急诊经导管主动脉瓣置换术临床实践及预后分析  

Clinical practice and prognosis of emergent transcatheter aortic valve replacement

作　　者：周道 刘先宝[1] 范嘉祺 王力涵[1] 胡泼[1] 蒋巨波 蒲朝霞[1] 林心平 李华俊 戴晗怡 朱钢杰 许烨铭 王建安[1] Zhou Dao;Liu Xianbao;Fan Jiaqi;Wang Lihan;Hu Po;Jiang Jubo;Pu Zhaoxia;Lin Xinping;Li Huajun;Dai Hanyi;Zhu Gangjie;Xu Yeming;Wang Jian’an(Department of Cardiology,Second Affiliated Hospital Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院心内科,杭州310009

出　　处：《中华急诊医学杂志》2022年第3期368-373,共6页Chinese Journal of Emergency Medicine

基　　金：浙江省科技厅重点研发计划(2022C03063)浙江省科技厅重点研发计划(2021C03097);浙江省科技厅重点研发计划(2018C03084)。

摘　　要：目的探讨急诊经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)的临床疗效及预后,为我国急诊TAVR的发展提供规范化流程建议。方法回顾性分析2020年1月至2021年4月期间于浙江大学医学院附属第二医院接受急诊TAVR的12例患者的相关资料(TORCH前瞻性注册队列研究),描述患者的基线、术后围术期及30 d随访结局等数据,并将术后资料与术前资料进行配对样本比较。结果12例患者的胸外科医师学会评分(society of thoracic surgeons score,STS score)中位值为15.432%。TAVR术后主动脉跨瓣流速较术前明显降低(1.69 m/s vs.4.90 m/s,P<0.001)。术后30 d随访期间,1例患者死亡(8.3%),无致残性卒中,2例患者植入永久起搏器,无术后急性肾损伤、主要血管并发症发生。存活患者中81.8%的患者心功能改善为纽约心功能Ⅰ/Ⅱ级,左室射血分数较术前明显改善[(58.8±8.0)%vs.(47.4±9.5)%,P=0.026],主动脉瓣瓣口面积为(1.57±0.30)cm2,无中度及以上瓣周漏,B型脑钠肽前体(1089.9 pg/mL vs.12215.5 pg/mL,P=0.001)、肌钙蛋白T(0.020 ng/mL vs.0.337 ng/mL,P=0.003)均较术前显著下降。结论对于病情危重的重度主动脉瓣狭窄患者,急诊TAVR是一项可行且有效的抢救治疗方式。Objective To evaluate the effectiveness and prognosis of emergent transcatheter aortic valve replacement(TAVR)and to provide standardized procedural suggestion for the development of emergent TAVR in China.Methods From January 2020 to April 2021,12 patients who underwent emergent or salvage TAVR in the Second Affiliated Hospital Zhejiang University School of Medicine were retrospectively enrolled from the TORCH registry(Transcatheter Aortic Valve Replacement Single Center Registry in Chinese Population,a prospective cohort study;NCT02803294).Baseline,periprocedural and 30-day follow up data were collected.Post-operative data were compared with pre-operative data using Paired-Samples test.Results Patients’median Society of Thoracic Surgeons score(STS score)was 15.432%.There was a significant decrease of mean gradient after emergent TAVR procedure(1.69 m/s vs.4.90 m/s,P<0.01).During the 30-day follow up,there were 1 patient(8.3%)died and 2 patients received permanent pacemaker implantation.No disabling stroke,acute kidney injury,major vascular complication occurred during the first month after emergent TAVR.Among the survival patients,there was a significant releasing of heart failure symptoms to New York Heart Association function stageⅠ/Ⅱin 81.8%patients at 30-day follow up.Left ventricular ejection fraction also improved significantly from(47.4±9.5)%to 58.8±8.0%(P=0.026).The mean gradient were(1.57±0.30)cm2 and no patients had a moderate or severe paravalvular leakage.Besides,a significant decrease of pro-B-type natriuretic peptide(1089.9 pg/mL vs.12215.5 pg/mL,P=0.001)and troponin T(0.020 ng/mL vs.0.337 ng/mL,P=0.003)were found at 30 days after emergent TAVR.Conclusions For patients with severe aortic stenosis and acute cardiac decompensated,emergent TAVR is a safe and effective rescue treatment.

关 键 词：重度主动脉瓣狭窄 急诊 经导管主动脉瓣置换术 

分 类 号：R654.2[医药卫生—外科学]