多排CT对经股动脉与经心尖主动脉瓣置换术的对比分析

Comparative Analysis of Transfemoral and Transapical Transcatheter Aortic Valve Replacement Measured by MDCT

目的对比经股动脉主动脉瓣置换术(TF-TAVR)与经心尖主动脉瓣置换术(TA-TAVR)患者的多排CT等影像学资料,评价两种术式的治疗效果及术后并发症情况。资料与方法回顾性纳入经导管主动脉瓣置换术(TAVR)患者229例,其中141例经股动脉入路,88例经心尖入路,通过术前主动脉CT血管成像(CTA)收集主动脉参数,通过术后主动脉CT血管成像、床旁胸片、经胸超声心动图(TTE)判断瓣周漏、心包积液、胸腔积液及肺膨胀不全等术后并发症的发生情况,比较TFTAVR与TA-TAVR的治疗效果及术后并发症发生情况。结果TA-TAVR患者术前左心室内径大于TF-TAVR患者[(56.2±10.5)mm比(50.6±8.3)mm,P<0.001)],术后瓣周漏及心包积液发生率低于TF-TAVR患者(43.2%比63.8%,P=0.002;6.8%比17.0%,P=0.026),术后肺膨胀不全发生率高于TF-TAVR患者(10.2%比2.8%,P=0.019)。两种术式术后胸腔积液发生率差异无统计学意义(48.9%比43.3%,P>0.05)。术前左主干到主动脉瓣环距离(13.6±3.0)mm,右冠状动脉到主动脉瓣环距离(15.3±3.7)mm。结论TA-TAVR术后瓣周漏、心包积液等并发症的发生率较低,可以作为TAVR较理想的入路选择之一,对主动脉瓣病变进行有效治疗。

Purpose To compare the imaging data of transfemoral-transcatheter aortic valve replacement(TF-TAVR) and transapicaltranscatheter aortic valve replacement(TA-TAVR) measured by MDCT, and to evaluate the therapeutic effects and the postoperative complications led to these two surgical approaches. Meterials and Methods A total of 229 patients undergoing transcatheter aortic valve replacement(TAVR) were retrospectively collected, including 141 cases with TF and 88 cases with TA. Parameters of aorta were collected by preoperative aorta CTA, and postoperative complications, including paravalvular regurgitation, pericardial effusion, pleural effusion and atelectasis, were also detected and recorded via aorta CTA, postoperative bedside chest X-ray, transthoracic echocardiography(TTE). The therapeutic effects and postoperative complications between TF-TAVR and TA-TAVR were compared. Results The preoperative diameter of left ventricle(LV) in patients with TA-TAVR was significantly larger than that in patients with TF-TAVR [(56.2±10.5) mm,(50.6±8.3) mm, P<0.001]. The incidence of paravalvular regurgitation and pericardial effusion in patients with TA-TAVR was significantly lower than that in patients with TF-TAVR(43.2% vs. 63.8%, P=0.002;6.8% vs. 17.0%, P=0.026). The incidence of postoperative atelectasis in patients with TA-TAVR was significantly higher than that in patients with TF-TAVR(10.2% vs. 2.8%, P=0.019). There was no statistical difference in the incidence of pleural effusion between these two groups(48.9% vs. 43.3%, P=0.408). Preoperative distance from LM to AV was(13.6±3.0) mm, and the distance from RCA to AV was(15.3±3.7) mm, respectively. Conclusion Low incidence of complications such as paravalvular regurgitation and pericardial effusion are showed in patients with TA-TAVR compared to patient with TF-TAVR. TA-TAVR could be used as an ideal approach to TAVR for effective treatment in patients with aortic valve diseases.