超大瓣环单纯主动脉瓣反流的经导管主动脉瓣置换术经验  

Experience in transcatheter aortic valve replacement for isolated aortic regurgitation in patients with oversized annulus

作　　者：李岳环 周佳卫 罗天戈[1] 陈章 李昊阳 沈经伦 吴凯胜 王坚刚[1] 张海波[1] LI Yue-huan;ZHOU Jia-wei;LUO Tian-ge;CHEN Zhang;LI Hao-yang;SHEN Jing-lun;WU Kai-sheng;WANG Jian-gang;ZHANG Hai-bo(Center for Valve and Atrial Fibrillation Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院瓣膜与房颤外科中心,北京市100029

出　　处：《中国心血管病研究》2025年第4期310-315,共6页Chinese Journal of Cardiovascular Research

摘　　要：目的 总结本中心创新性应用J-Valve支架加宽和(或)保险绳技术对超大瓣环径患者成功行经导管主动脉瓣置换术(TAVR)术的经验。方法 纳入2018年4月至2023年9月在首都医科大学附属北京安贞医院瓣膜与房颤外科中心因主动脉瓣环径>29 mm,心脏直视手术高风险或禁忌,最终行TAVR手术的患者。结果 19例患者因瓣环径>29 mm采用了支架加宽和或保险绳技术的改良TAVR,平均年龄(65.4±10.9)岁。中位胸外科协会(STS)评分和欧洲心血管手术风险评分(EuroSCORE)Ⅱ预测的病死率分别为12.4(7.8~17.3)%和(23.3±3.7)%。主动脉瓣环径及左心室流出道内径分别为(30.5±1.4)mm和(33.7±5.4)mm。合并有左心室收缩功能受损,左心室射血分数为(46.1±13.0)%。左心室显著扩大,左心室舒张末期内径(67.8±10.5)mm,左心室收缩末期内径(54.1±13.0)mm。所有患者均使用J-Valve系统并使用经心尖入路。手术成功率为94.7%。中位随访时间和最长随访时间分别为12(4,41)个月和60个月。5例患者随访期间死亡,全因死亡率为29.4%。结论 使用J-Valve系统结合支架加宽和或保险绳技术行经心尖主动脉瓣置换术治疗大瓣环单纯主动脉瓣关闭不全是安全可行的。Objective To summarize the experience in the innovative application of the J-Valve system,including stent widening and/or the safety cord technique,for successful transcatheter aortic valve replacement(TAVR) in patients with oversized annular diameters.Methods The patients who underwent TAVR at the Center for Valve and Atrial Fibrillation Surgery,Beijing Anzhen Hospital,Capital Medical University between April 2018and September 2023 were included.These patients had severe aortic regurgitation with an aortic annulus diameter >29 mm and were at high risk or had contraindications for open-heart surgery.Results Modified TAVR with stent widening and/or the safety cord technique was performed in 19 patients with a mean age(65.4±10.9)years with an annular diameter greater than 29 mm.The predicted mortality rates by the society of thoracic surgeons(STS) score and EuroSCORE Ⅱ were 12.4(7.8-17.3)% and(23.3 ± 3.7)%,respectively.The aortic annulus diameter and left ventricular outflow tract diameter were(30.5±1.4) mm and(33.7±5.4) mm,respectively.Impaired left ventricular systolic function was observed,with a left ventricular ejection fraction of(46.1±13.0)%.The left ventricle was significantly enlarged,with the end-diastolic and end-systolic diameters of(67.8±10.5) mm and(54.1±13.0) mm,respectively.All patients were treated with the J-Valve system using a transapical approach.The surgical success rate was 94.7%.The median and maximum follow-up durations were 12(4~41) months and60 months,respectively.During the follow-up,5 patients died,resulting in an all-cause mortality rate of 29.4%.Conclusions Transapical aortic valve replacement using the J-Valve system,combined with stent widening and/or the safety cord technique,is safe and feasible for treating pure severe aortic regurgitation in patients with a large annulus.

关 键 词：心脏瓣膜病 主动脉瓣关闭不全 经导管主动脉瓣置换术 心功能不全 大瓣环 

分 类 号：R654.7[医药卫生—外科学]