经股动脉经导管主动脉瓣置换术(TAVR)治疗单纯主动脉瓣关闭不全的临床疗效分析及术前评估

Outcomes and preoperative evaluation of transfemoral transcatheter aortic valve replacement(TAVR) in the treatment of pure native aortic valve regurgitation

目的探讨经股动脉经导管主动脉瓣置换术(TAVR)治疗主动脉瓣单纯关闭不全的临床疗效和术前评估要点。方法回顾性分析阜外医院2019年5月至2020年10月行经股动脉TAVR 129例患者的临床资料,其中男83例、女46例,平均年龄(72.26±8.97)岁。根据疾病情况分为单纯主动脉瓣关闭不全组(17例)和主动脉瓣狭窄组(112例)。分析主动脉根部形态学特点、手术有效性及安全性。结果单纯主动脉瓣关闭不全组与主动脉瓣狭窄组比较,3MENSIO测量的瓣环[(25.75±2.21)mm vs.(24.70±2.90)mm,P=0.068]及流出道直径[(25.82±3.75)mm vs.(25.37±3.92)mm,P=0.514]差异无统计学意义。单纯主动脉瓣关闭不全组与主动脉瓣狭窄组相比,瓣中瓣发生率较高(47.0%vs.16.1%,P<0.01)。中转外科手术、术中使用体外循环辅助、术中左室破裂、术后使用体外膜肺氧合辅助、术后外周血管并发症、术后致残性脑卒中、死亡、术后起搏器植入两组差异无统计学意义。结论单纯主动脉瓣关闭不全患者行经股动脉TAVR可行。术前应重点评估瓣环平面直径、流出道直径以及流出道的形态。

Objective To assess outcomes of transcatheter aortic valve replacement(TAVR)for pure native aortic valve regurgitation.Methods A total of 129 patients underwent transfemoral TAVR in Fuwai Hospital from May 2019 to October 2020 were retrospectively analyzed.There were 83 males and 46 females with an average age of 72.26±8.97 years.The patients were divided into a pure native aortic valve regurgitation group(17 patients)and an aortic valve stenosis group(112 patients).Results The incidence of valve in valve was higher in the pure native aortic valve regurgitation group(47.0%vs.16.1%,P<0.01).There was no statistical difference between the two groups in conversion to surgery,intraoperative use of extracorporeal circulation,intraoperative left ventricular rupture,postoperative use of extracorporeal membrane oxygenation(ECMO),peripheral vascular complications,disabled stroke,death,or pacemaker implantation.There was no statistical difference in the diameter of annulus(25.75±2.21 mm vs.24.70±2.90 mm,P=0.068)or diameter of outflow tract(25.82±3.75 mm vs.25.37±3.92 mm,P=0.514)between the pure native aortic valve regurgitation group and the aortic valve stenosis group.Conclusion Transfemoral TAVR is a feasible method for patients with pure native aortic valve regurgitation.The diameter of annulus plane,the diameter of outflow tract and the shape of outflow tract should be evaluated.