使用左心室导丝起搏技术行经导管主动脉瓣置换术  

Left ventricular guidewire pacing during transcatheter aortic valve replacement

作　　者：宋光远[1] 刘新民[1,2] 滕思勇[1] 罗彤[1] 王墨扬[1] 王宇彬[1] 周政[1] 牛冠男 钱杰[1] 吴永健[1] Song Guangyuan;Liu Xinmin;Teng Siyong;Luo Tong;Wang Moyang;Wang Yubin;Zhou Zheng;Niu Guannan;Qian Jie;Wu Yongjian(Structure Heart Disease Center,Fuwai Hospital,National Center for Cardiovascular Disease,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结构性心脏病中心,100037 [2]首都医科大学附属北京安贞医院国家心血管疾病临床医学研究中心,100029

出　　处：《中华心血管病杂志》2021年第5期461-466,共6页Chinese Journal of Cardiology

基　　金：中国医学科学院医学与健康科技创新工程(2017-12M-3-002)。

摘　　要：目的:总结经导管主动脉瓣置换术(TAVR)中应用左心室导丝起搏技术的初步经验。方法:本研究为回顾性研究。收集2019年10至12月于中国医学科学院阜外医院应用左心室导丝起搏技术行TAVR治疗的患者13例。收集患者的临床资料、手术操作,术中密切观察血压、心电图变化,行升主动脉造影评估瓣膜释放后主动脉瓣反流情况,记录院内和出院3个月随访期间主要心脏不良事件的发生情况。结果:本研究共纳入13例患者,其中男性7例,年龄为(73.8±8.3)岁 。13例患者中三叶式主动脉瓣9例,二叶式主动脉瓣3例,主动脉瓣人工生物瓣置换术后1例。所有患者均在左心室导丝起搏下完成球囊扩张和瓣膜释放,球囊扩张时,以180次/min起搏后,血压均能降至60 mmHg(1 mmHg=0.133 kPa)以下;瓣膜释放过程顺利,位置稳定。升主动脉造影结果显示,瓣膜释放后无反流7例,轻度反流5例,中度反流1例。术中有3例患者因三度房室传导阻滞经股静脉置入临时起搏导线,其中1例住院期间置入永久起搏器,另外2例术后24 h内传导恢复。另有1例患者,术中心电图无明显变化,术后10 d出现三度房室传导阻滞,置入永久起搏器。其余10例患者均在术后24 h开始进行床旁活动、康复训练。住院及出院3个月随访期间无死亡、心肌梗死、卒中等主要心脏不良事件发生。 结论:TAVR中使用左心室导丝起搏是安全、可行的。Objective To investigate the safety and efficacy of left ventricular guidewire pacing during transcatheter aortic valve replacement(TAVR).Methods This is a retrospective study.Thirteen patients,who underwent TAVR with left ventricular guidewire pacing from October 2019 to December 2019 in Fuwai Hospital,were included.Clinical data and operational procedure data of the patients were collected.Changes in blood pressure and electrocardiogram were observed during operations.Ascending aorta angiography was performed to evaluate the regurgitation of aortic valve after valve implantion.The incidence of major adverse cardiac events during hospitalization and at 3-months after discharge was recorded.Results There were 7 male and 6 female patients in this cohort,and age was(73.8±8.3)years old.Among the 13 patients,9 were tricuspid aortic valves,3 were bicuspid aortic valves,and 1 was degenerated bioprosthetic surgical aortic valve.TAVR were successfully performed in all of the 13 cases using pacing through the left ventricular guidewire.During balloon dilation,the blood pressure decreased to below 60 mmHg(1 mmHg=0.133 kPa)after 180 beats/min pacing,and the valve release process was smooth and the position was stable.The results of aortography showed that there was no regurgitation in 7 cases,mild regurgitation in 5 cases and moderate regurgitation in 1 case.Three patients required temporary pacing during the procedure due to complete heart block,among whom 1 patient was implanted with permanent pacemaker during hospitalization,and the other 2 patients recovered within 24 hours after operation.In another case,there was no significant change of electrocardiogram during the operation,and complete heart block occurred 10 days after the operation,and treated with permanent pacemaker.The other 10 patients began to carry out bedside activities and rehabilitation training 24 hours after operation.There was no death,myocardial infarction,stroke and other major adverse cardiac events during hospitalization and at 3-month follow-up

关 键 词：心脏瓣膜假体植入 心脏瓣膜 人工 左心室导丝起搏技术 经导管主动脉瓣置换术 

分 类 号：R654.2[医药卫生—外科学]