二叶式主动脉瓣畸形患者经导管主动脉瓣置换术或外科主动脉瓣置换术后升主动脉改变的研究  

Progression of Ascending Aortic Dilatation and Adverse Aortic Events After Transcatheter Aortic Valve Replacement in Patients With Bicuspid Aortic Valve Comparison With Surgical Aortic Valve Replacement

作　　者：安康 张帅[1] 龚嘉淼 林宏远 朱坤[1] 郑哲[1] 侯剑峰[1] AN Kang;ZHANG Shuai;GONG Jiamiao;LIN Hongyuan;ZHU Kun;ZHENG Zhe;HOU Jianfeng(Adult Cardiac Surgery Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),C hina)

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,阜外医院成人外科中心,北京市100037

出　　处：《中国循环杂志》2022年第10期1002-1007,共6页Chinese Circulation Journal

基　　金：国家重点研发计划资助(2020YFC2008100)。

摘　　要：目的:比较二叶式主动脉瓣畸形(BAV)患者接受经导管主动脉瓣置换术(TAVR)或外科主动脉瓣置换术(SAVR)后,升主动脉直径改变以及主动脉不良事件发生率间有无差异。方法:选取2015年1月至2019年12月在中国医学科学院阜外医院行TAVR或SAVR的≥65岁的BAV患者89例,其中行TAVR患者33例(TAVR组),行SAVR患者56例(SAVR组)。结果:TAVR组患者中位年龄长于SAVR组患者[73(70,77)岁vs.69(66,71)岁,P<0.001],男性分别占66.7%和55.4%(P=0.294)。TAVR组患者相比于SAVR组患者NYHA心功能分级Ⅲ/Ⅳ级比例更高(87.9%vs.41.1%,P<0.001),合并冠心病比例更高(57.6%vs.35.7%,P=0.045),且术前升主动脉直径更大[41(35,45)mm vs.38(35,41)mm,P=0.042]。SAVR组患者的中位随访时间长于TAVR组患者[44(33,62)个月vs.23(19,36)个月,P<0.001],随访期间两组均无主动脉不良事件发生。TAVR组患者总体生存率与SAVR组患者差异无统计学意义[(93.3±4.6)%vs.(91.7±4.9)%,P=0.476]。TAVR组患者与SAVR组患者超声心动图随访中位时间分别为20(12,31)个月与21(13,39)个月(P=0.744)。TAVR组患者与SAVR组患者的升主动脉直径年增长率差异无统计学意义[0.9(-0.7,2.3)mm/年vs.0.3(-1.2,1.7)mm/年,P=0.525]。结论:对于年龄≥65岁的BAV患者,TAVR和SAVR手术均安全有效,中期生存率及主动脉不良事件发生率均满意。尽管TAVR术后升主动脉仍然持续扩张,但扩张速率相对缓慢,且与SAVR患者相比无显著差异。Objectives:To compare the incidence of adverse aortic events and the progression of ascending aortic dilation between bicuspid aortic valve(BAV)patients who underwent transcatheter aortic valve replacement(TAVR)or surgical aortic valve replacement(SAVR).Methods:A total of 89 patients were included(33 TAVR and 56 SAVR)in this retrospective review.BAV patients aged≥65 years who underwent TAVR or SAVR between January 2015 and December 2019 were enrolled in this study.Results:The patients were older(73 years vs.69 years,P<0.001),the proportion of NYHAⅢ/Ⅳ(87.9%vs.41.1%,P<0.001)and coronary artery disease(57.6%vs.35.7%,P=0.045)was higher and preoperative ascending aortic diameter was larger(41[35,45]mm vs.38[35,41]mm,P=0.042)in TAVR group as compared to SAVR group.The median follow-up time was 23(19,36)months for TAVR group and 44(33,62)months for SAVR(P<0.001).There were no adverse aortic events in both groups during the follow-up period.Overall survival was(93.3±4.6)%in TAVR group and(91.7±4.9)%in SAVR group(P=0.476).The median echocardiography follow-up duration was 20(12,31)months and 21(13,39)months respectively for TAVR and SVAR patients(P=0.744).The annual median dilation rate of ascending aortic was 0.9(-0.7,2.3)mm/y and 0.3(-1.2,1.7)mm/y for TAVR and SAVR group,respectively(P=0.525).Conclusions:Outcome post TAVR and SAVR is satisfactory among BAV patients aged≥65 years in terms of mid-term survival and incidence of adverse aortic events.Although ascending aortic diameter continues to increase after TAVR,the dilation rate is acceptable and comparable to that post SAVR.

关 键 词：二叶式主动脉瓣畸形 经导管主动脉瓣置换术 外科主动脉瓣置换术 升主动脉扩张 主动脉不良事件 

分 类 号：R541.4[医药卫生—心血管疾病]