股动脉路径经导管主动脉瓣置换术式简化的单中心经验  

Single center experience of transcatheter aortic valve replacement with a simplified operative protocol

作　　者：宋光远 赵跃武 杜国勇 陈阳[1] 王墨扬[1] 滕思勇[1] 罗彤[1] 周政 牛冠男[1] 赵振燕[1] 卢志楠 吴永健[1] Song Guangyuan;Zhao Yuewu;Du Guoyong;Chen Yang;Wang Moyang;Teng Siyong;Luo Tong;Zhou Zheng;Niu Guannan;Zhao Zhenyan;Lu Zhinan;Wu Yongjian(Coronary Artery Disease Center,Fuwai Hospital,National Center for Cardiovascular Disease,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Valvular Heart Diaease Intervention Center,Beijing Anzhen Hospital,Capital Medical University,National Clinical Research Center of Cardiovascular Diseases,Beijing 100029,China;Department of Cardiology,Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University,Xuzhou 221000,China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院冠心病中心,北京100037 [2]首都医科大学附属北京安贞医院国家心血管疾病临床医学研究中心心脏瓣膜病介入中心,北京100029 [3]徐州医科大学附属徐州市立医院心内科,徐州221000

出　　处：《中华心血管病杂志》2022年第6期563-569,共7页Chinese Journal of Cardiology

基　　金：首都卫生发展科研专项项目(2020-1-4031)。

摘　　要：目的总结经导管主动脉瓣置换(TAVR)术式简化的单中心临床经验。方法2020年10月中国医学科学院阜外医院开始有计划地对经股动脉途径TAVR(TF-TAVR)的术式进行进一步简化,开展超声引导主入路穿刺,桡动脉副入路、无导尿,左心室导丝起搏等策略。本研究回顾性连续收集2020年10月之前3个月(2020年7—9月,常规组)和之后3个月(2020年10—12月,简化组)患者的基线特征、手术相关数据、术后30 d随访结果,并进行比较分析。结果共纳入患者93例,常规组42例,简化组51例。简化组中计划应用超声引导入路穿刺51例,成功应用51例(100%);计划应用桡动脉副入路49例,成功应用45例(92%);计划无导尿48例,最终无导尿35例(73%);计划左心室导丝起搏12例,最终成功应用11例(92%)。两组患者在基线资料、器械成功率、主要终点事件发生率、术后瓣膜功能等方面差异无统计学意义,但简化组的平均手术时间[(62.5±17.9)min比(78.3±16.7)min,P<0.001]、手术室时间[(133.7±25.1)min比(159.2±42.6)min,P<0.001]、X线照射时间[(17.2±6.5)min比(20.2±7.7)min,P=0.027]均短于常规组。结论本中心针对TF-TAVR术式的简化方案安全、可行,有效提高了手术效率。Objective To summarize the single center experience of transcatheter aortic valve replacement(TAVR)with a simplified operative protocol.Methods Consecutive patients who underwent transfemoral TAVR(TF-TAVR)from July 2020 to December 2020 in Fuwai Hospital were retrospectively analyzed.We compared the baseline characteristic,procedure information,30-day follow-up outcomes of the patients who underwent TF-TAVR without the simplified operative protocol(routine group)or with the simplified operative protocol(simplified protocol group).Results 93 patients were collected,42 patients belonging to routine group,51 patients belonging to simplified protocol group.In simplified protocol group,there were 51 patients planned to use ultrasound-guided femoral access puncture,procedure was successful in all 51 patients(100%).There were 49 patients planned to use the radial artery as the secondary access,procedure was successful in 45 patients(92%).There were 48 patients planned to use the strategy of avoidance of urinary catheter,this strategy was achieved in 35 patients(73%).There were 12 patients planned to use the left ventricular guidewire to pace,procedure was successful in 11 patients(92%).There were no differences in baseline characteristics,major clinical endpoints and 30-day follow-up outcomes between the two groups.Meanwhile,the procedure time((62.5±17.9)min vs.(78.3±16.7)min,P<0.001),operation room time((133.7±25.1)min vs.(159.2±42.6)min,P<0.001),X-ray exposure time((17.2±6.5)min vs.(20.2±7.7)min,P=0.027)were significantly shorten in simplified protocol group compared with the routine group.Conclusion Our study results indicate that the simplified operative protocol of TF-TAVR is as effective and safe as the routine operative protocol,meanwhile using the simplified operative protocol can significantly increase the operative efficiency of TF-TAVR.

关 键 词：主动脉瓣狭窄 经导管主动脉瓣置换术 术式简化 

分 类 号：R654.2[医药卫生—外科学]