“All in One”技术在“一站式”经导管主动脉瓣置换术联合经皮冠状动脉介入治疗术中的应用Application of “All in One” technique in the concomitant transcatheter aortic valve replacement and percutaneous coronary interventions
宋光远,刘新民,姚晶,阴赪茜,吴文辉,苑飞,罗太阳,常三帅,闫云峰,卢志南,蒲俊舟
摘要(Abstract):
目的 总结“All in One”技术在“一站式”经导管主动脉瓣置换术联合经皮冠状动脉介入治疗(PCI)中应用的初步经验。方法 连续收集2021年7月至2022年9月首都医科大学附属北京安贞医院心脏瓣膜病介入中心在“一站式”经导管主动脉瓣置换术联合PCI中应用“All in One”技术的患者27例进行回顾性分析,总结临床资料、影像学资料、手术操作、住院和出院随访期间主要不良心脑血管事件的发生情况。结果 27例患者平均年龄(74.1±7.8)岁;男15例,女12例;平均美国胸外科医师协会评分(6.02±3.25)%;主动脉瓣重度狭窄22例,单纯主动脉瓣重度反流5例;三叶式主动脉瓣20例,二叶式主动脉瓣7例。术前平均跨主动脉瓣血流速度(4.2±1.2)m/s,跨主动脉瓣平均压差(52.1±13.3)mmHg。所有患者均置入药物洗脱支架,其中左主干病变4例,多支血管病变11例,平均置入支架数量(1.8±0.9)枚,应用冠状动脉斑块旋磨术1例。所有患者在PCI术后均置入自膨胀瓣膜,术中无死亡、心肌梗死、脑卒中、急诊转外科手术、血管并发症发生,1例患者行瓣中瓣手术,无中重度瓣周反流。住院期间无死亡、心肌梗死、脑卒中、血管并发症发生,1例患者行永久起搏器植入术。平均随访(7.8±3.7)个月,无死亡、脑卒中及肾功能恶化发生,3例患者因胸闷复查冠状动脉造影,均未发现明显冠状动脉狭窄。结论 在“一站式”经导管主动脉瓣置换术联合PCI中应用“All in One”技术是安全可行的。
关键词(KeyWords): 经导管主动脉瓣置换术;经皮冠状动脉介入治疗;“All in One”技术
基金项目(Foundation): 首都卫生发展科研专项(首发2022-2-2065)
作者(Author): 宋光远,刘新民,姚晶,阴赪茜,吴文辉,苑飞,罗太阳,常三帅,闫云峰,卢志南,蒲俊舟
参考文献(References):
- [1]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(2020更新版)[J].中国介入心脏病学杂志,2020,28(6):301-309. DOI:10.3969/j.issn.1000-3614.2022.01.003.
- [2] Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in lowrisk patients[J]. N Engl J Med, 2019, 380(18):1695-1705. DOI:10.1056/NEJMoa1814052.
- [3] Popma JJ, Deeb GM, Yakubov SJ, et al. Transcatheter aortic-valve replacement with a self-expand ing valve in low-risk patients[J]. N Engl J Med, 2019, 380(18):1706-1715.DOI:10.1056/NEJMoa1816885.
- [4] Faroux L, Guimaraes L, Wintzer-Wehekind J, et al. Coronary artery disease and transcatheter aortic valve replacement:JACC state-ofthe-art review[J]. J Am Coll Cardiol, 2019, 74(3):362-372. DOI:10. 1016/j. jacc. 2019. 06. 012.
- [5] Walther T, Hamm CW, Schuler G, et al. Perioperative results and complications in 15 964 transcatheter aortic valve replacements:prospective data from the GARY registry[J]. J Am Coll Cardiol, 2015, 65(20):2173-2180. DOI:10.1016/j. jacc. 2015. 03. 034.
- [6]刘新民,姚晶,董哲,等.使用单动脉入路技术行经导管主动脉瓣置换术三例[J].中国循环杂志,2022,37(4):421-424. DOI:10.3969/j.issn.1000-3614.2022.04.018.
- [7] Ramee S, Anwaruddin S, Kumar G, et al. The rationale for performance of coronary angiography and stentingbefore transcatheter aortic valve replacement:from the interventional section leadership council of the american college of cardiology[J].JACC Cardiovasc Interv, 2016, 9(23):2371-2375. DOI:10.1016/j.jcin.2016.09.024.
- [8] Gasparetto V, Fraccaro C, Tarantini G,et al. Safety and effectiveness of a selective strategy for coronary artery revascularization before transcatheter aortic valve implantation[J]. Catheter Cardiovasc Interv,2013,81(2):376-383. DOI:10.1002/ccd.24434.
- [9] Abdel-Wahab M, Mostafa AE, Geist V, et al. Comparison of outcomes in patients having isolated transcatheter aortic valve implantation versus combined with preprocedural percutaneous coronary intervention[J]. Am J Cardiol,2012,109(4):581-586. DOI:10.1016/j.amjcard.2011.09.053.
- [10]王墨扬,宋光远,张倩,等.“一站式”经皮冠状动脉介入治疗+经导管主动脉瓣置换术的临床应用[J].中国循环杂志,2021,36(9):846-851. DOI:10.3969/j.issn.1000-3614.2021.09.003.
- [11]李练,方臻飞.经导管主动脉瓣置换术围术期急性肾功能不全的研究现状[J].中国介入心脏病学杂志,2022,30(11):855-858. DOI:10. 3969/j. issn. 1004-8812. 2022. 11. 010.