经心尖经导管主动脉瓣置换术治疗大瓣环主动脉瓣关闭不全的有效性与安全性  

Efficacy and safety of transapical transcatheter aortic valve replacement in the treatment of aortic regurgitation in patients with large aortic annulus

作　　者：曾飞 徐臣年 金屏 马燕燕 郭红 周国磊 高伟[1] 刘洋 杨剑 ZENG Fei;XU Chennian;JIN Ping;MA Yanyan;GUO Hong;ZHOU Guolei;GAO Wei;LIU Yang;YANG Jian(Department of Cardiothoracic Surgery,Chinese Medicine Hospital,Xinjiang Medical University,Urumqi,830000,P.R.China;Department of Cardiovascular Surgery,Air Force Medical University,Xi’an,710032,P.R.China;Gansu University of Chinese Medicine,Lanzhou,730000,P.R.China)

机构地区：[1]新疆医科大学附属中医医院心胸外科,乌鲁木齐830000 [2]空军军医大学西京医院心血管外科,西安710032 [3]甘肃中医药大学,兰州730000

出　　处：《中国胸心血管外科临床杂志》2021年第7期757-764,共8页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家重点研发计划(2016YFC1101000);陕西省自然科学基础研究计划项目杰出青年科学基金(S2018-JC-15);陕西省创新能力支撑计划-科技创新团队项目(S2020-ZC-TD-0029)。

摘　　要：目的探讨经心尖途径经导管主动脉瓣置换术(TAVR)应用于大瓣环主动脉瓣关闭不全的可行性与安全性。方法选取2019年11月至2020年5月在西京医院心血管外科接受TAVR的主动脉瓣关闭不全患者10例,均为男性,平均年龄(64.50±4.20)岁;采用29^(#)J-valve^(TM)瓣膜(苏州杰成医疗科技有限公司,中国)并进行瓣膜改良,血管造影下行TAVR,通过比较患者行TAVR前后超声、CT测量结果,总结患者术前术后心功能、瓣膜反流量、并发症情况、左心室重塑情况等。结果10例患者共植入10枚瓣膜,其中1例患者术中瓣膜移位至主动脉弓部,急诊转行经胸主动脉瓣置换术;余9例成功植入瓣膜,术后心功能分级(NYHA)Ⅱ级6例,Ⅲ级4例。左室射血分数(44.70%±8.78%vs.39.80%±8.48%,P<0.05)、主动脉瓣反流量[(1.75±0.72)mL vs.(16.51±8.71)mL,P<0.05]术前和术后差异均有统计学意义。3个月后常规复查超声,患者心功能状况良好。结论采用Jvalve^(TM)治疗以主动脉瓣关闭不全为主的大瓣环重度瓣膜病患者安全、有效。Objective To investigate the feasibility and safety of transcatheter aortic valve replacement(TAVR)through apical approach for aortic regurgitation of large annulus.Methods From November 2019 to May 2020,10 male patients aged 64.50±4.20 years with aortic valve insufficiency(AI)underwent TAVR in the Department of Cardiovascular Surgery,Xijing Hospital.The surgical instruments were 29^(#)J-valve^(TM) modified and the patients underwent TAVR under angiography.The preoperative and postoperative cardiac function,valve regurgitation,complications and left ventricular remodeling were summarized by ultrasound and CT before and after TAVR.Results A total of 10 valves were implanted in 10 patients.Among them,1 patient was transferred to the aortic arch during the operation and was transferred to surgical aortic valve replacement;the other 9 patients were successfully implanted with J-valve,with 6 patients of cardiac function(NYHA)classⅡ,4 patients of gradeⅢ.And there was a significant difference between preoperation and postoperation in left ventricular ejection fraction(44.70%±8.78%vs.39.80%±8.48%,P<0.05)or aortic regurgitation(1.75±0.72 mL vs.16.51±8.71 mL,P<0.05).After 3 months,the patients’cardiac function was good.Conclusion TAVR is safe and effective in the treatment of severe valvular disease with AI using J-valve.

关 键 词：经导管主动脉瓣置换术 主动脉瓣关闭不全 J-valve^(TM) 有效性 安全性 介入治疗 

分 类 号：R654.2[医药卫生—外科学]