经导管主动脉瓣置换术对主动脉瓣反流患者术后左心室逆重构影响的临床研究  

Effect of transcatheter aortic valve replacement on postoperative left ventricular reverse remodeling in patients with aortic regurgitation

作　　者：赵星 姜兆磊[1] 梅举[1] 黄健兵[1] 丁芳宝[1] 汤敏[1] 刘浩[1] 蔡捷 沈赛娥[2] ZHAO Xing;JIANG Zhaolei;MEI Ju;HUANG Jianbing;DING Fangbao;TANG Min;LIU Hao;CAI Jie;SHEN Sai'e(Department of Cardiothoracic Surgery,Xinhua Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai,200092,P.R.China;Department of Anesthesiology,Xinhua Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai,200092,P.R.China)

机构地区：[1]上海交通大学医学院附属新华医院心胸外科,上海200092 [2]上海交通大学医学院附属新华医院麻醉科,上海200092

出　　处：《中国胸心血管外科临床杂志》2023年第8期1121-1127,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金项目(82170324,81974023);上海市科委科研计划项目(22QC1401100,20Y11910700);上海交通大学“交大之星”计划医工交叉研究基金(YG2022ZD008);国家临床重点专科。

摘　　要：目的研究主动脉瓣反流患者经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)治疗后左心室逆重构情况及影响因素。方法回顾性分析2018—2021年于上海交通大学医学院附属新华医院心胸外科接受TAVR的主动脉瓣关闭不全患者的临床资料,参照指南标准,将左心室射血分数<55%的患者纳入射血分数降低型主动脉瓣关闭不全(aortic valve insufficiency with reduced ejection fraction,AIrEF)组,将左心室射血分数≥55%的患者纳入射血分数保留型主动脉瓣关闭不全(aortic valve insufficiency with preserved ejection fraction,AIpEF)组。分析两组患者的临床资料。结果共纳入50例患者,AIrEF组19例,其中男15例、女4例,平均年龄(74.5±7.1)岁;AIpEF组31例,其中男19例、女12例,平均年龄(72.0±4.8)岁。所有患者均顺利完成经股动脉或经心尖TAVR手术。经胸超声心动图显示,两组患者术前均表现出显著的左心室重构。AIpEF患者于术后早期(术后第1 d)出现明显的左心室逆重构后即维持相对稳定,而AIrEF患者术后早期(术后第1 d)至术后3个月持续出现左心室逆重构,之后维持相对稳定。与术前相比,AIrEF组患者术后第1 d平均左心室舒张末期和收缩末期容积指数分别降低16.8 mL/m^(2)(P=0.003)和8.6 mL/m^(2)(P=0.005),平均左心室舒张末期和收缩末期内径指数降低2.5 mm/m^(2)(P=0.003)和1.9 mm/m^(2)(P=0.003),与术后第1 d相比,AIrEF患者术后3个月左室射血分数平均提高了12.1%(P<0.001)。结论TAVR在AIrEF与AIpEF患者中均可以取得良好的治疗效果,显著促进患者左心室逆重构,其中AIrEF患者左心室逆重构更明显。Objective To investigate the left ventricular reverse remodeling(LVRR)in patients with aortic valve insufficiency with reduced ejection fraction(AIrEF)and aortic valve insufficiency with preserved ejection fraction(AIpEF)after transcatheter aortic valve replacement(TAVR).Methods The clinical and follow-up data of patients who underwent TAVR in the Department of Cardiothoracic Surgery,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from 2018 to 2021 were retrospectively analyzed.According to the guideline,the patients with left ventricular ejection fraction<55%were allocated to an AIrEF group,and the patients with left ventricular ejection fraction≥55%were allocated to an AIpEF group.Results A total of 50 patients were enrolled.There were 19 patients in the AIrEF group,including 15 males and 4 females with a mean age of 74.5+7.1 years.There were 31 patients in the AIpEF group,including 19 males and 12 females with a mean age of 72.0±4.8 years.All patients underwent TAVR successfully.Echocardiographic results showed that TAVR significantly promoted LVRR in the patients.Significant LVRR occurred in the early postoperative period(the first day after the surgery)in both groups.It remained relatively stable after the LVRR in the early postoperative period(the first day after surgery)in the AlpEF patients,while it continued to occur in the early postoperative period(the first day after surgery)to three months after the surgery in the AIrEF patients,and then remained relatively stable.Compared to preoperative values,AIrEF patients had a reduction in the average left ventricular end-diastolic volume index and left ventricular end-systolic volume index by 16.8 mL/m^(2)(P=0.003)and 8.6 mL/m^(2)(P=0.005),respectively,and the average left ventricular end-diastolic diameter index and end-systolic diameter index decreased by 2.5 mm/m^(2)(P=0.003)and 1.9 mm/m^(2)(P=0.003),respectively on the first day after the surgery.In comparison to the first day after the surgery,AIrEF patients experienced a

关 键 词：经导管主动脉瓣置换术 主动脉瓣关闭不全 左心室逆重构 

分 类 号：R654.2[医药卫生—外科学]