左心室射血分数小于30%的重度主动脉瓣狭窄患者经导管主动脉瓣置换术治疗:单中心临床分析  

Outcomes of transcatheter aortic valve replacement in patients with left ventricular ejection fraction less than 30%:a single-center clinical study

作　　者：刘庆荣 陈阳[1] 张倩 李喆 张洪亮[1] 李子昂 郭帅 许海燕 高润霖[1] 吴永健[1] LIU Qing-rong;CHEN Yang;ZHANG Qian;LI Zhe;ZHANG Hong-liang;LI Zi-ang;GUO Shuai;XU Hai-yan;GAO Run-lin;WU Yong-jian(Department of Cardiology,Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]国家心血管病中心,北京协和医学院,中国医学科学院阜外医院冠心病中心,北京100037

出　　处：《中国介入心脏病学杂志》2022年第9期660-664,共5页Chinese Journal of Interventional Cardiology

基　　金：国家重点研发计划项目:老年瓣膜性心脏病标准评估体系及优化治疗路径研究(2020YFC2008103);首都卫生发展科研专项项目:老年高危复杂主动脉瓣疾病优化治疗策略研究(首发2020-1-4031)。

摘　　要：目的探讨经导管主动脉瓣置换术(TAVR)治疗重度主动脉瓣狭窄(AS)合并重度心力衰竭[左心室射血分数(LVEF)<30%]患者的安全性和有效性,从而指导临床诊疗。方法回顾性研究收集2018年1月至2020年12月在中国医学科学院阜外医院接受TAVR治疗的重度AS合并重度心力衰竭患者48例。入选标准:超声心动图诊断为重度AS、LVEF<30%,且美国纽约心脏病协会(NYHA)心功能分级Ⅲ~Ⅳ级,不能常规接受外科开胸主动脉瓣置换术的患者。对比患者TAVR治疗前和术后12个月的相关指标和临床预后。结果48例患者的平均年龄为(71.35±8.82)岁,其中男37例(77.08%),平均美国胸外科医师协会(STS)评分为(5.94±1.39)%。手术成功率100%,平均手术时间为(45.25±5.66)min,12个月随访全因死亡率4例(8.33%)。术后12个月主动脉瓣瓣口面积[(1.37±0.33)cm^(2)比(0.33±0.35)cm^(2),P<0.001]、平均跨瓣压差[(10.27±2.18)mmHg比(38.89±19.22)mmHg,P<0.001]、LVEF[(54.45±12.25)%比(26.18±3.07)%,P<0.001]、左心室舒张末期内径[(52.55±13.10)mm比(64.02±7.69)mm,P=0.002]、N末端B型脑钠肽前体[(701.67±522.21)pg/ml比(12681.77±11571.33)pg/ml,P<0.001]均较术前基线有效改善,差异均有统计学意义。12个月随访时NYHA心功能分级Ⅰ级、Ⅱ级、Ⅲ级和Ⅳ级患者分别为30例(62.50%)、10例(20.83%)、6例(12.50%)和2例(4.17%),较术前基线(相应比例分别为0、0、54.17%、45.83%)明显改善,差异有统计学意义(P<0.001)。结论TAVR治疗在LVEF<30%的重度AS患者中是安全有效的。Objective Aims to explore the safety and effectiveness of transcatheter aortic valve replacement(TAVR)in patients with severe aortic stenosis(AS)combined with left ventricular ejection fraction(LVEF)<30%.Methods A total of 48 patients with severe AS and LVEF<30%were undergoing TAVR in our hospital from January 2018 to December 2020 were retrospectively enrolled.Inclusion criteria:Patients with symptomatic severe AS diagnosed by echocardiography,LVEF<30%,and NYHA classification fromⅢtoⅣ,who cannot routinely undergo SAVR.The baseline and 12 months post TAVR indicators and clinical prognosis of patients were compared.Results The mean age was(71.35±8.82)years,with males of 77.08%(37 cases).The mean STS score was(5.94±1.39)%.In this study,TAVR success rate was 100%,mean operation time was(45.25±5.66)min,and the all-cause mortality rate was 8.33%in 1 year follow-up.Compared with baseline,the aortic valve area[(1.37±0.33)cm^(2)vs.(0.33±0.35)cm^(2),P<0.001],the mean valve gradient[(10.27±2.18)mm Hg vs.(38.89±19.22)mm Hg,P<0.001],LVEF[(54.45±12.25)%vs.(26.18±3.07)%,P<0.001],left ventricular end-diastolic diameter[(52.55±13.10)mm vs.(64.02±7.69)mm,P=0.002]and amino-terminal probrain natriuretic peptide[(701.67±522.21)pg/ml vs.(12681.77±11571.33)pg/ml,P<0.001]were all signifi cantly improved at 12 months after the procedure.Conclusions This study found that TAVR is safe and eff ective in severe AS patients with LVEF<30%.

关 键 词：主动脉瓣狭窄 心力衰竭 经导管主动脉瓣置换术 

分 类 号：R541[医药卫生—心血管疾病]