经导管主动脉瓣置换术中自膨式瓣膜支架释放预测与实际投照角度的差异性分析  

The dif ference between the prediction of self-expandable valve stent and the actual projection angle in transcatheter aortic valve replacement

作　　者：郑胜能 李捷[1] 谈文开[1] 李光[1] 范瑞新[1] 罗建方 ZHENG Sheng-neng;LI Jie;TAN Wen-kai;LI Guang;FAN Rui-xin;LUO Jian-fang(Department of Cardiology,Guangdong Provincial People’s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China)

机构地区：[1]广东省人民医院医院血管病诊疗中心广东省医学科学院

出　　处：《中国介入心脏病学杂志》2019年第12期679-684,共6页Chinese Journal of Interventional Cardiology

摘　　要：目的探讨经导管主动脉瓣置换术(TAVR)术前应用多层计算机断层摄影(MSCT)预测投照角度与术中实际投照角度的差异,总结TAVR术中自膨式瓣膜支架释放的最佳投照角度的经验。方法回顾性分析2016年4月至2018年6月因有严重症状的主动脉瓣狭窄在广东省人民医院接受TAVR治疗的38例患者。收集基线资料、术前评估、手术情况。比较自膨式瓣膜支架释放的预测投照角度与术中实际投照角度的差异,以患者左右为横轴,头尾为纵轴。定义预测投照角度与术中实际投照角度的差异超过10°为有差异。定义预测投照角度与术中实际投照角度横轴和纵轴差异均有统计学意义为完全不相同,横轴或纵轴差异均无统计学意义为完全相同。结果预测投照角度与实际投照角度完全相同有14例(36.8%),完全不相同共13例(34.2%)。其中完全相同患者均为三叶式主动脉瓣且无横位心,而完全不相同患者均为为二叶式主动脉瓣且横位心。进一步对患者预测投照角度与术中实际投照角度进行配对样本t检验,发现两者横轴上差异无统计学意义[(8.18°±14.68°)比(9.18°±11.25°),P=0.712],而实际投照角度与预测投照角度在纵轴上差异有统计学意义[(–17.05°±11.56°)比(–6.58°±15.17°),P<0.001],较预测投照角度向足位偏移。结论实现TAVR中自膨式瓣膜支架的精准定位时,应当考虑个体化差异(瓣叶分型和是否横位心)和自膨式瓣膜支架因输送系统回直力造成与预测基线偏移且顺应性较差难以调整的特点,在瓣膜支架释放的最佳投照角度的预测和选择时进行适当的角度补偿,有助于完善TAVR术前评估准备工作,并提高手术成功率。Objective To discuss the difference between the actual projection angle in transcatheter aortic valve replacement(TAVR) and the predictive angle before the operation based on multi-slice computed tomography(MSCT), and to summarize the experience of the optimal projection angle for the release of selfexpanding valve stent in TAVR. Methods This study retrospectively enrolled 38 severe aortic valve stenosis patients who underwent TAVR in Guangdong General Hospital from April 2016 to June 2018. The baseline characteristics,preoperative assessment and surgery details were collected and analyzed. The left and right axis of the patient was defi ned as X axis and the head and tail was Y axis. The dif ference was defi ned as signifi cance when the projection angle subtracted the actual intraoperative projection angle is more than ±10 degrees. When there were not X axis nor Y axis dif ferent between two angles, it is defi ned as equality. While both X axis and Y axis showed dif ferent, it is defi ned as inequality. Results The dif ference between the predictive projection angle and the actual projection angle of each patient were analyzed. It was found exactly the same in 14 cases(36.8%) were tricuspid valves without horizocardia, completely dif ferent a total of 13 cases(34.2%) of two lobe and horizocardia. The relationship between the actual projection angle and the projection angle was further examined by the paired sample t test. There was no signifi cant dif ference in the horizontal axis[(8.18±14.68)degrees vs.(9.18±11.25)degrees,P=0.712]. The actual projection angle shifted from the projection angle to the tail position on the longitudinal axis, and the dif ference was statistically signifi cant[(-17.05±11.56)degrees vs. (-6.58±15.17)degrees,P<0.001]. Conclusions When the precision positioning of the self-expanding valve stent is realized, it is necessary to consider the characteristics of individualized discrepancies(valve classification and horizocardia) and the selfexpanding valve stent which is caused by th

关 键 词：经导管主动脉瓣置换术 自膨式瓣膜支架 投照角度 

分 类 号：R541.4[医药卫生—心血管疾病] R654.2[医药卫生—内科学]