张小雪,冯异,马先桃,杨宇杰,Wajeehullahi Akilu,颜晨曦,张子悦,陈子君,秦波,李师亮,程才

• 1:华中科技大学同济医学院附属同济医院心脏大血管外科
• 2:华中科技大学同济医学院附属中西医结合医院皮肤科
• 3:武汉泰康同济医院胸心外科
• 4:浙江大学医学院附属第二医院心脏大血管外科

摘要(Abstract)：

目的 本研究旨在评估经导管主动脉瓣置入术（TAVI）治疗原发性主动脉瓣反流（NAVR）的疗效和安全性，并与主动脉瓣狭窄（AS）对比人工瓣膜尺寸的选择的不同和并发症的差异。方法 根据瓣膜学术研究联盟（VARC-3）的定义，选取2019年3月至2024年9月华中科技大学同济医学院附属同济医院的143例接受TAVI治疗的NAVR/AS患者和接受外科主动脉瓣生物瓣置换术（SAVR）治疗的NAVR患者，对其基线、围术期和主要终点事件的临床数据进行回顾性收集并比较。结果 43例NAVR患者接受了TAVI治疗，设备成功率为86.0%，手术成功率为95.3%。（1）NAVR-TAVI组比NAVR-SAVR组：NAVR-TAVI组的患者手术时间明显短于NAVR-SAVR组（P<0.001）;NAVRTAVI组术后更易出现完全性左束支传导阻滞（P=0.042）,NAVR-SAVR组术后更易出现完全性右束支传导阻滞（P=0.044）。NAVR-SAVR组术后充血性心力衰竭的发生率更高（P=0.013）,NAVR-SAVR组死亡率明显高于NAVR-TAVI组（P=0.019）。（2）NAVR-TAVI组比AS-TAVI组：入路选择、THV尺寸[28(22,34)mm比24(22,32)mm,P=0.044]和THV超径率[14%(7%,20%)%比7%(3%,11%),P<0.001]差异均有统计学意义。AS-TAVI和NAVR-TAVI两组患者在TAVI治疗后均有1例永久起搏器植入。AS-TAVI组有2例转为外科手术治疗，6例患者死亡。结论 使用“标签外”（经股动脉）和“标签内”（经心尖）的TAVI设备（均来自国产）治疗NAVR比SAVR安全性更高，尤其是在老年和高危患者中。与采用TAVI治疗的AS患者相比，NAVR通常选择更大直径的瓣环，瓣膜移位率更高，但总体安全性和疗效与AS相当。

关键词(KeyWords)： 经导管主动脉瓣置入术;外科主动脉瓣置换术;原发性主动脉瓣反流;主动脉瓣狭窄

Abstract:

Keywords:

基金项目(Foundation): 国家重点研发计划项目（2023YFC2412400）

作者(Author): 张小雪,冯异,马先桃,杨宇杰,Wajeehullahi Akilu,颜晨曦,张子悦,陈子君,秦波,李师亮,程才

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