白英楠,张亚琦,李智行,邓欣,潘文志,周达新,葛均波

• 1:复旦大学附属中山医院心内科

摘要(Abstract)：

目的探讨经导管主动脉瓣置换术(TAVR)治疗二叶式、三叶式主动脉瓣狭窄的安全性及有效性。方法连续纳入2010年10月至2017年10月在复旦大学附属中山医院行TAVR的重度主动脉瓣狭窄患者92例,根据超声心动图及多排CT图像分为三叶式主动脉瓣组(49例)和二叶式主动脉瓣组(43例)。比较两组患者术前、术后24 h、术后48 h、出院时血清肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白T (cTnT)、N末端B型脑钠肽前体(NT-proBNP),术前、术后、术后1年主动脉瓣平均跨瓣压差及瓣口面积等。结果两组患者CK-MB术前、术后24 h、术后48 h、出院,cTnT术前、术后24 h、术后48 h,NT-proBNP术后24 h、术后48 h,左心室射血分数(LVEF)术前、术后1年,主动脉瓣跨瓣压差术前、术后、术后1年,瓣口面积术后、术后1年,住院时间,住冠心病重症监护室时间比较,差异均无统计学意义(均P>0.05)。二叶式主动脉瓣组患者出院cTnT[(0.225±0.209)μg/L比(0.129±0.097)μg/L,P=0.010]、术前NT-proBNP[(5356±6235)pg/ml比(2687±3043)pg/ml,P=0.015]、出院NT-proBNP[(3172±4310)pg/ml比(1593±1313)pg/ml,P=0.034]显著大于三叶式主动脉瓣组;而术后LVEF[(56.43±12.67)%比(61.21±7.39)%,P=0.047]、术前瓣口面积[(0.62±0.15)cm~2比(0.72±0.19)cm~2,P=0.006]显著小于三叶式主动脉瓣组,差异均有统计学意义。两组患者术中并发症、出院前并发症及术后1年并发症发生率比较,差异均无统计学意义(均P>0.05)。结论在行TAVR患者中,三叶式主动脉瓣狭窄患者在术前及出院时心功能、术前瓣口面积均优于二叶式主动脉瓣狭窄患者,但二叶式主动脉瓣狭窄患者的获益更大。在解剖改善、临床结局等方面,二叶式主动脉瓣狭窄较三叶式主动脉瓣狭窄患者无明显不足。

关键词(KeyWords)： 经导管主动脉瓣置换术;二叶式主动脉瓣;三叶式主动脉瓣;心肌损伤标志物

Abstract:

Keywords:

基金项目(Foundation): 中山青年基金(2015ZSYXQN25)

作者(Author): 白英楠,张亚琦,李智行,邓欣,潘文志,周达新,葛均波

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