张洪亮,刘庆荣,陈阳,牛冠男,王墨扬,赵杰,赵振燕,吴永健

• 1:国家心血管病中心北京协和医学院中国医学科学院阜外医院冠心病中心结构性心脏病一病房

摘要(Abstract)：

目的 总结经导管主动脉瓣置换术（TAVR）后行经皮冠状动脉介入治疗（PCI）的经验。方法 回顾中国医学科学院阜外医院冠心病中心和结构性心脏病一病房在2020年10月1日至2023年3月5日TAVR术后再次行PCI的患者，收集患者的临床资料及PCI相关数据。结果 共纳入8例TAVR术后接受PCI的患者，年龄66～84岁，其中男3例（3/8）,7例（7/8）患者置入自膨胀瓣膜，1例（1/8）患者置入球囊扩张瓣膜。2例（2/8）患者在TAVR术前即发现冠状动脉严重病变，先行TAVR纠正心力衰竭后择期再行PCI；其余6例（6/8）在TAVR时冠状动脉均为临界病变，在TAVR术后7～55个月因冠状动脉病变明显加重行PCI。5例（5/8）患者临床表现为急性非ST段抬高型心肌梗死，3例（3/8）表现为心绞痛。PCI靶血管均为左侧冠状动脉，以左前降支为主；6例（6/8）PCI路径为右桡动脉，2例（2/8）为股动脉。6例（6/8）患者选用Judikins left指引导管，2例（2/8）选用EBU指引导管。患者均成功完成PCI，原位病变置入支架，支架内再狭窄病变应用药物涂层球囊扩张，其中3例患者使用Guidezilla延长导管。PCI耗时25～100 min。PCI术后随访2～30个月未发生心肌梗死、靶血管血运重建、心原性猝死等主要不良心血管事件。结论 TAVR术后行PCI安全、可行且预后良好。

关键词(KeyWords)： 主动脉瓣狭窄;经导管主动脉瓣置换术;冠状动脉疾病;经皮冠状动脉介入治疗

Abstract:

Keywords:

基金项目(Foundation): 首都卫生发展科研专项,老年高危复杂主动脉瓣疾病优化治疗策略研究（首发2020-1-4031）;; 国家重点研发计划,老年重度主动脉瓣狭窄优化治疗策略及临床路径研究（2020YFC2008103）

作者(Author): 张洪亮,刘庆荣,陈阳,牛冠男,王墨扬,赵杰,赵振燕,吴永健

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