经导管瓣中瓣技术治疗外科生物瓣衰败的单中心回顾性研究  

Transcatheter valve-in-valve aortic valve replacement for degenerated aortic surgical bioprostheses:A retrospective study in a single center

作　　者：张韶鹏 赵丰 白云鹏[1] 付博[1] 陈彤云 李景辉 陈庆良 姜楠[1] ZHANG Shaopeng;ZHAO Feng;BAI Yunpeng;FU Bo;CHEN Tongyun;LI Jinghui;CHEN Qingliang;JIANG Nan(Department of Cardiac Surgery,Tianjin University Chest Hospital,Tianjin Institute of Cardiovascular Disease,Tianjin Key Laboratory of Cardiovascular Emergency and Critical Care,Tianjin,300070,P.R.China)

机构地区：[1]天津大学胸科医院心外科、天津市心血管病研究所、天津市心血管急危重症重点实验室,天津300070

出　　处：《中国胸心血管外科临床杂志》2024年第6期842-847,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：天津市医学重点学科(专科)建设项目(TJYXZDXK-042A)。

摘　　要：目的总结国产自膨式支架瓣膜治疗主动脉瓣位外科生物瓣衰败的随访结果和临床经验。方法纳入2019年1月—2023年4月因主动脉瓣外科生物瓣衰败于天津市胸科医院心外科行经导管瓣中瓣手术患者,分析瓣膜使用特征、围术期并发症、术后早期和随访期间血流动力学表现。结果共纳入24例患者,其中男14例、女10例,平均年龄(68.17±7.72)岁,两次手术平均间隔时间(10.48±4.09)年。所有患者均顺利出院,无死亡、冠状动脉阻塞、起搏器植入等并发症,出院前平均跨瓣压差(16.39±6.52)mm Hg。术后中位随访时间16个月,随访期间左心室舒张期末内径、左心室射血分数等得到持续改善。结论国产自膨式支架瓣膜治疗主动脉瓣位外科生物瓣衰败安全可行。合理的病例选择和手术策略是获得良好血流动力学的关键。Objective To summarize the results and clinical experience of transcatheter valve-in-valve implantation using domestic self-expanding valve in patients with aortic degenerated bio-prosthesis.Methods From January 2019 to April 2023,the patients who underwent transcatheter valve-in-valve surgery in the Department of Cardiac Surgery of Tianjin Chest Hospital due to surgical bio-prosthesis failure were included.Characteristics of valves,perioperative complications,and hemodynamic manifestations during the early postoperative and follow-up period were analyzed.Results A total of 24 patients were enrolled,including 14 males and 10 females with an average age of 68.17±7.72 years,and the average interval between the two operations was 10.48±4.09 years.All patients were successfully discharged without complications such as coronary artery obstruction and pacemaker implantation,and the average transvalvular pressure gradient was 16.39±6.52 mm Hg before discharge.During the median follow-up time of 16 months,the left ventricular diastolic inner diameter and ejection fraction were continuously improved.Conclusion Transcatheter valve-in-valve using domestic self-expanding valves is safe and feasible to treat aortic bioprosthetic valve failure.Sound patient selection and surgical strategies are critical to achieve good hemodynamics.

关 键 词：经导管瓣中瓣手术 生物瓣衰败 自膨瓣 主动脉瓣 

分 类 号：R54[医药卫生—心血管疾病]