单中心61例经导管主动脉瓣置换的结果分析  

Analysis of the results of 61 cases of transcatheter aortic valve replacement(TAVR) in a single center

作　　者：张辉[1] 张华[1] 赵建明 马伸 张瑞成[1] 朱汝军[1] 袁义强 ZHANG Hui;ZHANG Hua;ZHAO Jian-ming;MA Shen;ZHANG Rui-cheng;ZHU Ru-jun;YUAN Yi-qiang(Department of Cardiac Surgery,Henan Provincial Chest Hospital,Zhengzhou 450000,China)

机构地区：[1]河南省胸科医院心血管外科,河南省郑州市450000

出　　处：《中国心血管病研究》2021年第11期970-974,共5页Chinese Journal of Cardiovascular Research

基　　金：郑州市科技惠民计划项目(2019KJHM0006)。

摘　　要：目的分析单中心经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)的临床效果。方法回顾性分析2020年1月至2021年4月在本中心行TAVR治疗的61例重度主动脉瓣狭窄(aortic valve stenosis,AS)患者的临床资料,包括患者的基本资料、术中并发症情况、术后超声心动图、死亡率等,并观察随访期间严重心血管并发症等不良事件发生。结果全组患者均使用自膨胀式瓣膜,均经股动脉途径。患者平均年龄(76.1±2.7)岁,其中男性38例,胸外科协会(Society of Thoracic Surgeons,STS)平均分数(9.7±5.6)。60例患者应用一个瓣膜,1例患者采用"瓣中瓣"技术应用第2个瓣膜。术中无患者死亡,无中转外科主动脉瓣置换术(surgery aortic valve replacement,SAVR),术中预扩张球囊平均大小(19.5±2.2)mm,瓣膜置入平均深度为瓣环下(4.2±3.1)mm;术后轻中度瓣周漏2例,中度瓣膜反流1例,卒中1例,永久性心脏起搏器置入2例,术后早期因卒中死亡1例;超声心动图显示术前、术后平均主动脉瓣跨瓣压(mean pressure gradient,MPG)分别为(68.7±20.3)mmHg和(8.1±3.6)mmHg(P<0.05),术前、术后瓣口流速分别为(4.8±0.4)m/s和(1.2±0.3)m/s(P<0.05)。随访3个月内,左心室射血分数均较术前显著提高(P<0.05),无严重心血管并发症等不良事件发生。结论 TAVR对我国重度AS患者具有较高的安全性及有效性。随着手术技术的改进,操作流程的优化,对危险因素的干预,TAVR将会是中高风险AS患者首选的治疗方法。Objective To analyzes the effects of transcatheter aortic valve replacement in a sing center.Methods From January 2020 to April 2021, the clinical data of 61 patients with severe aortic valve stenosis(AS)treated by TAVR in our center were retrospectively analyzed and all the basic data, intraoperative complications,and mortality rate of the patients were compared,and the serious vascular complications and other adverse events were observed. Results All the patients had successful TAVR with a self-expanding valve via the femoral artery.The patients, mean age was(76.1± 2.7) years with 38 males and the Society of Thoracic Surgeons’ average score was(9.7 ± 5.6). There were 60 patients using 1 self-expanding valve and 1 patient underwent valve-in-valve implantation using 2 nd valve. No patients died during operation and no patient was converted to surgery aortic valve replacement(SAVR). The mean size of expandable balloon was(19.5 ± 2.2) mm and the average depth of valve implantation was under the annular(4.2±3.1) mm. There were 2 cases of mild and moderate para-valvular leak(PVL), 1 case of moderate valve regurgitation, 1 case of stroke, 2 patients implanted permanent pacemaker and 1 case of death due to stroke in the early postoperative period. Echocardiography showed that preoperative and postoperative mean trans-aortic valve pressure gradient were(68.7 ± 20.3) mmHg and(8.1 ± 3.6) mmHg and the valve orifice flow rates were(4.8±0.4) m/s and(1.2±0.3) m/s(P<0.05), respectively. During 3 months of followup, the left ventricular ejection fraction was significantly increased(P<0.05);there were no serious cardiovascular complications and other adverse events occurred. Conclusion TAVR is safe and effective for patients with severe aortic valve stenosis. With the improvement of operation techniques, optimization of surgical procedures and intervention of risk factors, TAVR will be the preferred treatment for patients with moderate and high risk of severe aortic valve stenosis.

关 键 词：经导管主动脉瓣置换术 介入治疗 自膨胀式瓣膜 

分 类 号：R542.5[医药卫生—心血管疾病]