单中心经心尖途径TAVI治疗高危主动脉瓣病变早期临床经验  

Early clinical experience of transcatheter aortic valve implantation via apical approach for high-risk aortic valve disease in single-center

作　　者：张力[1] 王平凡[1] 王枫岭[1] 李玉珍[1] 刘海霞[1] 刘建华[1] 刘旭平[1] 肖长波[1] 高夏[1] 武刚[1] 张向辉 崔聪[1] 陈玉新 郑一[1] ZHANG Li;WANG Pingfan;WANG Fengling;LI Yuzhen;LIU Haixia;LIU Jianhua;LIU Xuping;XIAO Changbo;GAO Xia;WU Gang;ZHANG Xianghui;CUI Cong;CHEN Yuxin;ZHENG Yi(Henan Provincial Chest Hospital,Zhengzhou,450003,P.R.China)

机构地区：[1]河南省胸科医院

出　　处：《中国胸心血管外科临床杂志》2019年第12期1194-1198,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的总结通过心尖途径经导管行主动脉瓣置换术治疗高危重症主动脉瓣病变患者的临床经验并评价其早期疗效。方法回顾性分析我院2017年9月至2019年2月收治的5例通过心尖途径行经导管主动脉瓣置换术患者的临床资料,其中男3例、女2例,年龄65~84(74.6±4.5)岁。结果均采用左侧小切口进胸(3~5 cm),经心尖通过J-Valve输送系统,在数字减影血管造影下精确定位后成功释放人工主动脉瓣。1例患者手术过程突发心室颤动,紧急股动静脉插管,在体外循环辅助下完成手术;1例患者因合并冠状动脉重度狭窄病变同期先行冠状动脉介入治疗;1例患者围术期阵发心房颤动,术后出现肝肾功能不全、血小板下降,经内科治疗好转;1例患者术中出现瓣周漏,再次置入瓣膜后改善;1例患者术中平稳,术后恢复顺利。本组5例患者均手术成功,随访时间2~19个月,早期临床疗效良好。结论通过心尖途径经导管行主动脉瓣置换术治疗高危重症主动脉瓣病变患者近期临床效果确切,安全可行,但仍需进一步评价其中远期效果。Objective To summarize the clinical experience in the treatment of high-risk patients with severe aortic valve disease by transcatheter aortic valve implantation(TAVI)via heart apex approach and to evaluate the early efficacy.Method Five patients who underwent TAVI via heart apex approach from September 2017 to February 2019 in Henan Thoracic Hospital were retrospectively analyzed,including 3 males and 2 females,aged 65-84(74.6±4.5)years.Result All operations were performed through a small left incision into the thoracic cavity(3-5 cm),and then through the J-Valve transport system,the aortic valve was successfully released via heart apex after precise positioning under digital subtraction angiography.One patient developed ventricular fibrillation during the operation,and the operation was completed with the assistance of emergency femoral arteriovenous catheterization cardiopulmonary bypass;one patient underwent percutaneous coronary intervention first because of severe coronary stenosis;one patient had paroxysmal atrial fibrillation during the perioperative period,and had hepatorenal insufficiency and thrombocytopenia after the operation,and was improved after medical treatment;one patient had perivalvular leak during the operation,and was improved after re-implantation of the valve;one patient was in stable condition during operation and recovered smoothly after operation.Surgery was successful in all 5 patients.The follow-up time was 2-19 months,and the early clinical effect was good.Conclusion The short-term clinical efficacy of TAVI via heart apex approach in the treatment of high-risk severe aortic valve disease is definite and safe,but the long-term and medium-term effects need to be further evaluated.

关 键 词：主动脉瓣病变 经导管主动脉瓣置换术(TAVI) 心尖途径 高危重症 

分 类 号：R54[医药卫生—心血管疾病]