闭式体外循环下微创与经导管主动脉瓣膜置换术治疗主动脉瓣病变的疗效对比

Comparison of the efficacy of mini-incision and transcatheter aortic valve replacement under closed extracorporeal circulation in the treatment of aortic valvular lesion

目的 对比分析闭式体外循环下微创主动脉瓣膜置换术(MIS-AVR)与经导管主动脉瓣置换术(TAVR)对主动脉瓣病变患者疗效的影响。方法 选取2021年5月至2022年6在该院接受治疗的主动脉瓣病变患者108例,根据手术类型将其分为TAVR组(n=54,行TAVR治疗)和MIS-AVR组(n=54,行MIS-AVR治疗)。比较2组患者临床疗效、围手术期指标、炎症因子水平、心功能指标及并发症发生情况。结果 MIS-AVR组患者总有效率为98.15%(53/54),与TAVR组的96.30%(52/54)比较,差异无统计学意义(P>0.05);MIS-AVR组患者伤口大小、手术时间、术中输血量、住院时间均显著高于TAVR组,差异均有统计学意义(P<0.05);治疗后,2组患者细胞间黏附分子1、单核细胞趋化蛋白1、长正五聚蛋白3水平,左心室内径、肺动脉收缩压、室间隔厚度、二尖瓣环速度均较治疗前显著降低,且MIS-AVR组低于TAVR组,差异均有统计学意义(P<0.05);MIS-AVR组患者并发症发生率为5.55%(3/54),与TAVR组的9.25%(5/54)比较,差异无统计学意义(P>0.05)。结论 MIS-AVR与TAVR治疗主动脉瓣病变疗效均较好,TAVR操作简单,对围手术期患者创伤小,但MIS-AVR对患者炎症因子和心功能的改善较优,且并发症发生率略低。

Objective To compare and analyze the effects of mini-incision aortic valve replacement(MIS-AVR)and transcatheter aortic valve replacement(TAVR)under closed extracorporeal circulation on patients with aortic valvular lesion.Methods A total of 108 patients with aortic valvular lesion who accepted therapy in the hospital from May 2021 to June 2022 were selected and divided into the TAVR group(n=54,TAVR treatment)and the MIS-AVR group(n=54,MIS-AVR treatment)according to the type of surgery.The clinical potency,perioperative indicators,inflammatory factor standards,cardiac ability targets and complications of the two groups were compared.Results The total effective rate of the MIS-AVR group was 98.15%(53/54),compared with 96.30%(52/54)in the TAVR group,the difference was not statistically significant(P>0.05).The slash size,surgery time,intraoperative blood transfusion and length of stay at hospital in the MIS-AVR group were significantly higher than those in the TAVR group,and the differences were statistically significant(P<0.05).After treatment,the levels of intercellular adhesion molecule-1,monocyte chemoattractant protein-1,long-term pentraxin-3,left ventricular diameter,pulmonary artery systolic pressure,interventricular septum thickness and mitral annulus velocity in the two groups were significantly lower than those before treatment,and the MIS-AVR group were less than those in the TAVR group,and the differences were statistically significant(P<0.05).The incidence of complications in the MIS-AVR group was 5.55%(3/54),and there was no significant difference compared with 9.25%(5/54)in the TAVR group(P>0.05).Conclusion MIS-AVR and TAVR are both effective in the treatment of aortic valvular lesion.TAVR is easy to operate and has less trauma to perioperative sicks.However,MIS-AVR has better improvement in inflammatory factors and cardiac function,and the syndromes are slightly lower.