二叶式主动脉瓣狭窄患者主动脉根部形态学特点对经导管主动脉瓣置换术瓣膜置入深度的影响  

Impact of aortic root morphology on the implantation depth of aortic valve prosthesis during trans-catheter aortic valve replacement in patients with native bicuspid aortic valve stenosis

作　　者：王墨扬[1] 宋光远[1] 王媛[1] 牛冠男[1] 张倩[1] 周政 张昊[1] 张文佳[1] 罗彤[1] 腾思勇[1] 杨跃进[1] 吴永健[1] Wang Moyang;Song Guangyuan;Wang Yuan;Niu Guannan;Zhang Qian;Zhou Zheng;Zhang Hao;Zhang Wenjia;Luo Tong;Teng Siyong;Yang Yuejin;Wu Yongjian(Coronary Intervention Center,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院冠心病中心,100037

出　　处：《中华心血管病杂志》2018年第8期629-634,共6页Chinese Journal of Cardiology

基　　金：首都临床特色应用研究基金（Z171100001017117）

摘　　要：目的 探讨二叶式主动脉瓣狭窄患者主动脉根部形态学特点对经导管主动脉瓣置换术（TAVR）中瓣膜置入深度的影响.方法 回顾性分析2014年1月至2017年10月在阜外医院采用Venus-A自膨胀式人工主动脉瓣膜行TAVR的40例二叶式主动脉瓣狭窄患者的临床资料,并将患者分为瓣膜置入未过深组（术中即刻造影图像测量的第1个人工瓣膜下缘与瓣环距离≤10 mm,29例）和瓣膜置入过深组（术中即刻造影图像测量的第1个人工瓣膜下缘与瓣环距离〉10 mm,11例）.患者均在术前检查CT,记录主动脉根部钙化、角度和径线等形态学特点,分析其对TAVR术中瓣膜置入深度及预后的影响.结果 患者年龄（75.1±5.9）岁,无嵴二叶式主动脉瓣19例（占47.5％）,带嵴二叶式主动脉瓣21例（占52.5％）.与瓣膜置入未过深组比较,瓣膜置入过深组主动脉-左心室成角更大[（56.5±4.5）°比（47.4±9.4）°,P=0.004],主动脉瓣钙化体积（HU850）〈200 mm3或〉1000 mm3的比例更高（7/11比4/29,P=0.006）,左心室流出道周长/瓣环周长更大[（109.2±7.5）％比（101.5±6.5）％,P=0.004].住院期间,瓣膜置入过深组患者新发束支传导阻滞或房室传导阻滞比例高于瓣膜置入未过深组（6/11比2/29,P=0.030）.术前瓣膜置入过深组与瓣膜置入未过深组患者的左心室射血分数差异无统计学意义[（49.9±8.9）％比（55.8±10.4）％,P=0.117],术后30 d瓣膜置入过深组患者的左心室射血分数低于瓣膜置入未过深组[（51.6±12.8）％比（60.9±8.1）％,P=0.020].结论 二叶式主动脉瓣狭窄患者的主动脉根部形态特点与TAVR术中瓣膜置入深度有一定关系,并可能影响术后心脏传导系统及左心室功能.Objective To investigate the impact of aortic root morphology on the implantation depth of aortic valve prosthesis during trans-catheter aortic valve replacement （TAVR） in bicuspid aortic valve patients. Methods Clinical data of 40 patients with native bicuspid aortic valve stenosis who underwent TAVR using the self-expandable prosthesis （the Venus A-valve） from 2014 to 2017 in Fuwai Hospital was retrospectively analyzed. The patients were divided into non-deep implantation group （implant depth ≤10 mm by instant angiogram after implantation,29 cases） and deep implantation group （implant depth〉 10 mm by instant angiogram after implantation, 11 cases）. Pre-procedural aortic root characteristics （e. g. calcification, angle and dimensions） were assessed by CT. The impact of aortic root morphology on the implantation depth and clinical outcomes were also evaluated. Results The age was （75.1±5.9） years with equal representation from the raphe-type and non-raphe type （52.5%（21/40） and 47.5%（19±40））.The bigger aorta angle （（56.5±4.5）° vs. （47.4±9.4）°, P=0.004）,more frequent mild-calcification （HUB50, 〈200 mm3） or severe-ealcification（HU850, 〉 1 000 mm3） of aortic leaflets （7/11 vs. 4/29, P=0.006）, as well as higher ratio of left ventricular outflow tract perimeter to annulus perimeter （（109.2±7.5）% vs. （101.5±6.5）%, P=0.004） were fimnd in the deep implantation group compared to the non-deep implantation group. The new in-hospital onset of bundle-branchheart-block or atrioventricular block conduction disturbance rate was higher in the deep implantation group than in the non-deep implantation group （6/11 vs. 2/29, P=0.030）.Left ventricular ejection fraction was similar between deep implantation group and non-deep implantation group at baseline （（49.9±8.9）% vs. （55.8±10.4）%, P=0.117）, and was significantly lower in the deep implantation group than in the non-deep implantation group at 30 days after implantation （（51

关 键 词：主动脉瓣狭窄 预后 经导管主动脉瓣置换术 

分 类 号：R654.2[医药卫生—外科学]