高危重度主动脉瓣狭窄经颈动脉途径行经导管主动脉瓣置换术治疗的安全性和有效性  

Safety and efficacy of transcarotid transcatheter aortic valve replacement in severe aortic valve stenosis patients

作　　者：牛冠男[1] 宋光远[1] 王墨扬[1] 张倩[1] 罗彤[1] 王旭[1] 吴永健[1] Niu Guannan;Song Guangyuan;Wang Moyang;Zhang Qian;Luo Tong;Wang Xu;Wu Yongjian(Fuwai Hospital,Peking Union Medical College,Academy of Medical Sciences,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院阜外医院

出　　处：《中华老年心脑血管病杂志》2019年第7期687-690,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：中国医学科学院医学与健康科技创新工程协同创新团队项目(2017-12M-3-002)

摘　　要：目的分析高危主动脉瓣重度狭窄患者经颈动脉途径行经导管主动脉瓣置换术(TAVR)治疗的安全性和有效性.方法选择2017年9月~2019年2月于北京阜外医院、空军军医大学西京医院、南昌大学第二附属医院、大连医科大学第一附属医院、北京医院经颈动脉途径TAVR的症状性重度主动脉瓣疾病患者21例,男性13例,年龄58~91(72.8±8.5)岁.对入选患者临床资料、手术方法及效果进行回顾性分析.结果 21例患者中,12例接受全麻手术,9例在局麻下完成手术.20例患者经右颈动脉途径TAVR,1例经左颈动脉行TAVR治疗.置入Venus A瓣膜20例,VitaFlow Ⅱ瓣膜1例.其中1例患者出现颈动脉血肿,经局部处理后,血肿吸收好转,其余患者手术过程顺利.21例患者均完成术后随访,其中2例患者出现Ⅲ度房室传导阻滞,行永久起搏器置入术.患者术后随访(30±7)d,均未发生短暂性脑缺血发作、脑卒中、血管并发症、心肌梗死、瓣周漏等不良事件.术后超声心动图显示,未见中量及以上反流;且术后1个月LVEF较术前明显改善[(61.44±6.48)% vs (51.90±13.17)%,P<0.05];术后1周和术后1个月平均跨瓣压差较术前明显下降[(14.90±8.03)mm Hg(1 mm Hg=0.133 kPa)vs (59.48±22.43)mm Hg,P<0.01;(13.11±8.45)mm Hg vs (59.48±22.43)mm Hg,P<0.01].结论对不适合行股动脉入路的患者以及主动脉瓣病变复杂,尤其是严重钙化、二叶式主动脉瓣患者、既往曾行二尖瓣瓣膜置换术的症状性重度主动脉瓣狭窄患者,实施经颈动脉途径TAVR安全有效.Objectives The purpose of this study was to assess the safety and efficacy of transcarotid transcatheter aortic valve replacement(TAVR).Methods The clinical data of 21 symptomatic severe aortic valve stenosis patients who had high or prohibitive risk for surgery and suitable for transcarotid TAVR in Fuwai hospital,Airforce medical military university Xijing hospital,The second affiliated hospital of Nanchang university,The first affiliated hospital of Dalian medical university, Beijing Hospital from September 2017 to February 2019 were retrospectively analyzed. The patients were followed up to observe the safety and efficacy of the procedure.Results There were 13 male and 8 female patients in this cohort, and age was 58-91(72.8±8.5)years old.20 patients were treated by right carotid artery approach.One patient developed carotid artery hematoncus after the procedure,and was fully recovered.Two patients were implanted with permanent pacemaker because of third degree atrioventricular block during the procedure.TAVR procedure was successful in all patients.All patients were followed up at(30±7)days after the procedure, and there were no adverse events.There was no moderate or severe paravalvular leakage.Echocardiography examination showed that LVEF was increased 1 month after the procedure(61.44%± 6.48% vs 51.90%±13.17%,P <0.05),the tranvalvular mean gradient was reduced at 1 week after procedure and one month after procedure[(14.90±8.03)mm Hg(1 mm Hg=0.133 kPa) vs (59.48±22.43)mm Hg,P <0.01,(13.11±8.45)mm Hg vs (59.48±22.43)mm Hg,P < 0.01].Conclusion Our result indicates that transcarotid TAVR is safe and effective for patients with severe aortic valve stenosis.

关 键 词：主动脉瓣狭窄 经导管主动脉瓣置换 治疗结果 经颈动脉 

分 类 号：R654.2[医药卫生—外科学]