RESUMO
Objective To investigate the baseline clinical characteristics,ascending aortic root anatomical characteristics,and related factors of the surgical strategy of patients with new-onset conduction disturbance(NOCD)after transcatheter aortic valve replacement(TAVR)with self-expanding valve(SEV)implantation.Methods A retrospective study was conducted on 245 patients who underwent TAVR at the Xiamen Cardiovascular Hospital Xiamen University between December 2014 and November 2022.According to the inclusion and exclusion criteria,167 patients with SEV implantation during surgery were continuously included.They were divided into tricuspid aortic valve group(TAV group,113 cases)and bicuspid aortic valve group(BAV group,54 cases)according to aortic valve morphology.The TAV group was divided into NOCD group(43 cases)and non NOCD group(70 cases)according to postoperative electrocardiogram characteristics.The BAV group was divided into NOCD group(16 cases)and non NOCD group(38 cases).Collect clinical data such as preoperative electrocardiogram and ascending aortic root CT angiography from patients.Results The right-non valvular calcification quantification(P=0.005)in the non-NOCD group was significantly greater than that in the NOCD group,but the aortic angle(P=0.002)was smaller in TAV patients.Multivariate analysis suggested that the risk of NOCD after TAVR is reduced by 2.6％for every 10 mm3 increase in right-non valvular calcification in patients(OR 0.974,P=0.039),the risk of postoperative NOCD nearly 7.3％for every degree increase in aortic angulation(OR 1.073,P=0.003).In BAV patients the increase of the risk of NOCD after TAVR is nearly 3.3％for every l ms increase in preoperative PR interval(OR 1.033,P=0.041),the risk of NOCD is reduced by 6.6％for every 10 mm3 increase in calcification quantification in the right coronary valve area(OR 0.934,P=0.013).Conclusions In TAV patient,right-non valvular calcification may have a protective effect on the cardiac conduction system,but a larger aortic angle increases the risk of NOCD.In BAV patients,a longer preoperative PR interval is a risk factor for NOCD,and the right coronary valve area may protect the cardiac conduction system.
RESUMO
Objective To explore the clinical features of acute myocardial infarction(AMI) caused by left main coronary artery(LMCA)sudden total occlusion and to investigate the clinical efficacy of percutaneous coronary intervention(PCI). Methods A retrospective analysis was carried out and patients with AMI due to LMCA sudden occlusion proved by emergency coronary angiography in General Hospital of DaQing Oil Field between 2000 and 2016 were included. The patients were divided into the survival group and the deceased group. The clinical condition during hospitalization were compared. All in survived cases were followed up by telephone or at out-patient clinic. Results Among 1281 emergency coronary angiography cases,15 patients were proved to have LMCA sudden occlusion and 13 of them received PCI. 6 patients died during hospitalization and the in-hospital mortality rate was 46.2％(6/13). Among the 9 patients who received direct PCI ,5 of them died(55.6％);while 4 patients had elective PCI ,1 patient of them died(25％). Three out of the 4 patients who presented TIMI grade 3 flow died. Among the 9 patients who had TIMI grade 1～2 flow,3 patients died. Eight patients received deal anti-platelet therapy with clopidogrel and aspirin after PCI,and among them,4 patients died. Among the 5 given ticagrelor,2 patients died. During the follow-up period. 1 patient died of cardiogenic shock,2 patients had recurrent angina and 1 patient required elective PCI to the RCA. Conclusions The morality of LMCA sudden total occlusion was significantly high. Successful PCI may be feasible to these patients,while the major adverse cardiovascular events(MACE)occurrence during long-term follow-up period remained high.
