姜正明,胡彩娜,常三帅,刘新民,姚晶,苑飞,闫云峰,席子惟,赵茂翔,董建增,宋光远

• 1:首都医科大学附属北京安贞医院心脏瓣膜病介入中心国家心血管病临床医学研究中心
• 2:郑州大学第一附属医院心内科

摘要(Abstract)：

目的 探讨等周长扩张法指导球囊扩张式瓣膜（球扩瓣）用于二叶式主动脉瓣（BAV）患者经导管主动脉瓣置换术（TAVR）治疗，分析其安全性和有效性。方法 本研究连续入选2021年3月至2023年3月首都医科大学附属北京安贞医院和郑州大学第一附属医院45例BAV行TAVR且选择球扩瓣的患者，采用等周长扩张法指导TAVR术前CT分析及球扩瓣选择。收集患者基线特征、手术相关指标、手术并发症及术后12个月随访情况。结果 45例患者中男25例（55.6%），平均年龄（71.3±5.6）岁，其中Type 0型BAV 20例（44.4%）,Type 1型BAV 24例（53.3%），美国胸外科医师协会评分（4.3±1.8）%。根据主动脉瓣环上多平面测量的形态，BAV形态可分为管形24例（53.3%）、倒梯形12例（26.7%）和梯形9例（20.0%）。所有患者均采用Sapien 3瓣膜行TAVR手术，采用等周长扩张法指导主动脉瓣CT锚定平面和封闭平面描记，预测的锚定平面平均直径（23.9±2.7）mm；封闭平面周长导出直径（24.4±3.1）mm，实际采用的人工生物瓣环平均直径（24.6±2.3）mm，所有患者均成功完成手术，无住院死亡、瓣环破裂及中重度瓣周漏。出现1例术中冠状动脉阻塞，1例永久起搏器植入，1例股动脉穿刺点出血。12个月随访无主要不良事件；术后患者纽约心脏病协会心功能分级较基线显著改善，左心室射血分数显著改善，差异均有统计学意义（均P<0.001）。结论 等周长扩张法通过“二叶瓣分型+锚定平面测量+周长导向的封闭平面测量+多平面验证”的核心逻辑指导球扩瓣用于BAV患者TAVR治疗具有较高的安全性和有效性，可降低术后中重度瓣周漏风险，改善患者心功能及12个月预后。

关键词(KeyWords)： 二叶式主动脉瓣狭窄;经导管主动脉瓣置换术;球囊扩张式瓣膜;多平面测量;等周长扩张

Abstract:

Keywords:

基金项目(Foundation): 北京市医院管理中心“登峰”计划项目（DFL20240604）

作者(Author): 姜正明,胡彩娜,常三帅,刘新民,姚晶,苑飞,闫云峰,席子惟,赵茂翔,董建增,宋光远

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