经导管主动脉瓣置入术的初步经验

Initial experience of transcatheter aortic valve implantation

目的评估经导管主动脉瓣置入术（TAVI）的安全性及有效性，并对初步的操作经验做一总结。方法2010年10月至2011年5月，使用18FCorevalve瓣膜系统对3例外科手术高危的重度钙化性主动脉瓣狭窄患者实施TAVI。分析3例患者的手术效果及并发症，总结相关的手术经验。结果3例患者均完成手术，顺利出院。手术时间（109．0±22．6）min，X线曝光时间（24．0±9．5）min。术后患者的主动脉跨瓣压差从（84±15）mmHg（1mmHg=0．133kPa）降至（6±3）mmHg，并有轻微至轻度瓣周漏。病例1围手术期未发生并发症；病例2术后出现一过性完全性左束支传导阻滞；病例3出现三度房室传导阻滞（置入永久心脏起搏器）、心包填塞（经心包穿刺引流等保守治疗后好转）及急性肾功能损害。结论初步经验显示，使用18F Corevalve瓣膜系统对高危的严重钙化性主动脉瓣狭窄患者行TAVI安全有效，但有一定的手术并发症。严格筛选患者、熟练掌握手术的技巧及相关注意事项可减少并发症的发生。

Objective To evaluate the safety and efficacy and summarize the initial experience of transcatheter aortic valve implantation （TAVI） for treating patients with severe aortic stenosis. Methods From October 2010 to May 2011, TAVI using 18 F Corevalve system was applied in 3 patients with severe calcified aortic valve stenosis at high risk for surgery. The efficacy and complications of the procedure were analyzed and the procedure experiences were summarized. Results TAVI procedure was successful in all 3 cases. The mean operation time was （109.0 ± 22.6） minutes and X-ray exposure time was （24.0 ± 9.5） minutes. The peak pressure gradients after surgery were significantly reduced [ from （ 84 ± 15 ） mm Hg （1 mm Hg=0. 133 kPa） to （6 ± 3） mm Hg]. A trivial to mild paravalvular leak was observed in all patients post procedure. Case 1 was free from perioperative complications. Case 2 experienced a transient complete left bundle branch block. Case 3 developed 3 degree atrioventricular block and implanted with a permanent cardiac pacemaker, cardiac tamponade which was relieved through conservative treatment, including pericardial puncture and drainage and acute kidney injury. Conclusions Our initial experience showed that TAVI using the 18 F Corevalve system is safe and effective for patients with severe calcified aortic valve stenosis at high-risk for surgery, though the procedure may cause some complications. Strict patient selection and proficient surgical techniques may reduce the incidence of complications.