单中心经导管主动脉瓣置换术的疗效及安全性分析  

Analysis of the efficacy and safety regarding transcatheter aortic valve replacement from a single clinical center

作　　者：苏亚民[1] 耿海华[1] 李晓飞[1] 范勐慷 陆晓晨[1] 黄荣[1] 曹翔[2] 刘琨[2] 薛群[2] 尤庆生[2] 于小红[1] 盛红专[1] SU Yamin;GENG Haihua;LI Xiaofei;FAN Mengkang;LU Xiaochen;HUANG Rong;CAO Xiang;LIU Kun;XUE Qun;YOU Qingsheng;YU Xiaohong;SHENG Hongzhuan(Department of Cardiology,the Affiliated Hospital of Nantong University,Jiangsu 226001;Department of Cardiac Surgery,the Affiliated Hospital of Nantong University,Jiangsu 226001)

机构地区：[1]南通大学附属医院心血管内科,江苏226001 [2]南通大学附属医院心外科,江苏226001

出　　处：《南通大学学报（医学版）》2024年第2期117-121,共5页Journal of Nantong University(Medical sciences)

基　　金：南通市卫生健康委科研课题(MSZ2023001),博士科研启动基金项目(Tdb2114)。

摘　　要：目的:回顾南通大学附属医院心脏瓣膜中心经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)的临床数据,总结手术相关经验。方法:2020年10月—2023年6月在本中心接受TAVR手术患者28例,收集患者的病史、实验室检验以及辅助检查等临床资料,对手术成功率、并发症、院内结果以及6个月随访结果进行回顾性分析。结果:28例患者中男女各14例,平均年龄(75.54±6.08)岁,其中重度主动脉瓣狭窄22例,重度单纯主动脉瓣反流6例,美国胸外科医师协会平均积分为(4.05±3.48)分,手术成功率为96.43%,因Ⅲ度房室传导阻滞植入永久起搏器5例(17.86%);术中中度瓣周漏3例(10.71%),其中采用球囊后扩张1例,采用“瓣中瓣”技术2例使瓣膜反流显著减轻;发生瓣膜跳脱1例(3.57%),植入第2个瓣膜使其锚定于升主动脉;术中心包填塞3例(10.71%),2例予心包置管、鱼精蛋白中和肝素后出血终止;另1侧发生瓣环撕脱转行开胸手术后死亡;半年随访期间1例患者因重度贫血再次入院,所有患者生活质量显著提高。结论:TAVR治疗重度主动脉瓣狭窄或反流具有良好的有效性和安全性。Objective:To sum up the procedural experience through analyzing the clinical data regarding transcatheter aortic valve replacement(TAVR)in our center.Methods:From October 2020 to June 2023,28 patients were treated by TAVR procedure in the Valvular Heart Disease Center,the Affiliated Hospital of Nantong University.The clinical data such as medical history,laboratory tests and auxiliary examinations were collected.The procedural success rate,procedural complications,in-hospital results and 6-month follow-up results were retrospectively analyzed.Results:The mean age of the 28 patients with 14 females and 14 males respectively was(75.54±6.08)years,including 22 patients with severe aortic stenosis and 6 patients with pure severe aortic regurgitation.The Society of Thoracic Surgeons average score was 4.05±3.48,and the procedural success rate was 96.43%.There were 5 patients(17.86%)implanted permanent pacemaker implantation due to degreeⅢatrioventricular block.Moderate para-valvular leakage occurred in 3 patients(10.71%)during the operation,in which 1 case underwent post-balloon dilation and 2 cases underwent"valve-in-valve"technique to significantly reduce valve regurgitation.1 patient(3.57%)suffered from the valve jumping,and the second valve was implanted to fix the first one at the ascending aorta.Pericardial tamponade occurred in 3 patients(10.71%),in which 2 patients survived because that the hemorrhage was terminated after pericardial catheterization and protamine neutralization of heparin,while the third one left suffered from the aorticannulus avulsion and died after conversion to thoracotomy.During the 6 months follow-up,1 patient was re-hospitalized due to the severe anemia.The life quality of all patients was significantly improved.Conclusion:TAVR processes favourable efficacy and safety in the treatment of severe aortic valve stenosis or regurgitation.

关 键 词：经导管主动脉瓣置换术 主动脉瓣狭窄 主动脉瓣反流 手术安全性 手术有效性 

分 类 号：R541.4[医药卫生—心血管疾病]