = 0.014),severe aortic valve calcification(or 7.205,95% CI [1.387,37.429],P = 0.019)and valve oversize(or1.117,95% CI [1.017,1.227],P = 0.021)were the influencing factors and risk factors of the need for permanent pacemaker after TAVR.After regression analysis,age and post dilation balloon size are no longer independent factors of the need for permanent pacemaker after TAVR.The ROC curve is established by measuring the valve oversize rate.According to the yoden index,the best interception value is 8.75%.When the valve oversize rate was converted into two categories with 8.75% as the boundary value,the results still showed a good statistical difference(P = 0.001).Conclusion:Based on the case data of our center,it can be considered that preoperative complete right bundle branch block,severe aortic valve calcification and valve oversize rate are the independent influencing factors of the need for permanent pacemaker after TAVR;Age and post dilation balloon size may be related to the need for permanent pacemaker after TAVR,but they cannot be determined as independent factors.