In recent years, transcatheter aortic valve replacement (TAVR) has developed rapidly in China, and the number and quality of operations have increased significantly. TAVR has become an important treatment strategy for patients with severe aortic stenosis and regurgitation following surgical aortic valve replacement. Prosthesis-patient mismatch (PPM) is one of the main complications after TAVR, but the incidence of TAVR-related PPM is significantly lower than surgical aortic valve replacement. Most studies believe that PPM has no significant effect on the clinical prognosis of most patients after TAVR, and only increases postoperative mortality in a specific population. This article will review the incidence, influencing factors, impact on clinical prognosis and related coping strategies of PPM after TAVR.
ObjectiveTo analyze the impact of balloon post-dilation on cardiac conduction in patients undergoing transcatheter aortic valve replacement (TAVR). MethodsFrom June 2021 to December 2022, patients with severe aortic valve stenosis or regurgitation who underwent TAVR surgery using domestically produced valves at Xijing Hospital, Air Force Military Medical University were selected. The occurrence of intraoperative and postoperative cardiac conduction block was recorded. According to whether balloon post-dilation was performed during the surgery, patients were divided into the post-dilation group and the non-post-dilation group. The baseline data, postoperative cardiac conduction block occurrence, and cardiac function of the two groups were analyzed. ResultsA total of 126 patients were included, including 83 males and 43 females, with an average age of 66.6±7.6 years. There were 30 patients in the post-dilation group and 96 patients in the non-post-dilation group. On the first day after TAVR, the average QRS intervals in the post-dilation group and the non-post-dilation group were 105.6±13.8 ms and 125.9±28.2 ms, respectively (P=0.017). At discharge, the average PR intervals in the two groups were 168.7±36.8 ms and 192.1±44.2 ms, respectively (P=0.024). After TAVR, 9 (7.1%) patients developed new atrioventricular block, 5 (4.0%) patients developed complete right bundle branch block, and 33 (26.2%) patients developed complete left bundle branch block. During hospitalization, 2 (1.6%) patients received permanent cardiac pacemakers, both of whom were in the non-post-dilation group. There was no statistical difference in postoperative left ventricular structure and function between the two groups (P>0.05). ConclusionPostoperative expansion using domestically produced interventional valves for TAVR do not increase the incidence of early atrioventricular block and permanent cardiac pacemaker implantation after valve implantation, and there are no significant changes in cardiac structure and function in patients with conduction block in the short term after surgery.