经导管主动脉瓣置换术治疗主动脉瓣重度狭窄的疗效评价  

Efficacy of transcatheter aortic valve replacement in patients with severe aortic stenosis

作　　者：李柳[1] 郑庆厚[1] 王乐[1] 郑明奇[1] 刘刚[1] 王硕 LI Liu;ZHENG Qinghou;WANG Le;ZHENG Mingqi;LIU Gang;WANG Shuo(Department of Cardiology,The First Hospital of Hebei Medical University,Shijiazhuang 050011,China;Department of Cardiology,Shijiazhuang People’s Hospital,Shijiazhuang 050031,China)

机构地区：[1]河北医科大学第一医院心内科,石家庄050011 [2]石家庄市人民医院心内科,石家庄050031

出　　处：《中国医科大学学报》2024年第11期989-993,共5页Journal of China Medical University

基　　金：河北省中医药管理局科研计划(2023322)。

摘　　要：目的评价经导管主动脉瓣置换术(TAVR)治疗主动脉瓣重度狭窄的效果。方法回顾性研究2020年5月至2023年5月在河北医科大学第一医院心脏中心住院行TAVR并完成6个月随访的主动脉瓣重度狭窄患者46例的临床资料。患者均完善术前检查,行简明精神状态检查(MMSE)和蒙特利尔认知评估量表(MOCA)检查,观察手术安全性指标(包括瓣膜置入即刻成功率、瓣膜移位、死亡、心脏传导阻滞、瓣周漏、冠状动脉阻塞、脑卒中、入径血管破裂、心脏压塞、主动脉夹层、大出血),有效性指标[包括术前及术后1 d、7 d、3个月、6个月的临床症状、B型利尿钠肽(BNP)、可溶性生长刺激表达基因2蛋白(sST2)、超声心动图结果],以及认知功能指标(包括术前及术后3个月、6个月的MMSE和MOCA检查)。通过上述指标评价TAVR的疗效。结果TAVR手术安全性指标:瓣膜置入即刻成功率100%,发生瓣膜移位1例,新发束支传导阻滞4例,瓣周漏2例,脑卒中2例,入径血管破裂1例,大出血1例,无死亡、冠状动脉阻塞、心脏压塞、主动脉夹层病例。TAVR手术有效性指标:术后临床症状改善明显,NYHAⅠ~Ⅱ级(30例)显著高于术前(18例)。心功能指标BNP、sST2下降显著,主动脉瓣最大跨瓣流速、主动脉瓣收缩期跨瓣压差、主动脉瓣平均跨瓣压差、左心室舒张末期内径均明显改善。TAVR手术认知功能指标:术后3个月、6个月MMSE和MOCA检查结果均明显改善。结论TAVR手术应用于主动脉瓣重度狭窄患者安全、有效,且能改善患者的认知功能。Objective To evaluate the efficacy of transcatheter aortic valve replacement(TAVR)in patients with severe aortic valve stenosis.Methods This study included 46 patients with severe aortic valve stenosis who underwent TAVR and completed a six-month follow-up at the Heart Center of the First Hospital of Hebei Medical University between May 2020 and May 2023.All patients underwent a preoperative examination,mini-mental state examination(MMSE),the Montreal cognitive assessment scale(MOCA),and the following safety indicators of surgery,including immediate success rate of valve implantation,valve displacement,death,heart conduction block,perivalve leakage,coronary occlusion,stroke,approach vessel rupture,cardiac tamponade,aortic dissection,and massive bleeding.Effectiveness indicators included clinical symptoms,BNP,sST2,and cardiac color Doppler ultrasound preoperatively and one day,seven days,three months,and six months postoperatively.Cognitive function indicators(MMSE and MOCA),were used preoperatively and three and six months postoperatively.The efficacy of transcatheter aortic was evaluated using these indicators.Results The immediate success rate of valve implantation was 100%,with one case of valve displacement,four cases of new bundle branch block,two cases of perivalve leakage,two cases of stroke,one case of inlet vessel rupture,one case of major bleeding,and no deaths,coronary artery occlusion,cardiac tamponade,or aortic dissection.Clinical symptoms improved significantly postoperatively,with 30 cases of NYHA gradesⅠtoⅡbeing significantly higher than the 18 cases preoperatively.The indicators of cardiac function,BNP,and sST2 significantly decreased,and the maximum aortic valve cross-valve flow velocity,aortic valve systolic cross-valve pressure difference,average aortic valve cross-valve pressure difference,and left ventricular end-diastolic diameter significantly improved.The MMSE and MOCA showed significant improvements three and six months postoperatively.Conclusion TAVR is a safe and effective method t

关 键 词：经导管主动脉瓣置换术 主动脉瓣重度狭窄 认知功能 

分 类 号：R542.5[医药卫生—心血管疾病]