冠脉高风险患者TAVR术中预植保护性导丝2例并文献复习  

Preimplantation of protective guide wire during transcatheter aortic valve replacement for patients with high coronary risk:A report of two cases and literature review

作　　者：张航[1] 安景辉[1] 刘苏[1] 马千里[1] 石凤梧[1] ZHANG Hang;AN Jinghui;LIU Su;MA Qianli;SHI Fengwu(Department of Cardiac Surgery,The Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院心脏外科,河北石家庄050000

出　　处：《精准医学杂志》2024年第1期59-62,共4页Journal of Precision Medicine

基　　金：2020年政府资助临床医学优秀人才培养项目(20-20397)。

摘　　要：目的探讨冠状动脉(冠脉)高风险患者经导管主动脉瓣置换术(TAVR)术中预植保护性导丝的临床价值。方法收集我院心脏外科2021年2例TAVR术中预植保护性导丝的冠脉高风险患者的临床资料,对其围手术期临床资料进行回顾性分析。结果2例患者均顺利完成了TAVR,其中1例患者左冠脉植入冠脉支架1枚,另1例患者仅行术中冠脉导丝、支架预保护,术后撤出导丝及支架。2例患者术后造影见人工介入瓣膜开放良好,轻度反流,冠脉通畅;术后心衰症状均不同程度地减轻或消失。术后3个月随访,2例患者的超声心动图均提示主动脉瓣人工生物瓣膜功能正常,少量瓣周反流;冠脉CTA均未见冠脉明显异常。结论保护性导丝预植入技术预防TAVR术中冠脉闭塞安全、有效。Objective To investigate the clinical value of preimplantation of protective guide wire during transcatheter aortic valve replacement(TAVR)for patients with high coronary risk.Methods Clinical data were collected from two patients with high coronary risk who received the preimplantation of protective guide wire during TAVR in Department of Cardiac Surgery in our hospital in 2021,and a retrospective analysis was performed for their perioperative clinical data.Results Both patients underwent a successful TAVR surgery,among whom one patient had a coronary stent implanted in the left coronary artery,and the other patient only received pre-protection with coronary guide wire and stent,which were removed after surgery.Postoperative angiography showed that both patients had good opening of the artificial interventional valve,mild regurgitation,and coronary artery patency,with varying degrees of alleviation or disappearance of heart failure symptoms after surgery.After 3 months of postoperative follow-up,echocardiography of the two patients showed normal function of the artificial biological valve of the aortic valve,with slight perivalvular regurgitation,and coronary CT angiography showed no obvious abnormality in the coronary artery.Conclusion The technique of protective wire preimplantation is safe and effective in preventing coronary artery occlusion during TAVR.

关 键 词：放射学 介入性 经导管主动脉瓣置换 冠状动脉闭塞 支架 病例报告 

分 类 号：R612[医药卫生—外科学]