国产自膨式介入肺动脉瓣支架经胸植入术治疗肺动脉瓣反流的前瞻性队列研究  

Domestic self-expanding interventional pulmonary valve stent in transthoracic implantation for pulmonary valve regurgitation:A prospective cohort study

作　　者：周子秦 黄陶然 乃吉木丁·阿布都热西提 张勇[1,2] 袁海云 谢年谨[1,4] 费洪文 刘辉[1,5] 庄建 陈寄梅[1,2] 温树生[1,2] ZHOU Ziqin;HUANG Taoran;ABUDUREXITI Naijimuding;ZHANG Yong;YUAN Haiyun;XIE Nianjin;FEI Hongwen;LIU Hui;ZHUANG Jian;CHEN Jimei;WEN Shusheng(Guangdong Cardiovascular Institute,Guangdong Provincial People’s Hospital,Guangdong Academy of Medical Sciences,Southern Medical University,Guangzhou,510080,P.R.China;Department of Cardiovascular Surgery,Guangdong Cardiovascular Institute,Guangdong Provincial People’s Hospital,Guangdong Academy of Medical Sciences,Guangzhou,510080,P.R.China;Department of Cardiology,Guangdong Cardiovascular Institute,Guangdong Provincial People’s Hospital,Guangdong Academy of Medical Sciences,Guangzhou,510080,P.R.China;Department of Adult Echocardiography,Guangdong Cardiovascular Institute,Guangdong Provincial People’s Hospital,Guangdong Academy of Medical Sciences,Guangzhou,510080,P.R.China;Department of Radiology,Guangdong Cardiovascular Institute,Guangdong Provincial People’s Hospital,Guangdong Academy of Medical Sciences,Guangzhou,510080,P.R.China)

机构地区：[1]广东省心血管病研究所南方医科大学附属广东省人民医院广东省医学科学院,广州510080 [2]广东省人民医院广东省医学科学院广东省心血管病研究所心外科,广州510080 [3]广东省人民医院广东省医学科学院广东省心血管病研究所心内科,广州510080 [4]广东省人民医院广东省医学科学院广东省心血管病研究所心血管辅助诊断科,广州510080 [5]广东省人民医院广东省医学科学院广东省心血管病研究所放射科,广州510080

出　　处：《中国胸心血管外科临床杂志》2024年第9期1305-1312,共8页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家重点研发计划项目(2020YFC1107904,2022YFC2407406);广州市科技计划项(2023B03J0596)。

摘　　要：目的探索自膨式介入肺动脉瓣支架(SalusTM)经胸植入术治疗右心室流出道功能不全合并重度肺动脉瓣反流患者术后1年结果。方法按严格的入组、随访标准,前瞻性纳入2021年9月2日—2023年7月18日广东省人民医院行经胸肺动脉瓣支架植入术患者,并分析患者的临床资料。结果共纳入38例肺动脉瓣重度反流患者,其中男23例(60.5%)、女15例(39.5%),平均年龄(24.08±8.12)岁,平均体重(57.66±13.54)kg。患者术前平均右心室舒张末期容积指数(right ventricular end-diastolic volume index,RVEDVI)和右心室收缩末期容积指数(right ventricular end-systolic volume index,RVESVI)分别为(151.83±42.84)mL/m^(2)和(83.34±33.05)mL/m^(2)。所有患者均成功行经胸自膨式肺动脉瓣支架植入术,其中3例(7.9%)患者术中出现瓣膜支架移位。围术期并发症包括术后下壁心肌梗死1例(2.6%),术后伤口愈合不良1例(2.6%)。中位随访时间12.00(6.00,17.50)个月。随访期间,无死亡或再干预患者,无复发肺动脉瓣重度反流患者,3例(7.9%)患者出现胸闷、胸痛,1例(2.6%)出现频发性室性早搏。与术前相比,患者术后6个月、术后1年右心房上下径、右心室上下径、三尖瓣环收缩期位移均显著减小,肺动脉瓣反流程度改善(P<0.01)。与术前相比,术后1年RVEDVI和RVESVI分别降至(109.51±17.13)mL/m^(2)和(55.88±15.66)mL/m^(2)(P<0.01)。结论自膨式肺动脉瓣支架经胸植入术治疗重度肺动脉瓣反流安全、有效,患者术后1年显示出良好的临床和血流动力学结果。Objective To analyze and summarize the early and medium-term outcomes of self-expanding interventional pulmonary valve stent(SalusTM)for right ventricular outflow tract dysfunction with severe pulmonary valve regurgitation.Methods We established strict enrollment and follow-up criteria.Patients who received interventional pulmonary valve in transthoracic implantation in Guangdong Provincial People’s Hospital from September 2,2021 to July 18,2023 were prospectively included,and all clinical data of patients were collected and analyzed.Results A total of 38 patients with severe pulmonary regurgitation were included,with 23(60.5%)males and 15(39.5%)females.The mean age was 24.08±8.12 years,and the mean weight was 57.66±13.54 kg.The preoperative mean right ventricular end-diastolic volume index(RVEDVI)and right ventricular end-systolic volume index(RVESVI)were 151.83±42.84 mL/m2 and 83.34±33.05 mL/m2,respectively.All patients successfully underwent transcatheter self-expandable pulmonary valve implantation,with 3(7.9%)patients experiencing valve stent displacement during the procedure.Perioperative complications included 1(2.6%)patient of postoperative inferior wall myocardial infarction and 1(2.6%)patient of poor wound healing.The median follow-up time was 12.00(6.00,17.50)months.During the follow-up period,there were no deaths or reinterventions,and no patients had recurrent severe pulmonary regurgitation.Three(7.9%)patients experienced chest tightness and chest pain,and 1(2.6%)patient developed frequent ventricular premature beats.Compared with preoperative values,the right atrial diameter,right ventricular diameter,and tricuspid annular plane systolic excursion were significantly reduced at 6 months and 1 year postoperatively,with improvement in the degree of pulmonary regurgitation(P<0.01).Compared with preoperative values,RVEDVI and RVESVI decreased to 109.51±17.13 mL/m2 and 55.88±15.66 mL/m2,respectively,at 1 year postoperatively(P<0.01).Conclusion Self-expanding interventional pulmonary valve in trans

关 键 词：自膨式肺动脉瓣支架 肺动脉瓣反流 右心室流出道 右心功能 

分 类 号：R654.2[医药卫生—外科学]