重度主动脉瓣关闭不全患者经导管主动脉瓣置换术围手术期二尖瓣关闭不全转归的临床研究  

Clinical study of perioperative mitral regurgitation outcomes of transcatheter aortic valve implantation in patients with severe aortic regurgitation

作　　者：朱可心 刘金凤 谢萌 吴山[1] 李晓明[1] 于惠梅 张纯[1] 王云龙[2] Zhu Kexin;Liu Jinfeng;Xie Meng;Wu Shan;Li Xiaoming;Yu Huimei;Zhang Chun;Wang Yunlong(Department of Interventional Ultrasound,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;A Ward,Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院介入超声科,北京100029 [2]首都医科大学附属北京安贞医院心内科3A病房,北京100029

出　　处：《中国医药》2023年第11期1623-1627,共5页China Medicine

基　　金：国家自然科学基金(81970272);首都卫生发展科研专项(首发2020-2-1054)。

摘　　要：目的探讨重度主动脉瓣关闭不全(AR)合并中重度功能性二尖瓣关闭不全(FMR)患者经导管主动脉瓣置换术(TAVI)术后二尖瓣关闭不全(MR)的转归情况,并分析持续性MR的影响因素。方法回顾性分析2021年1月至2023年6月在首都医科大学附属北京安贞医院接受TAVI的重度AR合并中重度FMR患者的临床资料,对比分析手术前后MR情况,并通过Logistic回归方法分析持续性MR的危险因素。结果51例行TAVI患者术后1个月左心房内径(LAD)、左心室舒张末期内径、二尖瓣反流面积均小于术前,肺动脉收缩压优于术前(均P<0.05)。术后1个月超声心动图提示,18例患者存在持续性MR。持续性MR患者的LAD大于非持续性MR患者,且合并陈旧性心肌梗死比例更高(均P<0.05)。Logistic回归分析结果显示,术前LAD增加是重度AR合并中重度FMR患者TAVI后发生持续性MR的独立危险因素(比值比=1.138,95%置信区间:1.020~1.270,P=0.021)。结论TAVI可有效改善重度AR合并中重度FMR患者情况及二尖瓣反流程度。LAD增大为持续性MR的独立危险因素。Objective To investigate the outcome of mitral regurgitation(MR)after transcatheter aortic valve implantation(TAVI)in patients with severe aortic regurgitation(AR)combined with moderate to severe functional mitral regurgitation(FMR),and to analyze the influencing factors of persistent MR.Methods The clinical data of patients with severe AR combined with moderate to severe FMR who received TAVI in Beijing Anzhen Hospital,Capital Medical University from January 2021 to June 2023 were retrospectively analyzed,and the preoperative and postoperative MR were compared and analyzed,and the risk factors for persistent MR were analyzed by Logistic regression method.Results At 1 month after TAVI,left atrial diameter(LAD),left ventricular end-diastolic diameter,and mitral regurgitation area of 51 patients were significantly lower than those before TAVI,and pulmonary artery systolic pressure was better than that before TAVI(all P<0.05).Echocardiography at 1 month after surgery showed that 18 patients had persistent MR.The LAD of patients with persistent MR was greater than that of patients with non-persistent MR,and the proportion of old myocardial infarction was higher(all P<0.05).Logistic regression analysis showed that the increase of preoperative LAD was an independent risk factor for persistent MR after TAVI in patients with severe AR and moderate to severe FMR(odds ratio=1.138,95%confidence interval:1.020-1.270,P=0.021).Conclusion TAVI can effectively improve the condition and the degree of mitral regurgitation in patients with severe AR and moderate to severe FMR.The increase of LAD is an independent risk factor for persistent MR.

关 键 词：经导管主动脉瓣置换术 主动脉瓣关闭不全 持续性二尖瓣关闭不全 

分 类 号：R542.5[医药卫生—心血管疾病]