不同跨瓣压差的重度主动脉瓣狭窄患者经导管主动脉瓣置换术治疗长期预后分析  

Analysis of long-term prognosis of patients with severe aortic stenosis and different gradient after transcatheter aortic valve replacement

作　　者：戚鑫瑞 戴晗怡 许烨铭 刘先宝[1] 王建安[1] QI Xinrui;DAI Hanyi;XU Yeming;LIU Xianbao;WANG Jian'an(Department of Cardiology,The 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血管内科,杭州310009

出　　处：《心电与循环》2022年第3期215-220,共6页Journal of Electrocardiology and Circulation

基　　金：浙江省科技计划项目(2021C03097)。

摘　　要：目的分析不同跨瓣压差的重度主动脉瓣狭窄患者经导管主动脉瓣置换术(TAVR)治疗的长期预后。方法选择2015年1月至2018年3月浙江大学医学院附属第二医院接受TAVR治疗的重度主动脉瓣狭窄患者204例,根据平均主动脉瓣跨瓣压差是否>40 mmHg(1 mmHg=0.133 kPa)分为高跨瓣压差(HGAS)组和低跨瓣压差(LGAS)组,比较两组患者的一般资料,于TAVR手术前后行超声心动图检测,测量并比较左心室射血分数(LVEF)、最大血流流速、平均跨瓣压差、室间隔厚度、左心室后壁舒张期厚度和主动脉瓣口面积。随访3年,观察终点事件发生情况。采用单因素及多因素Cox回归分析患者3年死亡的危险因素。采用Kaplan-Meier曲线分析患者生存情况。结果LGAS组心包压塞发生率高于HGAS组,差异有统计学意义(P<0.05)。LGAS组患者手术前后LVEF、最大血流流速、平均跨瓣压差、室间隔厚度、左心室后壁舒张期厚度均小于HGAS组,手术前主动脉瓣口面积大于HGAS组,差异均有统计学意义(均P<0.05)。LGAS组第1年、第3年全因死亡率、心血管死亡率高于HGAS组,差异均有统计学意义(均P<0.05)。多因素Cox回归分析显示LGAS、既往卒中、透析和既往起搏器植入均是3年全因死亡的独立预测因素。结论重度主动脉瓣狭窄患者经TAVR治疗长期预后良好,其中LGAS患者的3年预后劣于HGAS者。Objective To analyze the long-term prognosis of patients with severe aortic stenosis and different gradient after transcatheter aortic valve replacement(TAVR).Methods A total of 204 patients underwent TAVR for severe aortic stenosis in the Second Affiliated Hospital Zhejiang University School of Medicine from January 2015 to March 2018were enrolled.They were divided into high gradient aortic stenosis(HGAS)group and low gradient aortic stenosis(LGAS)group according to whether the mean gradient was higher than 40 mmHg(1 mmHg=0.133 kPa).The general data of the two groups were compared.Echocardiography was performed before and after TAVR operation.Left ventricular ejection fraction(LVEF),Max velocity,mean gradient,interventricular septal thickness,left ventricular posterior wall thickness at diastole and aortic valve area were measured and compared.The end-point events were observed after 3 years of follow-up.Univariate and multivariate analysis of risk factors for 3-year mortality were performed.Kaplan-Meier curve was used to analyze patient survival rate.Results The incidence of tamponade in LGAS group was higher than that in HGAS group(P<0.05).Left ventricular ejection fraction,max velocity,mean gradient,interventricular septal thickness and left ventricular posterior wall thickness in diastole were significantly lower in LGAS group than in HGAS group before and after the procedure(all P<0.05).Aortic valve area was significantly larger in LGAS group than in HGAS group before the procedure(P<0.05).The all-cause mortality and cardiovascular mortality were significantly higher in LGAS group than in HGAS group at the first year and the third year(all P<0.05).Multivariate analysis of risk factors showed that LGAS,prior stroke,dialysis and prior pacemaker implantation were independent predictors of 3-year all-cause mortality.Conclusion Patients with severe aortic stenosis who underwent TAVR may have a good long-term prognosis.The 3-year prognosis of patients with LGAS is inferior to those with HGAS.

关 键 词：重度主动脉瓣狭窄 经导管主动脉瓣置换术 低跨瓣压差 长期预后 生存率 

分 类 号：R654.2[医药卫生—外科学]