经导管主动脉瓣置换术治疗二叶式主动脉瓣重度狭窄的短期疗效及安全性评价

纪军; 何胜虎; 徐冰; 陈述; 廖清池; 张勤; 张建秋

doi:10.7619/jcmp.201921002

经导管主动脉瓣置换术治疗二叶式主动脉瓣重度狭窄的短期疗效及安全性评价

江苏省苏北人民医院心内科, 江苏扬州, 225001

基金项目:

江苏省苏北人民医院院级特殊重大扶持项目 fcjs201702

详细信息

通讯作者:
何胜虎, E-mail: jijun12008@163.com

中图分类号: R542.5
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出版历程
- 收稿日期: 2019-07-27
- 网络出版日期: 2021-02-28
- 发布日期: 2019-11-14

Evaluation on short-term efficacy and safety of transcatheter aortic valve replacement for patients with severe stenosis of bicuspid aortic valve

Department of Cardiology, Subei People′s Hospital, Yangzhou, Jiangsu, 225001

摘要

摘要:
目的探讨经导管主动脉瓣置换术(TAVR)在二叶式主动脉瓣重度狭窄患者中的短期疗效及安全性。
方法纳入8例入院诊断为重度主动脉瓣狭窄的住院患者为研究对象，均行TAVR术，随访3个月，分析患者的基本资料、术中并发症情况、术后超声心动图，并观察随访期间病死率和严重血管并发症、严重出血情况等不良事件发生率等。
结果 8例患者均为二叶式主动脉瓣重度狭窄，手术均成功。8例患者平均年龄(77.4±8.2)岁，入院时均合并严重心力衰竭(NYHA心功能Ⅲ~Ⅳ级)，平均美国胸外科医师协会(STS)评分为(8.9±5.2) %, 平均欧洲心脏手术风险回归评分为(28.3±22.5) %。1例患者术后行永久起搏器植入, 1例采用瓣中瓣技术。所有患者术中无急性冠脉堵塞情况发生。术后随访3个月，无死亡病例, 1例轻度消化道出血，无严重血管并发症。术后即刻以及术后3个月时，超声心动图检查平均跨主动脉瓣压差均较术前显著降低(P < 0.05), 左心室射血分数均较术前显著提高(P < 0.05)。
结论对高危二叶式主动脉瓣重度狭窄患者实施TAVR技术，能有效降低平均跨瓣压差，改善患者心功能，且安全有效。
- 主动脉瓣狭窄 /
- 经导管主动脉瓣置换术 /
- 心力衰竭 /
- 超声心动图 /
- 左心室射血分数
Abstract:
Objective To evaluate the short-term efficacy and safety of transcatheter aortic valve replacement (TAVR)in patients with severe stenosis of bicuspid aortic valve.
Methods A total of 8 patients diagnosed with severe aortic valve stenosis in our hospital were selected and underwent TAVR. All patients were followed up for three months, the basic data, intraoperative complications, and postoperative echocardiography were compared. The mortality rate, serious vascular complications, serious bleeding and other adverse events were observed.
Results All the 8 patients were diagnosed as severe bicuspid aortic valve stenosis, and were performed TAVR successfully. All the eight patients, aged(77.4±8.2)years averagely, were complicated with impaired heart function (NYHA Ⅲ-Ⅳ), with a (8.9±5.2) % of mean mortality scores of Society of Thoracic Surgery (STS) and a (28.3±22.5) % of mean European Heart Surgery Risk Regression Score. Among them, 1 patient received permanent pacemaker implantation after surgery, and l patient received valve-in-valve implantation technique. No acute coronary artery occlusion occurred in all patients. After 3 months follow-up, no death was found, only 1 case occurred mild gastrointestinal bleeding, but no serious vascular complications. The mean aortic valve pressure gradient decreased significantly right after surgery and three months after surgery (P < 0.05). The left ventricular ejection fraction (LVEF) increased significantly compared to the surgery before(P < 0.05).
Conclusion TAVR can effectively reduce the mean aortic valve pressure difference and improve cardiac function in patients with severe bicuspid aortic valve stenosis.
- aortic valve stenosis /
- transcatheter aortic valve replacement /
- heart failure /
- echocardiogram /
- left ventricular ejection fraction

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表 1 患者围术期超声检查结果比较(x±s)

指标	术前	术后即刻	术后3个月
跨主动脉瓣流速/(m/s)	4.5±0.4	1.3±0.4^*	1.3±0.3^*
主动脉瓣平均跨瓣压差/mmHg	59.8±19.2	9.5±4.6^*	8.8±3.9^*
左心室舒张末内径/mm	52.3±3.3	52.3±3.3	51.1±2.6
左心室射血分数/%	44.5±17.4	58.6±11.5^*	59.6±10.5^*
与术前比较, *P < 0.05。

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