一站式TAVR+PCI治疗主动脉瓣病变合并冠心病患者的近期临床疗效分析  

Short-term clinical efficacy of one-stop TAVR+PCI in the treatment of patients with aortic valve disease and coronary heart disease

作　　者：王华君 张航[1] 苏彤 廖红娟[1] 陈子英[1] 石凤梧[1] 马千里[1] 刘苏[1] 安景辉[1] WANG Huajun;ZHANG Hang;SU Tong;LIAO Hongjuan;CHEN Ziying;SHI Fengwu;MA Qianli;LIU Su;AN Jinghui(Department of Cardiovascular Surgery,The Second Hospital of Hebei Medical University,Shijiazhuang,050004,P.R.China)

机构地区：[1]河北医科大学第二医院心脏大血管外科,石家庄050004

出　　处：《中国胸心血管外科临床杂志》2024年第6期848-852,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：2023年度河北省医学科学研究课题(20230440)。

摘　　要：目的分析一站式经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)+经皮冠状动脉介入术(percutaneous coronary intervention,PCI)治疗主动脉瓣病变合并冠状动脉粥样硬化性心脏病(冠心病)患者的近期临床疗效及预后。方法回顾性分析2018年1月—2023年6月在河北医科大学第二医院心脏大血管外科接受一站式TAVR+PCI治疗的主动脉瓣病变合并冠心病患者的临床资料,比较患者术前及术后相关临床数据,并记录术后1个月随访结果。结果共纳入37例患者,其中男22例、女15例,平均年龄(69.14±6.47)岁。36例患者术后康复出院,1例(2.7%)患者术中死亡。所有患者均经股动脉途径置入自膨式TAVR瓣膜,35例(94.6%)患者PCI开通1支冠状动脉,2例(5.4%)患者PCI开通2支冠状动脉。所有PCI开通血管狭窄均>70%。36例患者术后住院期间出现肺部感染11例(30.6%),重症肺炎10例(27.8%),肝功能损伤14例(38.9%),肾功能损伤5例(13.9%),脑梗死1例(2.8%),心房颤动1例(2.8%),室性早搏2例(5.6%),房室传导阻滞2例(5.6%),完全性左束支传导阻滞5例(13.9%)。术后中位呼吸机辅助时间12.0(0.0,17.0)h,ICU监护时间1.0(0.0,2.0)d,术后住院时间5.0(4.0,7.0)d。患者术前及术后纽约心脏协会心功能分级差异有统计学意义(P<0.001)。术后少量瓣周漏21例(58.3%),少-中量瓣周漏6例(16.7%),无中量及以上程度瓣周漏。术后随访1个月,36例康复出院的患者心力衰竭症状均较术前明显改善,无再发急性冠状动脉综合征患者,无再次行PCI患者,无心血管系统疾病相关再住院患者。结论一站式TAVR+PCI治疗主动脉瓣病变合并冠心病患者可获得满意的近期临床疗效,值得进一步尝试和研究。Objective To analyze the short-term clinical efficacy and prognosis of one-stop transcatheter aortic valve replacement(TAVR)+percutaneous coronary intervention(PCI)in the treatment of aortic valve disease with coronary heart disease.Methods The clinical data of patients with aortic valve disease complicated with coronary heart disease who underwent one-stop TAVR+PCI treatment at the Department of Cardiovascular Surgery,the Second Hospital of Hebei Medical University from January 2018 to June 2023 were retrospective analyzed.The preoperative and postoperative clinical data were compared,and 1-month follow-up results were recorded.Results A total of 37 patients were enrolled,including 22 males and 15 females,with an average age of 69.14±6.47 years.Thirty-six patients recovered and were discharged after the surgery,and 1(2.7%)patient died during the surgery.Self-expanding TAVR valves were implanted through the femoral artery in all patients.One coronary artery was opened by PCI in 35(94.6%)patients,and two coronary arteries were opened by PCI in 2(5.4%)patients.All PCI opened arteries had a stenosis>70%.During the postoperative hospitalization,the complications included pulmonary infection in 11(30.6%)patients,severe pneumonia in 10(27.8%)patients,liver function injury in 14(38.9%)patients,renal function injury in 5(13.9%)patients,cerebral infarction in 1(2.8%)patient,atrial fibrillation in 1(2.8%)patient,ventricular premature beats in 2(5.6%)patients,atrioventricular block in 2(5.6%)patients,and complete left bundle branch block in 5(13.9%)patients.The median postoperative ventilation assistance time was 12.0(0.0,17.0)h,the ICU monitoring time was 1.0(0.0,2.0)d,and the postoperative hospitalization time was 5.0(4.0,7.0)d.There was a significant improvement in the New York Heart Association cardiac function grading after surgery(P<0.001).After surgery,there were 21(58.3%)patients had minor perivalve leakage,6(16.7%)patients had minor to moderate perivalve leakage,and no moderate or above degree of perivalve leakage

关 键 词：冠状动脉粥样硬化性心脏病 主动脉瓣病变 经导管主动脉瓣置换术 经皮冠状动脉介入治疗 

分 类 号：R54[医药卫生—心血管疾病]