经导管主动脉瓣置换术在外科低危主动脉瓣狭窄患者中的疗效分析Safety and efficacy of transcatheter aortic valve replacement in patients with low surgical risk
李捷,孙英皓,李光,范瑞新,董豪坚,付明,于长江,罗建方
摘要(Abstract):
目的探讨经导管主动脉瓣置换术(TAVR)在外科低危主动脉瓣狭窄(AS)患者中的疗效。方法回顾性收集分析2016年4月至2018年8月在广东省人民医院因症状性重度AS行TAVR治疗患者的基线资料、术前评估、手术资料及短期临床结局。结果接受TAVR治疗的患者共52例,最终纳入外科低危[美国胸外科医师协会(STS)评分<4%]AS患者30例进行分析。平均STS评分为(2.4±0.8)%。TAVR术后30 d死亡率为3.3%。围术期并发症:卒中发生率为0,心肌梗死发生率为3.3%,主要血管并发症发生率为10.0%,急性肾损伤比例为13.3%,瓣周漏>中度比例为3.3%,起搏器植入比例为3.3%。平均随访时间为(9±7)个月,总死亡率为3.3%。结论 TAVR在外科低危AS患者中的应用可能是安全有效的,但长期疗效有待进一步研究。
关键词(KeyWords): 主动脉瓣狭窄;经导管主动脉瓣置换术;外科主动脉瓣置换术;低危
基金项目(Foundation): 广东省公益研究与能力建设专项(2014A020215023);; 广州市产学研协同创新重大专项(1561000356)
作者(Author): 李捷,孙英皓,李光,范瑞新,董豪坚,付明,于长江,罗建方
参考文献(References):
- [1]NishimuraRA,OttoCM, BonowRO, etal. 2017AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease:a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol,2017,70(2):252-289.
- [2]Thyregod HG,SteinbrüchelDA,IhlemannN,et al.Transcatheter versus surgical aortic valve replacement in patients with severe aortic valve stenosis:1-Year results from the all-comers NOTION randomized clinical trial. J Am Coll Cardiol,2015,65(20):2184-2194.
- [3]Rogers T,Torguson R,Bastian R,et al.Feasibility of transcatheter aortic valve replacement in low-risk patients with symptomatic severe aortic stenosis:rationale and design of the Low Risk TAVR(LRT)study.Am Heart J,2017,189:103-109.
- [4]Waksman R, Rogers T, Torguson R, et al.Transcatheter aortic valve replacement in low-risk patients with symptomatic severe aortic stenosis.J Am Coll Cardiol,2018,72(18):2095-2105.
- [5]WitbergG,LadorA, YahavD, etal. Transcatheterversus surgical aortic valve replacement in patients at low surgical risk:a metaanalysis of randomized trials and propensity score matched observational studies.Catheter Cardiovasc Interv,2018,92(2):408-416.
- [6]潘文志,周达新,葛均波.经导管主动脉瓣置换术在外科手术中、低危患者中的研究现状及展望.中国介入心脏病学杂志,2016,24(2):107-109.