左西孟旦在经心尖经导管主动脉瓣置换术中的临床应用

Levosimendan in patients undergoing transapical transcatheter aortic valve replacement

目的探讨左西孟旦在经心尖经导管主动脉瓣置换术(TA-TAVR)中的临床应用价值。方法收集中国医学科学院阜外医院2014年7月2日至2020年6月24日行TA-TAVR术的全部患者的病历资料,根据术中是否应用左西孟旦分为应用左西孟旦组和未用左西孟旦组。比较2组术中情况、术后结局和手术前后心肌酶学指标水平。结果本研究共入选行TA-TAVR手术患者51例,其中应用左西孟旦组24例(47.1%),未用左西孟旦组27例(52.9%)。2组患者手术时间、机械通气时间、重症监护病房停留时间及术后住院时间差异均无统计学意义(均P>0.05)。应用左西孟旦组多巴胺应用比例明显高于未用左西孟旦组[100.0%(24/24)比66.7%(18/27)],差异有统计学意义(P=0.002)。2组围术期主要并发症发生率及院内死亡率比较差异均无统计学意义(均P>0.05)。应用左西孟旦组术后高敏肌钙蛋白I(hs-TnI)水平明显低于未用左西孟旦组[1.924(1.113,3.323)μg/L比3.182(2.201,5.644)μg/L],差异有统计学意义(P=0.012)。结论TA-TAVR手术患者术中应用左西孟旦能够降低术后hs-TnI水平,具有一定的心肌保护作用。

Objective To investigate the clinical value of levosimendan in transapical transcatheter aortic valve replacement(TA-TAVR).Methods All patients who underwent TA-TAVR in Fuwai Hospital,Chinese Academy of Medical Sciences from July 2,2014 to June 24,2020 were included.According to whether levosimendan was used during the operation,they were divided into levosimendan group and non levosimendan group.The intraoperative conditions,postoperative outcomes and myocardial enzyme levels before and after operation were compared between the two groups.Results A total of 51 patients undergoing TA-TAVR were enrolled in this study,including 24 patients(47.1%)in levosimendan group and 27 patients(52.9%)in non levosimendan group.There were no significant differences in operation time,mechanical ventilation time,length of intensive care unit stay and postoperative length of stay between the two groups(all P>0.05).The proportion of dopamine use in levosimendan group was significantly higher than that in non levosimendan group[100.0%(24/24)vs 66.7%(18/27)](P=0.002).There were no significant differences in the incidences of major complications and hospital mortality between the two groups(all P>0.05).The level of high-sensitivity cardiac troponin I(hs-TnI)in levosimendan group was significantly lower than that in non levosimendan group[1.924(1.113,3.323)μg/L vs3.182(2.201,5.644)μg/L](P=0.012).Conclusion Levosimendan can reduce the postoperative level of hs-TnI in patients undergoing TA-TAVR,which has a certain myocardial protective effect.