自展瓣与球扩瓣在经导管主动脉瓣置换术治疗二叶式主动脉瓣重度狭窄患者中的应用比较  

Comparison of the application of self expanding valve and bulbous valve in the treatment of severe bicuspid aortic valve stenosis in patients undergoing transcatheter aortic valve replacement

作　　者：崔姣姣 梁善福 张申伟 CUI Jiaojiao;LIANG Shanfu;ZHANG Shenwei(Department of Cardiology,the Seventh People's Hospital in Zhengzhou,Zhengzhou,450000,China)

机构地区：[1]郑州市第七人民医院心血管内科十病区,郑州450000

出　　处：《临床心血管病杂志》2025年第2期143-149,共7页Journal of Clinical Cardiology

基　　金：郑州市卫生健康委2022郑州市第二层次名医培养项目(No:郑卫科[2023]10号);河南省医学科技攻关计划项目(No:LHGJ20220835)。

摘　　要：目的:比较自展瓣与球扩瓣在经导管主动脉瓣置换术(TAVR)治疗二叶式主动脉瓣重度狭窄患者中的应用效果。方法:收集2020年7月—2023年6月接受TAVR治疗的二叶式主动脉瓣重度狭窄患者128例的临床资料,根据置入瓣膜分为自展瓣组(72例)、球扩瓣组(56例),采用1∶1倾向性评分匹配法筛选基线资料均衡两组病例(各52例),比较两组一般资料、血流动力学、心肌损伤标志物、主要终点事件。结果:术后1个月、术后6个月、术后1年,自展瓣组患者主动脉瓣瓣口面积(AVA)高于球扩瓣组,平均跨瓣压差(MPG)、主动脉瓣前向血流峰值速度(Vmax)低于球扩瓣组(P<0.05)。术后48 h、术后1周、术后2周,自展瓣组患者血清肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白T(cTnT)、肌红蛋白(MYO)高于球扩瓣组(P<0.05)。自展瓣组与球扩瓣组全因死亡(χ^(2)=0.153,P=0.696)、脑卒中(χ^(2)=0.343,P=0.588)、新发心房颤动(χ^(2)=0.210,P=0.647)比较,差异无统计学意义(P>0.05);自展瓣组血流动力学结构瓣膜功能障碍率(3.85%vs 21.25%,χ^(2)=7.121,P=0.008)、瓣膜-患者不匹配率(3.85%vs 13.46%,χ^(2)=9.983,P=0.046)低于球扩瓣组;新发传导阻滞率(23.38%vs 7.69%,χ^(2)=4.727,P=0.030)、永久性起搏器置入率(19.23%vs 5.77%,χ^(2)=4.308,P=0.038)、瓣周漏率(15.38%vs 3.85%,χ^(2)=3.983,P=0.046)高于球扩瓣组。结论:自展瓣与球扩瓣行TAVR术治疗二叶式主动脉瓣重度狭窄效果均值得肯定,自展瓣血流动力学优于球扩瓣,但心肌损伤相对较重。在行TAVR治疗二叶式主动脉瓣重度狭窄时,自展瓣应注意预防新发传导阻滞、永久性起搏器置入、瓣周漏发生的风险,球扩瓣应注意预防生物瓣膜功能障碍。Objective To compare the application effects of self expanding valve and bulbous valve in the treatment of severe bicuspid aortic valve stenosis in patients undergoing transcatheter aortic valve replacement(TAVR).Methods Clinical data of 128 patients with severe bicuspid aortic valve stenosis who received TAVR treatment from July 2020 to June 2023 were collected.The patients were divided into a self expanding valve group(72 cases)and a balloon dilation valve group(56 cases)based on the implanted valve.A 1:1 propensity score matching method was used to screen for baseline data balance between the two groups(52 cases each).General data,hemodynamics,myocardial injury markers,and primary endpoint events were compared between the two groups.Results At 1 month,6 months,and 1 year after surgery,the aortic valve area(AVA)of patients in the self expanding valve group was higher than that in the bulbous valve group,and the average transvalvular pressure gradient(MPG)and forward flow velocity(V_(max))of the aortic valve were lower than those in the bulbous valve group(P<0.05).At 48 hours,1 week,and 2 weeks after surgery,the serum levels of creatine kinase isoenzyme(CK-MB),cardiac troponin T(cTnT),and myoglobin(MYO)in the self expanding valve group were higher than those in the balloon expanding valve group(P<0.05).There was no significant difference in all-cause mortality(χ^(2)=0.153,P=0.696),stroke(χ^(2)=0.343,P=0.588),and new onset atrial fibrillation((χ^(2)=0.210,P=0.647)between the self expanding valve group and the balloon expanding valve group;The hemodynamic structural valve dysfunction rate(3.85%vs 21.25%)and valve patient mismatch rate(3.85%vs 13.46%)in the self expanding valve group were lower than those in the expanded valve group(χ^(2)=7.121,P=0.008);(χ^(2)=9.983,P=0.046);The incidence of new conduction block(23.38%vs 7.69%),permanent pacemaker implantation rate(19.23%vs 5.77%),and perivalvular leakage rate(15.38%vs 3.85%)were higher in the group with balloon dilation than in the group with balloon dilation

关 键 词：二叶式主动脉瓣狭窄 经导管主动脉瓣置换术 自展瓣 球扩瓣 血流动力学 心肌损伤 

分 类 号：R541[医药卫生—心血管疾病]