经导管主动脉瓣置换术与外科主动脉瓣置换术治疗重度主动脉瓣狭窄效果比较  

Comparison of effects of transcatheter aortic valve replacement and surgical aortic valve replacement in the treatment of aortic stenosis

作　　者：蔡超 杨少峰 刁文杰 刘戈 施超 CAI Chao;YANG Shaofeng;DIAO Wenjie;LIU Ge;SHI Chao(Department of Cardiology,The First Affiliated Hospital of Bengbu Medical University,Bengbu 233000,China)

机构地区：[1]蚌埠医科大学第一附属医院心脏外科,安徽蚌埠233000

出　　处：《山东医药》2025年第4期59-62,共4页Shandong Medical Journal

基　　金：安徽省卫健委科研项目(AHWJ2023A30184)。

摘　　要：目的比较经导管主动脉瓣置换术(TAVR)、外科主动脉瓣置换术(SAVR)治疗重度主动脉瓣狭窄(AS)的效果。方法选取2020年1月—2024年10月蚌埠医科大学第一附属医院心脏外科收治的重度AS患者41例,按照施行手术方式不同分为TAVR组(15例)和SAVR组(26例),TAVR组采用TAVR治疗,SAVR组采用SAVR治疗,比较两组手术前后左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)及术后机械通气时间、术后住院时间、术后第1天引流量、住ICU时间和术后并发症。结果与同组术前比较,TAVR组术后LVEDD、LVEF和SAVR组术后LVEDD均减小(P均<0.05);与SAVR组比较,TAVR组术后LVEDD减小(P<0.05)。与SAVR组比较,TAVR组术后第1天引流量少(P<0.05);与SAVR组比较,TAVR组术后机械通气时间、术后住院时间、住ICU时间短,但两组比较无统计学差异(P均>0.05)。TAVR组术后瓣周漏2例(13.33%),SAVR组术后瓣周漏1例(3.85%)、切口感染2例(7.69%)、二次手术止血1例(3.85%),两组比较,P>0.05。结论TAVR、SAVR治疗重度AS效果较好,均可以改善患者心功能,但TAVR较SAVR术后恢复时间短、手术创伤小及手术并发症少。Objective To compare the clinical efficacy of surgical aortic valve replacement(SAVR)and transcathe-ter aortic valve replacement(TAVR)in the treatment of aortic stenosis(AS).Methods From January 2020 to October 2024,41 patients with severe AS admitted to the Department of Cardiac Surgery,the First Affiliated Hospital of Bengbu Medical University were divided into the TAVR group(15 cases)and SAVR group(26 cases)according to different surgi-cal methods,and patients in the TAVR group were treated with TAVR,SAVR group with SAVR.Left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),postoperative mechanical ventilation time,postopera-tive hospitalization time,drainage on the first day after operation,intensive care unit(ICU)stay,and postoperative com-plications were compared between the two groups.Results Compared with the same group before operation,LVEDD and LVEF in the TAVR group,and LVEDD in the SAVR group decreased after operation(all P<0.05).Compared with the SAVR group,LVEDD in the TAVR group decreased after operation(P<0.05).Compared with the SAVR group,TAVR group had less drainage on the first day after operation(P<0.05).Compared with the SAVR group,the postopera-tive mechanical ventilation time,postoperative hospital stay and ICU stay in the TAVR group were shorter,but there were no statistical differences between the two groups(all P>0.05).Postoperative perivalvular leakage occurred in 2 cases(13.33%)in the TAVR group,and 1 case(3.85%)in the SAVR group,meanwhile,2 cases(7.69%)had wound infec-tion and 1 case(3.85%)had hemostasis of reoperation in the SAVR group,with no significant differences between the two groups(all P>0.05).Conclusion TAVR and SAVR are effective in treatment of severe AS,both of which can improve patients'cardiac function,but TAVR has shorter recovery time,less surgical trauma and fewer surgical complications than SAVR.

关 键 词：主动脉瓣狭窄 主动脉瓣膜置换术 心脏导管微创技术 开胸手术 

分 类 号：R542.5[医药卫生—心血管疾病]