经导管主动脉瓣置换术前主动脉解剖参数与术后并发症的相关性研究

Study on the correlation between anatomical parameters of aorta before transcatheter aortic valve replacement and postoperative complications

目的分析经导管主动脉瓣置换术(TAVR)患者术前主动脉解剖参数及术后并发症发生情况,研究二者之间的相关性。方法选取2016年5月至2020年9月首都医科大学附属北京安贞医院行TAVR的患者229例,每位患者术前行主动脉CT血管造影(CTA)检查分析其主动脉解剖参数及特征。术后用床旁胸部X线片、超声心动图及主动脉CTA检查观察患者瓣周漏、心包积液、胸腔积液、气胸、肺膨胀不全及肺内渗出等并发症的发生情况。对主动脉术前解剖参数与术后并发症的发生进行相关性分析。结果 229例患者术后共发生瓣周漏128例(55.9%),心包积液30例(13.1%),胸腔积液104例(45.4%),肺膨胀不全13例(5.7%),肺内渗出87例(38.0%),所有患者术后均未发现气胸。术后发生瓣周漏的患者中升主动脉钙化发生率高于未发生瓣周漏的患者[54.7%(70/128)比39.6%(40/101)],差异有统计学意义(χ^(2)=0.340,P=0.023)。术后发生心包积液的患者术前左心室内径显著小于未发生心包积液的患者[(49±9) mm比(53±10) mm],差异有统计学意义(t=2.410,P=0.017)。术后发生胸腔积液的患者术前左心房内径显著大于未发生胸腔积液的患者[(54±12) mm比(51±10) mm],差异有统计学意义(t=-2.010,P=0.045)。术后发生肺膨胀不全的患者术前左心房内径显著小于未发生肺膨胀不全的患者[(52±11) mm比(60±10) mm],差异有统计学意义(t=-2.560,P=0.011)。结论 TAVR患者术前主动脉解剖参数与术后瓣周漏等并发症的发生具有相关性,TAVR患者术前主动脉CTA对患者预后判断具有一定意义。

Objective To analyze the preoperative aortic anatomical parameters and postoperative complications in patients undergoing transcatheter aortic valve replacement(TAVR),and to study the correlation between them.Methods A total of 229 patients with TAVR in Beijing Anzhen Hospital,Capital Medical University from May 2016 to September 2020 were selected.The aortic CT angiography(CTA)examination was performed before operation in each patient,and the aortic anatomical parameters and characteristics were analyzed.The complications such as perivalvular leakage,pericardial effusion,pleural effusion,pneumothorax,atelectasis and pulmonary effusion were observed by bedside X-ray,echocardiography and CTA.The correlation between preoperative aortic anatomical parameters and postoperative complications was analyzed.Results Among 229 patients,there were128 cases(55.9%)with perivalvular leakage,30 cases(13.1%)with pericardial effusion,104 cases(45.4%)with pleural effusion,13 cases(5.7%)with pulmonary atelectasis,and 87 cases(38.0%)with pulmonary effusion.No pneumothorax case was found in all the 229 patients.The incidence of calcification of ascending aorta in patients with perivalvular leakage was higher than that in patients without perivalvular leakage[54.7%(70/128)vs39.6%(40/101)],and the difference was statistically significant(χ^(2)=0.340,P=0.023).The left ventricular diameter of patients with postoperative pericardial effusion was significantly smaller than that of patients without pericardial effusion[(49±9)mm vs(53±10)mm],and the difference was statistically significant(t=2.410,P=0.017).The left atrial diameter of patients with postoperative pleural effusion was significantly larger than that of patients without pleural effusion[(54±12)mm vs(51±10)mm],and the difference was statistically significant(t=-2.010,P=0.045).The diameter of left atrium in patients with postoperative atelectasis was significantly smaller than that in patients without atelectasis[(52±11)mm vs(60±10)mm],and the difference was statistically significant(t=-2.560,P=0.011).Conclusions Preoperative aortic anatomical parameters of TAVR patients are correlated with postoperative perivalvular leakage and other complications.Preoperative aortic CTA for TAVR patients has great significance to judge the prognosis of patients.