单纯主动脉瓣反流和狭窄患者经导管主动脉瓣置换术后并发症的差异及影响因素分析  

Analysis of differences in complications and risk factors after transcatheter aortic valve replacement between patients with pure aortic regurgitation and stenosis

作　　者：王若枫 张超 雷晨慧 张璇 王敏红 王娟 周运锋 Wang Ruofeng;Zhang Chao;Lei Chenhui;Zhang Xuan;Wang Minhong;Wang Juan;Zhou Yunfeng(Department of Radiology,the First Affiliated Hospital of Wannan Medical College,Wuhu 241000,China;Department of Cardiology,the First Affiliated Hospital of Wannan Medical College,Wuhu 241000,China)

机构地区：[1]皖南医学院第一附属医院放射科,芜湖241000 [2]皖南医学院第一附属医院心血管内科,芜湖241000

出　　处：《中华放射学杂志》2025年第4期432-440,共9页Chinese Journal of Radiology

摘　　要：目的探讨单纯主动脉瓣反流(PAR)和主动脉瓣狭窄(AS)患者经导管主动脉瓣置换术(TAVR)后并发症的差异,并分析主要并发症发生的危险因素。方法回顾性纳入2021年10月至2024年1月在皖南医学院第一附属医院接受TAVR手术治疗的124例患者,依据术前超声心动图将患者分为PAR组(64例)和AS组(60例)。收集患者术前临床资料、心脏超声及CT影像数据,并记录术后并发症。比较2组患者术后并发症及术前临床、影像资料的差异;以多因素logistic回归分析2组患者主要并发症的危险因素,并采用受试者操作特征(ROC)曲线分析各危险因素对2组患者术后主要并发症的预测效能。结果PAR组的主要并发症是传导阻滞(CD,33例);AS组的主要并发症是瓣周漏(PVL,41例)。术前资料比较显示PAR组患者术后有无CD在膜部室间隔(MS)最短径、MS最短径/最长径的差异上有统计学意义(P均<0.05);AS组患者术后有无PVL在主动脉瓣环长径、瓣环面积、瓣环周长、锚定区钙化积分的差异上有统计学意义(P均<0.05)。多因素logistic回归分析显示MS最短径是PAR患者术后发生CD的独立危险因素(OR=0.628,95%CI 0.437~0.902,P=0.012),其ROC曲线下面积为0.751(95%CI 0.630~0.872,P=0.001);而锚定区钙化积分是AS患者术后发生PVL的独立危险因素(OR=1.454,95%CI 1.055~2.003,P=0.022),其ROC曲线下面积为0.740(95%CI 0.601~0.879,P=0.003)。结论PAR和AS患者TAVR术后的并发症有所差异,其中CD是PAR患者的主要并发症,MS最短径是其发生的危险因素;而PVL是AS患者术后的主要并发症,锚定区钙化积分是其发生的危险因素。ObjectiveTo investigate the differences in complications after transcatheter aortic valve replacement(TAVR)between patients with pure aortic regurgitation(PAR)and aortic valve stenosis(AS),and to explore the risk factors for the occurrence of major complications.MethodsTotally 124 patients who underwent TAVR at the First Affiliated Hospital of Wannan Medical College between October 2021 and January 2024 were retrospectively included.Patients were divided into the PAR group(64 cases)and AS group(60 cases)based on preoperative echocardiography findings.Preoperative clinical data,echocardiography,CT imaging data,and postoperative complications were collected.The differences between the two groups in postoperative complications and preoperative clinical data,imaging data were compared.Multivariate logistic regression analysis was used to assess the risk factors for major complications in the two groups,receiver operating characteristic(ROC)curve analysis was performed to evaluate the predictive efficacy of major risk factors for common postoperative complications in both groups.ResultsThe major complication in the PAR group was conduction disturbance(CD,33 cases);the major complication in the AS group was perivalvular leakage(PVL,41 cases).Comparison of preoperative data showed that in the PAR group,there were statistically significant differences in the shortest diameter of the membranous septum(MS)and the ratio of the shortest to longest MS diameter between patients with and without postoperative CD(both P<0.05).In the AS group,there were statistically significant differences in the long diameter of the aortic annulus,annular area,annular perimeter,and calcification score of the anchoring zone between patients with and without postoperative PVL(all P<0.05).Multivariate logistic regression analysis revealed that the shortest diameter of the MS was an independent risk factor for postoperative CD in PAR patients(OR=0.628,95%CI 0.437-0.902,P=0.012),and the area under the ROC curve was 0.751(95%CI 0.630-0.872,P=0.001).M

关 键 词：主动脉瓣狭窄 经导管主动脉瓣置换术 单纯主动脉瓣反流 手术后并发症 

分 类 号：R654.2[医药卫生—外科学]