心脏瓣膜替换术后瓣周漏的介入与外科治疗的比较观察  

Comparison of interventional and surgical treatment of paravalvular leak after cardiac valve replacement

作　　者：蒲俊舟 吴文辉 科雨彤 黄连军 马晓海 张纯 Pu Junzhou;Wu Wenhui;Ke Yutong;Huang Lianjun;Ma Xiaohai;Zhang Chun(Interventional Department,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院,北京市心肺血管疾病研究所介入诊疗科,北京100029 [2]首都医科大学附属北京安贞医院,北京市心肺血管疾病研究所超声心动图科,北京100029

出　　处：《中华医学杂志》2021年第16期1160-1164,共5页National Medical Journal of China

基　　金：北京市医院管理局“培育计划”项目(PX2019024)。

摘　　要：目的比较介入和外科两种治疗方式对心脏瓣膜替换术后瓣周漏的治疗效果。方法采用回顾性分析筛选自2016年1月至2019年12月在北京安贞医院因心脏瓣膜替换术后瓣周漏接受介入或外科治疗患者,对两组治疗效果以及治疗成本进行比较分析。结果连续141例患者纳入本研究,其中介入组65例患者年龄大于外科组的76例患者[(56.8±12.8)岁比(50.1±12.8)岁,t=-3.124,P=0.002]。外科组的手术成功率更高[83.1%比98.7%(χ^(²)=10.960,P<0.001)],残余分流的发生率更低(33.3%比13.3%,χ^(²)=-2.525,P=0.012),而手术时间[(93±38)min比(395±132)min,t=19.065,P<0.001],重症监护病房(ICU)使用时间[0 h比28(21,74)h,Z=-10.738,P<0.001],住院时间[7(4,10)d比21(15,25)d,Z=-8.075,P<0.001],以及住院总费用[46073(36837,52448)元比130798(104048,186188)元,Z=-10.059,P<0.001]介入组更具优势。对数据资料矫正后,介入组和外科组30 d死亡率方面差异无统计学意义。在中位21(11.5,32.0)个月的随访后,全因死亡风险介入组优于外科组(OR=0.054,95%CI:0.007~0.445,P=0.007)。结论介入和外科两种治疗方式均是瓣周漏的有效治疗手段,外科治疗的即刻效果更好,而介入治疗中期效果更令人满意,且能减少医疗费用。Objective To assess the immediate and mid-term outcomes and hospital costs of patients who underwent trans-catheter closure(TC)or surgical closure(SC)of perivalvular leakage(PVL).Methods Patients who underwent treatment of TC and SC of PVL in our center between January 2016 and December 2019 were enrolled.Baseline characteristics,procedure success,in-hospital and mid-term outcomes and hospital costs were compared.Results A total of 141 patients were enrolled(TC,n=65 and SC,n=76).The patients in TC group were elder((56.8±12.8)years vs(50.1±12.8)years,t=-3.124,P=0.002).Technical success was significant higher in the SC group(83.1%vs 98.7%,χ^(²)=10.960,P<0.001).And the residual PVLs were less in SC group(33.3%vs 13.3%,χ^(²)=-2.525,P=0.012).One patient in SC group had procedure-related death.Procedure room time((93±38)min vs(395±132)min,t=19.065,P<0.001),intensive care unit time(0 h vs 28(21,74)h,Z=-10.738,P<0.001),length of stay from hospitalization to discharge(7(4,10)days vs 21(15,25)days,Z=-8.075,P<0.001)and costs(¥46073(36837,52448)vs¥130798(104048,186188),Z=-10.059,P<0.001)were significantly less in TC group.After risk adjustment,there was no significant difference in 30 days survival between TC group and SC group.At a median follow-up of 21 months,there was a trend towards reduced all-cause death following TC versus SC(OR=0.054,95%CI:0.07 to 0.445,P=0.007).Conclusions SC for PVL is associated with higher technical rates and less residual shunt compared with TC approach.But,the shorter length of stay and lower resources use with TC group significantly reduce hospital costs.In addition,TC achieve a better mid-term results in survival.

关 键 词：心脏瓣膜疾病 心脏外科 心导管 

分 类 号：R654.2[医药卫生—外科学]