经动脉入路经导管主动脉瓣置换术治疗单纯主动脉瓣反流的初步经验  

Preliminary experience of trans-arterial transcatheter aortic valve replacement in pure aortic regurgitation

作　　者：李捷[1] 孙英皓 李光[1] 付明[1] 莫与京[1] 郑胜能 董豪坚[1] 范瑞新[1] 罗建方 LI Jie;SUN Ying-hao;LI Guang;FU Ming;MO Yu-jing;ZHENG Sheng-neng;DONG Hao-jian;FAN Rui-xin;LUO Jian-fang(Guangdong Cardiovascular Institute,Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China)

机构地区：[1]广东省人民医院心内科广东省医学科学院广东省心血管病研究所,广东广州510080

出　　处：《中国介入心脏病学杂志》2021年第12期678-683,共6页Chinese Journal of Interventional Cardiology

基　　金：广东省人民医院高水平医院建设项目(DFJH201807)。

摘　　要：目的探索经动脉入路经导管主动脉瓣置换术(TAVR)治疗单纯主动脉瓣反流的安全性及有效性。方法本研究为回顾性研究。选取2016年4月至2021年7月在广东省人民医院行经动脉入路TAVR治疗的症状性单纯重度主动脉瓣反流患者。重度主动脉瓣反流由经胸超声心动图诊断,且主动脉瓣平均跨瓣压差≤20 mmHg(1 mmHg=0.133 kPa)。主要终点为术后1个月的全因死亡。采用配对样本t检验比较基线和术后经胸超声心动图指标。结果共入选16例患者,平均年龄(75.1±5.5)岁,男9例(9/16)。术中置入第二个瓣膜2例,术后残余中重度主动脉瓣反流1例,器械成功率为14/16。术后1个月内急性肾损伤(2级或3级)、新发心房颤动和永久起搏器植入各1例(1/16),未发生死亡、卒中、心肌梗死、严重出血或主要血管并发症事件。TAVR术后主动脉瓣反流面积显著减小[(2.2±3.4)cm^(2)比(9.7±2.2)cm^(2),Δ=(–7.4±2.5)cm^(2),P<0.001],左心室舒张末期内径显著减小[(54.1±6.8)mm比(60.8±5.7)mm,Δ=(–6.6±5.6)mm,P<0.001],左心室射血分数无显著变化[(49.4±12.4)%比(51.2±12.7)%,Δ=(–1.8±12.2)%,P=0.563]。结论经动脉入路TAVR治疗单纯主动脉瓣反流是可行的。Objective To investigate the safety and efficacy of trans-arterial transcatheter aortic valve replacement(TAVR)in patients with pure aortic regurgitation(AR).Methods This was a retrospective study.From April 2016 to July 2021 in Guangdong Provincial People's Hospital,patients undergoing trans-arterial TAVR for symptomatic pure severe AR were analyzed.Severe AR was diagnosed by transthoracic echocardiography,with mean aortic valve pressure gradient≤20 mmHg(1 mmHg=0.133 kPa).The primary endpoint was all-cause mortality at 1 month.Paired sample t-test was used to compare the baseline and post-procedural echocardiographic parameters.Results A total of 16 patients were included.The mean age was(75.1±5.5)years,and 9 cases(56.3%)were male.There were 2 cases of implantation of a second valve and 1 case with moderate to severe residual AR.The rate of device success was 14/16(87.5%).There was 1 case(6.3%)of acute kidney injury(stage 2 or 3),1 case of new-onset atrial fibrillation,and 1 case of permanent pacemaker implantation,but no death,stroke,myocardial infarction,severe bleeding or major vascular complication was observed.The post-procedural echocardiography at 1 month showed that AR area[(2.2±3.4)cm^(2)vs.(9.7±2.2)cm^(2),Δ=(–7.4±2.5)cm^(2),P<0.001]and left ventricular end diastolic diameter[(54.1±6.8)mm vs.(60.8±5.7)mm,Δ=(–6.6±5.6)mm,P<0.001]were reduced significantly compared to baseline.While there was no significant change in left ventricular eject fraction[(49.4±12.4)%vs.(51.2±12.7)%,Δ=(–1.8±12.2)%,P=0.563].Conclusions Trans-arterial TAVR is feasible in patients with pure AR.

关 键 词：经导管主动脉瓣置换术 主动脉瓣反流 股动脉 颈动脉 

分 类 号：R541[医药卫生—心血管疾病]