中国首两例经导管Lotus主动脉瓣置换术

First two cases of transcatheter aortic valve replacement with Lotus valve system in China

目的 探讨新一代Lotus瓣膜系统在经导管主动脉瓣置换术中的应用及注意事项.方法 回顾性分析2015年11月2日浙江大学医学院附属第二医院心脏中心开展的2例经导管Lotus主动脉瓣置换术的手术过程与患者预后情况,并对术前评估、术中操作以及患者术后情况进行总结.结果 2例外科手术高危的症状性主动脉瓣狭窄患者在局麻和镇静下成功接受了经导管主动脉瓣置换术,瓣膜位置、功能良好,术后仅有微量、少量瓣周漏.第二例患者第一次释放位置欠佳,重新回收后再次释放成功,未出现死亡、脑卒中、冠脉堵塞、心包填塞等并发症.第一例患者术后出现了完全性左束支传到阻滞,但无相关症状未植入起搏器,第二例患者未出现新发生的传导阻滞.1个月的随访提示患者症状明显缓解,超声心动图的相关指标显著改善.结论 经导管Lotus主动脉瓣置换术是安全可行的,但需要更大样本、更长时间随访评估其远期疗效.

Objective To explore the performance of the new generation of Lotus valve system in transcatheter aortic valve replacement （TAVR）.Methods Two patients underwent TAVR with Lotus valve system in the Second Affiliated Hospital of Zhejiang University School of Medicine on 2nd November 2015, were retrospectively analyzed for the process of procedure and patients＇ prognosis.Preoperative assessment, procedural process and the postoperative recovery were summarized.Results Twosurgical high risk patients with symptomatic severe aortic stenosis were successfully performed TAVR with local anesthesia and sedation.The position and function of prosthesis were good and only trace or mild paravalvular leakage was found.Reposition was successfully applied for the second patient because of unsatisfactory initial deployment.No death, stroke, coronary occlusion and cardiac tamponadeetc were found.New onset of complete left bundle branch block was observed in the first patient while not in the second patient, and no permanent pacemaker was implanted.Symptom and parameters of echocardiography were significantly improved 1 month after procedure.Conclusions Initial experience demonstrates that TAVR with Lotus valve is feasible and safe, while larger sample size and longer follow-up are necessary for the evaluation of long-term effectiveness.