经导管主动脉瓣置换术手术切开和经皮穿刺入路的临床结果比较  

Comparison of surgical cutdown and percutaneous puncture in transcatheter aortic valve replacement

作　　者：于园园 李怡坚 王雅莉[2] 郭惠利[2] 熊恬园[2] 廖延标 王玺 陈飞[2] 欧袁伟翔 刘琦[2] 陈茂[2] 冯沅[2] YU Yuanyuan;LI Yijian;WANG Yali;GUO Huili;XIONG Tianyuan;LIAO Yanbiao;WANG Xi;CHEN Fei;OU Yuanweixiang;LIU Qi;CHEN Mao;FENG Yuan(West China School of Medicine,Sichuan University,Chengdu,Sichuan 610041,P.R.China;Department of Cardiology,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China)

机构地区：[1]四川大学华西临床医学院,成都610041 [2]四川大学华西医院心脏内科,成都610041

出　　处：《华西医学》2022年第4期522-530,共9页West China Medical Journal

基　　金：国家自然科学基金(82001899);四川大学华西医院学科发展1·3·5工程项目(ZYGD20002);四川大学华西医院专职博士后研发基金(2019HXBH078)。

摘　　要：目的 比较使用不同血管入路方式的经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)患者手术相关临床并发症发生率和血流动力学结果。方法 回顾性分析四川大学华西医院2012年4月-2019年1月行TAVR的重度主动脉瓣狭窄患者的基线情况、手术情况、瓣膜学术研究联盟-2标准结局指标和术后血流动力学结果。结果 共纳入436例接受TAVR的患者,其中采用手术切开建立血管入路的患者58例,采用经皮穿刺建立血管入路的患者378例。手术切开组肿瘤患病率高于经皮穿刺组(8.62%vs. 2.65%,P=0.037),两组患者的平均年龄、男女比例、体质量指数、美国胸外科医师学会评分差异无统计学意义(P>0.05);术前心脏超声相关指标中,手术切开组主动脉瓣反流程度大于等于中度的患者较少(22.41%vs. 35.98%,P=0.043),其他指标两组差异无统计学意义(P>0.05)。手术切开组及经皮穿刺组手术成功率差异无统计学意义(96.55%vs. 98.68%,P=0.236)。术后即刻,手术切开组患者新发左束支传导阻滞发生率(43.10%vs. 24.87%,P=0.004)、严重出血事件发生率(12.07%vs. 4.23%,P=0.030)和轻度出血事件发生率(20.69%vs. 3.44%,P<0.001)均高于经皮穿刺组,术后血流动力学提示两组最大峰值流速差异无统计学意义[(2.37±0.52) vs.(2.50±1.67) m/s,P=0.274]。术后1年时,两组间心源性死亡率(5.17%vs. 3.17%,P=0.696)及全因死亡率(8.62%vs. 8.47%,P=1.000)差异无统计学意义。结论 与经皮穿刺法相比,手术切开法和更高的出血事件发生率相关,而血管并发症等其他临床并发症发生率及术后血流动力学结果相似。Objective To compare the clinical and hemodynamic results of patients undergoing transcatheter aortic valve replacement(TAVR) with different vascular approaches. Methods We retrospectively analyzed the baseline status, procedure status, procedure-related clinical complications defined by Valve Academic Research Consortium-2consensus document, and postoperative hemodynamic results of patients with severe aortic stenosis who underwent TAVR between April 2012 and January 2019 in West China Hospital of Sichuan University. Results A total of 436patients were enrolled, including 58 patients undergoing surgical cutdown and 378 patients undergoing percutaneous puncture. The prevalence of tumor in the surgical cutdown group was higher than that in the percutaneous puncture group(8.62% vs. 2.65%, P=0.037), while the other baseline characteristics, including age, male proportion, body mass index, and Society of Thoracic Surgeons scores, were similar between the two groups(P>0.05);the proportion of patients with aortic regurgitation equal to or greater than a moderate degree in the surgical cutdown group was lower than that in the percutaneous puncture group(22.41% vs. 35.98%, P=0.043), and there was no statistically significant difference in other preoperative cardiac ultrasound-related indicators(P>0.05). The procedure success rate was high in both groups(96.55% vs. 98.68%, P=0.236). Immediately after operation, the incidences of new-onset left bundle branch block(43.10%vs. 24.87%, P=0.004), severe bleeding(12.07% vs. 4.23%, P=0.030), and mild bleeding(20.69% vs. 3.44%, P<0.001) were higher in the surgical cutdown group than those in the percutaneous puncture group, and the postoperative hemodynamics indicated that there was no statistically significant difference in maximum blood flow velocity between the two groups [(2.37±0.52) vs.(2.50±1.67) m/s, P=0.274]. At the 1 year follow-up, the cardiac death rate(5.17% vs. 3.17%,P=0.696) and all-causes mortality rate(8.62% vs. 8.47%, P=1.000) between the two groups were not sta

关 键 词：经导管主动脉瓣置换术 手术切开 经皮穿刺 并发症 

分 类 号：R654.2[医药卫生—外科学]