经导管主动脉瓣置换术入路及血管并发症的研究现状  

Current status of accesses and vascular complications of transcatheter aortic valve replacement

作　　者：王昌进 罗淞元[1] 李捷[1] WANG Changjin;LUO Songyuan;LI Jie(Department of Cardiovascular Medicine,Guangdong General Hospital,Guangzhou,Guangdong 510080,P.R.China)

机构地区：[1]广东省人民医院心血管内科,广州510080

出　　处：《华西医学》2021年第9期1177-1183,共7页West China Medical Journal

基　　金：广东省心血管系统疾病临床医学研究中心(2020B1111170011)。

摘　　要：经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)逐渐成为治疗重度主动脉瓣狭窄的主要治疗方式。TAVR最常用的入路为股动脉,其他入路包括心尖、主动脉、锁骨下动脉、颈动脉、腔静脉,可根据入路血管直径与器械外径、血管扭曲情况、血管壁钙化情况选择最佳入路。血管并发症是TAVR最为常见的并发症,与不良结局和预后密切相关,其发生与术者、患者、手术器械等多种因素相关。可以通过瓣膜类型的选择及入路的选择、术前详细的影像学评估及改善患者的基础疾病情况降低血管并发症的发生风险,并根据血管并发症的严重程度选择保守或手术治疗。Transcatheter aortic valve replacement(TAVR)has become an increasingly important therapy option for patients with severe aortic stenosis who are not suitable for traditional aortic valve surgery.Transfemoral access remains the most utilized and preferred route for TAVR.Several alternative routes exist,including transapical,direct aortic,axillary-subclavian,transcarotid,and transcaval accesses.Many factors will be taken into account when operators determine the best vascular access,such as diameters of the access and sheater,valve size,calcification,and tortuosity.Vascular complications are the most common complications of TAVR,which are closely related to the adverse outcome and prognosis,and their occurrences are related to many factors,including the surgeon’s experience,the patient-associated factors,and the device-associated factors.The risk of vascular complications can be reduced through the choice of valve type and vascular approach,detailed preoperative imaging evaluation,and improvement of the patient’s baseline disease.It is suitable to determine whether conservative treatment or reintervention will be chosen according to the severity of the complications.

关 键 词：经导管主动脉瓣置换术 血管入路 血管并发症 

分 类 号：R654.2[医药卫生—外科学]