经皮冠状动脉介入治疗联合经导管主动脉瓣置换术治疗冠心病合并主动脉瓣疾病的临床疗效  

Results of percutaneous coronary intervention combined with transcatheter aortic valve replacement in treatment of coronary heart disease complicated with aortic valve disease

作　　者：牛毅菲 贺宇 黄琼 袁义强[3] NIU Yi-fei;HE Yu;HUANG Qiong;YUAN Yi-qiang(Xinxiang Medical University Graduate School,XinXiang 453003,China;Department of Cardliology,Henan Provincial Chest Hospital,Zhengzhou 450000,China;Department of Cardliology,The 7th People Hospital of Zhengzhou,Zhengzhou 450000,China)

机构地区：[1]新乡医学院研究生院,河南省新乡市453003 [2]河南省胸科医院心内科 [3]郑州市第七人民医院心内科

出　　处：《中国心血管病研究》2023年第3期263-268,共6页Chinese Journal of Cardiovascular Research

基　　金：郑州市2019科技惠民计划(2019KJHM006)。

摘　　要：目的评价经导管主动脉瓣置换术(TAVR)+经皮冠状动脉介入治疗(PCI)治疗重度动脉瓣狭窄/关闭不全(AS/AR)合并冠状动脉粥样硬化性心脏病(CAD)患者的临床效果。方法回顾性分析2020年1月至2021年7月郑州市第七人民医院及河南省胸科医院全麻下行TAVR+PCI治疗重度AS/AR合并CAD的患者27例,根据术前超声心动图分为AS组19例(包含重度AS合并重度AR患者3例)、AR组8例,收集患者资料,根据VARC-2标准分别于术前、术后1、6、12月行超声心动图和纽约心功能分级,评估死亡、心血管再住院、冠状动脉事件等事件发生率,记录高度房室传导阻滞及血管并发症等严重并发症发生率。结果27例(100%)主动脉瓣重度狭窄/关闭不全合并冠心病的患者均经股动脉行TAVR+PCI术。AS组与AR组患者均为外科手术中高危风险。所有患者均于瓣膜置入前行PCI术,除AS组1例患者术中死亡,其余患者手术过程中无术中转外科手术,无冠状动脉阻塞、瓣膜损坏、瓣中瓣置入、中/重度瓣周漏等事件发生。两组患者术后1,6,12个月随访期间,无患者因心力衰竭再入院治疗;两组患者分别进行组内比较,左心室舒末内径(LVEDD)、左心房内径(LAD)、二尖瓣反流(MR)面积在术前与术后1、6、12个月差异均有统计学意义(P<0.05);左心室射血分数(LVEF)在术前与术后6、12个月差异具有统计学意义(P<0.05)。结论经皮冠状动脉介入治疗联合经导管主动脉瓣置换术治疗冠心病合并主动脉瓣疾病患者是安全且有效的。Objective To evaluate the clinical effect of TAVR+PCI in the treatment of patients with severe AS/AR combined with CAD.Methods From January 2020 to July 2021,27 patients with severe AS/AR complicated with CAD were treated with TAVR+PCI under general anesthesia in Zhengzhou Seventh People’s Hospital and Henan Provincial Thoracic Hospital.According to preoperative cardiac color Doppler ultrasound,they were divided into AS group(19 patients,including 3 with severe AS complicated with severe AR)and AR group(8 patients).The patient data were collected.According to the VARC-2 standard,echocardiography and New York Heart function classification were performed before operation and 1,6,and 12 months after the operation.The incidence of death,cardiovascular rehospitalization,coronary events and other events as well as severe complications such as high atrioventricular block and vascular complications were recorded and evaluated Results 27 patients(100%)with severe aortic stenosis/regurgitation and coronary heart disease underwent TAVR+PCI via femoral artery.All the patients underwent PCI before valve implantation.Except for one patient in AS group who died during the operation,other patients did not change to surgery during the operation,and there were no events such as coronary artery occlusion,valve damage,valve insertion,moderate/severe perivalvular leakage.The patients were followed up for 1,6,and 12 months after the operation.NYHA cardiac function grading was gradeⅡin 17 cases,and gradeⅢin 9 cases.No patients were hospitalized again due to heart failure.Intragroup comparison was conducted between the two groups of patients.There were statistically significant differences in left ventricular end diastolic diameter(LVEDD),left atrial diameter(LAD),and mitral regurgitation(MR)area before and 1,6,and 12 months after surgery(P<0.05);There was a statistically significant difference in left ventricular ejection fraction(LVEF)between preoperative and postoperative 6 and 12 months(P<0.05).Conclusion Percutaneous coronary

关 键 词：主动脉瓣疾病 冠状动脉粥样硬化性心脏病 经导管主动脉瓣置换术 经皮冠状动脉介入治疗 

分 类 号：R542.5[医药卫生—心血管疾病]