过渡性经皮球囊主动脉瓣成形术治疗危重主动脉瓣狭窄的早期效果

Early clinical outcomes of percutaneous balloon aortic valvuloplasty in treating high-risk patients with severe aortic stenosis

目的 探讨过渡性经皮球囊主动脉瓣成形术（PBAV）治疗暂时不宜行外科主动脉瓣置换术和经导管主动脉瓣置入术（TAVR）危重主动脉瓣狭窄患者的早期临床结果.方法 回顾性分析2011年3月至2014年1月在阜外心血管病医院行过渡性PBAV的20例危重主动脉瓣狭窄患者的临床资料,患者年龄（72 ±8）岁.观察手术相关并发症及疗效,并在术后对患者进行随访.结果 所有患者均完成PBAV,主动脉瓣瓣口面积从术前的（0.55±0.09） m2增大至（0.77±0.15）m^2,主动脉瓣跨瓣压差从术前的（49.5±15.0） mmHg（1 mmHg =0.133 kPa）降至术后的（31.7±12.0） mmHg（P＜0.001）,左心室射血分数从术前的（31.7±9.0）％增加至术后的（39.0±11.0）％ （P =0.018）,肺动脉收缩压从术前的（55.1±18.0）mmHg降至术后的（38.7±^11.0）mmHg（P =0.025）,主动脉瓣反流分级手术前后差异无统计学意义（P=0.854）.术后发生低血压4例,一过性左束支传导阻滞5例,术后24 h和30 d分别死亡1例和3例患者.术后30 d内,5例患者实施外科主动脉瓣置换术,1例实施TAVR,5例等待TAVR.结论 对于不宜行外科主动脉瓣置换术和TAVR的危重主动脉瓣狭窄患者,PBAV可取得良好的早期临床结果,有望成为一种安全的过渡性治疗手段.

Objective To explore the procedural feasibility and early clinical outcomes of percutaneous balloon aortic valvuloplasty （PBAV） in patients with severe aortic stenosis,who were considered transiently unsuitable for surgical aortic valve replacement （sAVR） and transcatheter aortic valve replacement （TAVR）.Methods Between March 2011 and January 2014,datas of 20 patients underwent PBAV in Fuwai Hospital were retrospectively analyzed.Mean patients age was （72 ± 8） years.Initial procedural and clinical outcomes were evaluated.Results PBAV was successfully performed in all cases.Post-procedure,aortic valve area increased from （0.55 ±0.09） m^2 to （0.77 ±0.15） m^2（P 〈0.001）,left ventricle ejection fraction from （31.7 ± 9.0） % to （39.0 ± 11.0） % （P =0.018）,mean transaortic valve gradient decreased from （49.5 ±15.0）mmHg（1 mmHg=0.133 kPa） to （31.7 ±12.0）mmHg （P〈 0.001）,and pulmonary artery systolic pressure decreased from （55.1 ± 18.0） mmHg to （38.7 ± 11.0） mmHg（P =0.025）.There was no significant change in the aortic regurgitation grade （P =0.854）.The most common complications were hypotension （n =4） and transient left bundle branch block （n =5）.Overall 24-hour and 30-day mortality was 5% （n =1） and 15% （n =3）,respectively.Within 30 days after PBAV procedure,five patients underwent successful sAVR,one patient underwent TAVR,and five patients awaited TAVR.Conclusion In high-risk patients with severe aortic stenosis and temporary contraindication to sAVR or TAVR,PBAV can be safely used as a bridging intervention procedure and the short-term procedural and clinic outcomes are satisfactory.