经导管主动脉瓣植入术治疗主动脉瓣疾病患者的经验总结

Experience summarization of transcatheter aortic valve implantation in patients with aortic valve disease

目的回顾性评估广东省人民医院采用经导管主动脉瓣植入术(transcatheter aortic vavle implantion,TAVI)治疗主动脉瓣相关疾病患者的临床效果。方法回顾性分析广东省人民医院于2017年6月到2019年12月行TAVI手术患者86例的临床资料,其中男52例(60.5%),女34例(2%),年龄(74.6±6.9)岁,美国胸外科医师学会(Society of Thoracic Surgeons predicted risk of mortality,STS)评分为(11.2±4.3)分。术后30 d对患者进行随访,分析TAVI的手术效果及TAVI术后患者近期预后情况。结果86例患者中有70例(87.5%)诊断为重度主动脉瓣狭窄(aortic stenosis,AS),其中有38例(44.1%)为二叶式主动脉瓣,19例(22.1%)诊断为主动脉瓣重度反流,3例(3.5%)因生物瓣衰败导致主动脉瓣重度反流。TAVI经股动脉路径75例(87.2%),经颈动脉路径6例(7%),经心尖路径5例(5.8%);86例(100%)手术成功,9例(10.3%)术中需植入第2枚支架瓣膜。术后主动脉瓣轻中度瓣周漏5例(6.2%),中度瓣周漏3例(3.7%)。术后30 d死亡1例(1.3%),脑卒中1例(1.3%),急性心包填塞3例(3.4%),7例(8.0%)患者术后因Ⅲ度房室传导阻滞在本院行永久起搏器植入术。结论对于有外科手术禁忌症或不愿意行外科手术的二叶式及三叶式重度AS患者,TAVI手术可以得到满意的临床效果,而对于主动脉瓣重度反流的患者,经心尖途径放置特殊瓣膜的TAVI治疗可能也是一种有效的方案。

Objectives To retrospectively evaluate the clinical effect of transcatheter aortic vavle implantion(TAVI)in the treatment of patients with aortic valvule-related diseases in Guangdong Provincial People′s Hospital.Methods The clinical information of 86 patients who underwent TAVI surgery in Guangdong Provincial People′s Hospital from June 2017 to December 2019 was analyzed.The patients included 52 males(60.5%)and 34 females(2%)with an average age of(74.6±6.9)years and an average Society of Thoracic Surgeons predicted risk of mortality(STS)score of 11.2±4.3.The patients were followed up one month after surgery.The surgical effect of TAVI and the short-term prognosis of patients after TAVI were analyzed.Results Among the 86 patients,70(87.5%)were diagnosed with severe aortic valve stenosis(AS),of which 38(44.1%)patients had bicobular aortic valve,19(22.1%)patients were diagnosed with severe aortic regurgitation,and 3 patients were diagnosed with severe aortic regurgitation due to aortic valve prolapse.There were 75(87.2%)cases of TAVI via femoral artery,6(7%)cases via carotid artery,and 5(5.8%)cases via apical artery.TAVI was successfully performed in 86(100%)cases,and 9(10.3%)cases needed to implant a second stent valve intraoperatively.After the operation,5(6.2%)cases had mild and moderate perivalvular leakage,and 3(3.7%)cases had moderate perivalvular leakage.Thirty days after surgery,1(1.3%)patient died,1(1.3%)patient suffered from stroke,3(3.4%)patients received acute cardiac tamponade,and 7(8.0%)patients received permanent pacemaker implantation in our hospital due to degreeⅢatrioventricular block.Conclusions TAVI surgery can achieve satisfactory clinical results for patients with severe bicobular and tricobular AS with contraindications to surgery or those who are unwilling to undergo surgery.For patients with severe aortic regurgitation,TAVI treatment with special valve placement via apical approach may also be an effective plan.