“一站式”经皮冠状动脉介入治疗+经导管主动脉瓣置换术的临床应用  

Clinical Application and Efficacy of Single-stage Percutaneous Coronary Intervention and Transcatheter Aortic Valve Replacement

作　　者：王墨扬[1] 宋光远 张倩[1] 牛冠男[1] 叶蕴青[1] 罗彤[1] 滕思勇[1] 乔树宾[1] 吴永健[1] WANG Moyang;SONG Guangyuan;ZHANG Qian;NIU Guannan;YE Yunqing;LUO Tong;TENG Siyong;QIAO Shubin;WU Yongjian(Coronary Heart Disease Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,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冠心病中心,北京市100037 [2]首都医科大学附属北京安贞医院心脏瓣膜病介入中心

出　　处：《中国循环杂志》2021年第9期846-851,共6页Chinese Circulation Journal

基　　金：国家科技支撑计划(2015BAI12B02);中国医学科学院医学与健康科技创新工程(2017-I2M-3-002)。

摘　　要：目的:总结“一站式”经皮冠状动脉介入治疗(PCI)+经导管主动脉瓣置换术(TAVR)临床应用经验。方法:回顾性分析2015年10月至2020年4月中国医学科学院阜外医院行“一站式”PCI+TAVR的合并冠状动脉狭窄的主动脉瓣重度狭窄或反流患者35例,记录术中、术后不良事件及6个月随访结果。结果:35例患者平均年龄(77.0±6.6)岁,平均心胸外科协会风险评分(6.8±2.1)%。术前平均主动脉瓣最大流速(4.6±0.8)m/s,跨瓣压差(53.4±23.0)mmHg(1 mmHg=0.133 kPa)。35例患者均进行了PCI,其中处理冠状动脉靶病变≥2处共5例,左主干病变8例,重度钙化病变予以旋磨3例,所有患者PCI过程无并发症。PCI后立即应用国产自膨胀瓣膜行TAVR,1例术中死亡,2例急诊转外科,2例置入第二个TAVR瓣膜,无术后即刻中度及以上瓣周反流,无急性冠状动脉闭塞。住院期间永久起搏器植入5例,无大出血及脑卒中发生,6个月随访全因死亡2例,无新发冠状动脉血运重建及脑卒中。二叶瓣比三叶瓣瓣叶钙化程度更为严重[(529.5±277.8)mm^(3) vs.(301.8±316.2)mm^(3),P=0.041],二叶瓣患者术中死亡、急诊转外科及瓣中瓣比例相对三叶瓣患者更高,但差异均无统计学意义(P均>0.05)。二、三叶瓣比较30 d全因死亡率、早期安全率以及6个月全因死亡率、脑卒中发生率,差异均无统计学意义(P均>0.05)。结论:在具备成熟PCI和TAVR经验的中心行“一站式”PCI+TAVR安全、有效,在二、三叶瓣患者均具有可行性。Objectives:To explore the feasibility of the single-stage percutaneous coronary intervention(PCI)combined with transcatheter aortic valve replacement(TAVR)in treating coronary artery stenosis patients complicated with severe aortic stenosis or regurgitation.Methods:Thirty-five consecutive patients,who underwent single-stage PCI+TAVR from October 2015 to April 2020,in Fuwai hospital,were retrospectively analyzed,efficacy and safety of this procedure strategy were analyzed and 6 months follow up results were summarized.Results:The mean age was(77.0±6.6)years old and there were 23 males in this cohort.The mean Society of Thoracic Surgeons(STS)risk score was(6.8±2.1)%.The mean maximum velocity of aortic valve was(4.6±0.8)m/s,the mean gradient was(53.4±23.0)mmHg(1 mmHg=0.133 kPa),mean left ventricular ejection fraction(LVEF)was(59.5±10.5)%before operation.Operation was performed under local anesthesia and sedation in 30 cases(85.7%),while general anesthesia was applied to the remaining 5 patients.Femoral artery was the main access route in 32 cases(91.4%).All the patients underwent PCI before TAVR procedure,there were 5≥2 coronary lesions,8 left main diseases,3 severe calcification treated with rotational atherectomy.Domestic self-expanding valves(Venus-A and Venus-A Plus in 28 cases,Vitaflow valves in 3 cases,Taurusone valves in 4 cases)were implanted after percutaneous coronary intervention,33 cases underwent balloon pre-dilation and 3 cases underwent post dilation.Prevalence of all-cause mortality,covert to surgery,need the second TAVR was 2.9%(n=1),5.7%(n=2),5.7%(n=2),respectively and there were no cases with paravavular leak(PVL)≥moderate,acute coronary occlusion during the procedure.Permanent pacemaker was implanted in 5 cases post procedure,no patient developed major bleeding or stroke.The mean maximum velocity of aortic valve was(2.3±0.4)m/s,the mean gradient was(13.4±9.9)mmHg and one case had PVL≥moderate at discharge.According to the composite endpoints in the Valve Academic Research Consortium-

关 键 词：经皮冠状动脉介入治疗 经导管主动脉瓣置换术 一站式 主动脉瓣狭窄 

分 类 号：R54[医药卫生—心血管疾病]