经胸超声心动图评估TAVR术后远期疗效及瓣周漏危险因素分析  

Analysis of Long-Term Efficacy and Risk Factors of Paravalvular Leakage After TAVR by Transthoracic Echocardiography

作　　者：彭安庆 杨剑 孟欣 弓文清 赵晓妮 蔡金晔 郑敏娟 Peng Anqing;Yang Jian;Meng Xin;Gong Wenqing;Zhao Xiaoni;Cai Jinye;Zheng Minjuan(Department of Ultrasound,The First Affiliated Hospital of AirForceMedicalUniversity,Xi'an710032,China;Department of Cardiac Surgery,The First Affiliated Hospital of AirForceMedicalUniversity,Xi'an710032,China)

机构地区：[1]空军军医大学第一附属医院超声科,西安市710032 [2]空军军医大学第一附属医院心外科,西安市710032

出　　处：《中国超声医学杂志》2024年第11期1258-1261,共4页Chinese Journal of Ultrasound in Medicine

基　　金：陕西省国际科技合作计划重点项目(No.2022KWZ-19);空军军医大学临床研究项目(No.2023LC2310)。

摘　　要：目的经胸超声心动图评估经导管主动脉瓣置换术(TAVR)患者术后远期疗效并分析瓣周漏危险因素。方法回顾性分析100例TAVR患者,收集临床资料、主动脉根部内径(主动脉环部、窦部、窦管交界及近端升主动脉)、经胸超声参数及术后瓣周漏情况。比较术前、术后1个月、术后2年经胸超声参数差异,Logistic回归筛选提示术后瓣周漏影像学危险因素。结果与术前相比,患者术后1个月内左心室舒张末期容积(LVEDV)、舒张末期内径(LVEDD)、每搏量(LVSV)、主动脉瓣峰值流速(Vmax)及最大跨瓣压差(PGmax)等各指标均有改善,差异具有统计学意义(P<0.05);术后2年左心重构和心功能进一步改善(P<0.05)。Logistic回归分析提示术前主动脉窦管交界处增宽是TAVR术后发生瓣周漏的危险因素(OR=1.127)。结论TAVR手术对主动脉瓣膜疾病远期疗效明确且术后1个月左右出现左心室逆重构,2年后逆重构和心功能改善更明显;术前主动脉窦管交界处增宽的患者应警惕术后发生瓣周漏。Objective To analysis the long-term efficacy and risk facors of paravalvular leakage after transcatheter aortic valve replacement(TAVR)by transthoracic echocardiography.Methods One hundred patients undergoing TAVR were retrospectively analyzed,and clinical data,aortic root diameter(aortic ring,sinus,sinus tube junction,proximal ascending aorta),transthoracic ultrasound parameters and postoperative paravalvular leakage were collected.The transthoracic ultrasound parameters were compared before operation,1 month and 2 years after operation.Logistic regression analysis was used to screen the imaging risk factors of paravalvular leak.Results The left ventricular end-diastolic volume(LVEDV),end-diastolic diameter(LVEDD),stroke volume(LVSV),peak aortic valve velocity(Vmax)and maximum transvalvular pressure gradient(PGmax)were significantly improved within 1 month after surgery(P<0.05).Left ventricular remodeling and cardiac function were further improved at 2 years after operation(P<0.05).Logistic regression analysis showed that preoperative widening of the aortic sinus junction was a risk factor for paravalvular leak after TAVR(OR=1.127).Conclusions TAVR surgery has a clear long-term effect on aortic valve disease.Left ventricular reverse remodeling occurred about 1 month after surgery,and the reverse remodeling and cardiac function improvement are more obvious after 2 years.Patients with preoperative widened preoperative aortic sinus junction should be alert for postoperative paravalvular leakage.

关 键 词：超声心动图 经导管主动脉瓣置换术 远期疗效 瓣周漏 

分 类 号：R540.45[医药卫生—心血管疾病] R654.2[医药卫生—内科学]