主动脉瓣重度狭窄患者经导管主动脉瓣置换术的安全性和有效性分析Analysis of safety and efficacy of transcatheter aortic valve replacement in elderly patients with severe aortic stenosis
冯晔子,曹丰,李苏雷,程帅,张申伟
摘要(Abstract):
目的探讨主动脉瓣重度狭窄患者接受经导管主动脉瓣置换术(TAVR)治疗的有效性和安全性。方法回顾性选取2017年9月至2019年12月接受TAVR的主动脉瓣重度狭窄患者36例。收集患者的人口学、实验室检查、影像辅助检查等全部临床资料,对手术过程、成功率、并发症以及手术前后超声心动图结果等进行分析。结果患者平均年龄(72.42±6.14)岁,瓣膜置入成功率100%。与术前相比,术后第1天的脑钠肽、主动脉瓣最大跨瓣压差、主动脉瓣跨瓣流速差异均有统计学意义(均P<0.01),术后6个月随访左心室射血分数、左心室舒张末期内径及左心室收缩末期内径都有显著改善(均P<0.01)。并发症方面,住院期间1例(2.8%)患者因三度房室传导阻滞行永久性起搏器植入;术后1周有2例(5.6%)患者存在轻度瓣周漏(<2mm),术后6个月随访时只有1例(2.8%)患者存在轻度瓣周漏;术后6个月随访时1例(2.8%)患者缺血性卒中。结论主动脉瓣重度狭窄患者行TAVR治疗有较好的安全性和有效性,可有效改善左心室重塑。
关键词(KeyWords): 经导管主动脉瓣置换术;主动脉瓣重度狭窄;安全性;有效性
基金项目(Foundation):
作者(Author): 冯晔子,曹丰,李苏雷,程帅,张申伟
参考文献(References):
- [1]Murdoch DJ,Webb JG,Ye Jian,et al.Transcatheter aorticvalve replacement-10 years later[J].N Engl J Med,2019,380(18):1773-1774.
- [2]Nishimura RA,Otto CM,Bonow RO,et al.2017 AHA/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/OL].Circulation,2017,135(25):e1159-e1195.
- [3]葛均波,潘文志.我国结构性心脏病介入治疗进展与展望[J].中华心血管病杂志,2019,47(9):689-692.
- [4]中国医师协会心血管内科医师分会结构性心脏病专业委员会.经导管主动脉瓣置换术中国专家共识[J].中国介入心脏病学杂志,2015,23(12):661-666.
- [5]中国医师协会心血管内科医师分会结构性心脏病专业委员.经导管主动脉瓣置换术中国专家共识(2020更新版)[J].中国介入心脏病学杂志,2020,28(6):301-309.
- [6]Kappetein AP,Head S J,Genereux P,et al.Updated standardized endpoint definitions for transcatheter aortic valve implantation:the valve academic research Consortium-2 consensus document[J].Eur Heart J,2012,33(19):2403-2418.
- [7]Pibarot P,Hahn RT,Weissman NJ,et al.Association of paravalvular regurgitation with 1-year outcomes after transcatheter aortic valve replacement with the SAPIEN 3 valve[J].JAMA Cardiology,2017,2(11):1208-1216.
- [8]李明飞,潘文志,张蕾,等.基于单中心经导管主动脉瓣置换术治疗主动脉瓣狭窄初步临床疗效分析[J].中国临床医学,2018,25(1):5-8.
- [9]冯晔子,张申伟,马倩倩,等.主动脉瓣重度狭窄经导管主动脉瓣置换术后患者围术期效果观察[J].心肺血管病杂志,2019,38(11):1146-1149.
- [10]Kodali S,Thourani VH,White J,et al.Early clinical and echocardiographic outcomes after SAPIEN 3 transcatheter aortic valve replacement in inoperable,high-risk and intermediate-risk patients with aortic stenosis[J].Eur Heart J,2016,37(28):2252-2262.
- [11]Leon MB,Smith CR,Mack M J,et al.Transcatheter or surgical aorticvalve replacement in intermediate-risk patients[J].N Engl J Med,2016,374(17):1609-1620.
- [12]Kang DH,Park SJ,Lee SA,et al.Early surgery or conservative care for asymptomatic aortic stenosis[J].N Engl J Med,2020,382(2):111-119.
- [13]Treibel TA,Kozeor R,Schofield R,et al.Reverse myocardical remodeling following valve replaement in patients with aortic stenosis[J].J Am Coll Cardical,2018,71(8):860-871.
- [14]张倩,王建德,肖明虎,等.经导管主动脉瓣置换术后老年主动脉瓣重度狭窄患者左心室重构特征及影响因素分析[J].中华老年心脑血管病杂志,2019,21(7):683-686.