经导管主动脉瓣置换术后行经皮冠状动脉介入治疗初步经验  

Preliminary experience of percutaneous coronary intervention after transcatheter aortic valve replacement

作　　者：张洪亮[1] 刘庆荣 陈阳[1] 牛冠男 王墨扬 赵杰 赵振燕[1] 吴永健[1] ZHANG Hong-liang;LIU Qing-rong;CHEN Yang;NIU Guan-nan;WANG Mo-yang;ZHAO Jie;ZHAO Zhen-yan;WU Yong-jian(Structural Heart Disease Ward 1,Center for Coronary Heart Disease,National Center for Cardiovascular Diseases,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结构性心脏病一病房,北京100037

出　　处：《中国介入心脏病学杂志》2023年第6期427-431,共5页Chinese Journal of Interventional Cardiology

基　　金：首都卫生发展科研专项,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);国家重点研发计划,老年重度主动脉瓣狭窄优化治疗策略及临床路径研究(2020YFC2008103)。

摘　　要：目的总结经导管主动脉瓣置换术(TAVR)后行经皮冠状动脉介入治疗(PCI)的经验。方法回顾中国医学科学院阜外医院冠心病中心和结构性心脏病一病房在2020年10月1日至2023年3月5日TAVR术后再次行PCI的患者,收集患者的临床资料及PCI相关数据。结果共纳入8例TAVR术后接受PCI的患者,年龄66~84岁,其中男3例(3/8),7例(7/8)患者置入自膨胀瓣膜,1例(1/8)患者置入球囊扩张瓣膜。2例(2/8)患者在TAVR术前即发现冠状动脉严重病变,先行TAVR纠正心力衰竭后择期再行PCI;其余6例(6/8)在TAVR时冠状动脉均为临界病变,在TAVR术后7~55个月因冠状动脉病变明显加重行PCI。5例(5/8)患者临床表现为急性非ST段抬高型心肌梗死,3例(3/8)表现为心绞痛。PCI靶血管均为左侧冠状动脉,以左前降支为主;6例(6/8)PCI路径为右桡动脉,2例(2/8)为股动脉。6例(6/8)患者选用Judikins left指引导管,2例(2/8)选用EBU指引导管。患者均成功完成PCI,原位病变置入支架,支架内再狭窄病变应用药物涂层球囊扩张,其中3例患者使用Guidezilla延长导管。PCI耗时25~100 min。PCI术后随访2~30个月未发生心肌梗死、靶血管血运重建、心原性猝死等主要不良心血管事件。结论TAVR术后行PCI安全、可行且预后良好。Objective To summarize the experience of percutaneous coronary intervention(PCI)after transcatheter aortic valve replacement(TAVR).Methods Medical records of patients who underwent PCI after TAVR were respectively reviewed in coronary artery disease center and the fi rst ward of structural heart disease from October 1,2020 to March 5,2023.Clinical data and PCI related data were collected.Results A total of 8 patients aged 66-84 years were included.There were 3 males(3/8).Seven patients(7/8)were implanted with self-expanding valve,and 1 patient(1/8)with balloon-dilated valve.Severe coronary artery lesions were found in 2 patients,TAVR was performed fi rst and PCI was done after heart failure improvement.The remaining 6 patients(6/8)had intermediate coronary lesions at the time of TAVR,and were treated with PCI 7-55 months after TAVR due to signifi cant aggravation of coronary artery lesions.Five patients(5/8)presented with acute non-ST-segment elevation myocardial infarction,and three(3/8)presented with angina pectoris.All PCI target vessels were left coronary artery,mainly left anterior descending artery.The PCI approach was right radial artery in 6 cases(6/8)and femoral artery in 2 cases(2/8).Judikins left guiding catheter was used in 6 patients(6/8),and EBU guiding catheter in 2 patients(2/8).PCI was successfully done in all patients with stent implantation in de nova lesion in and drug-coated balloon dilation in restenosis lesions.Guidezilla extension catheter was used in 3 patients.PCI takes between 25 and 100 minutes.No major adverse cardiovascular events occurred after 2 to 30 months follow-up.Conclusions PCI after TAVR is safe and feasible,and has good outcomes.

关 键 词：主动脉瓣狭窄 经导管主动脉瓣置换术 冠状动脉疾病 经皮冠状动脉介入治疗 

分 类 号：R541[医药卫生—心血管疾病]