高危主动脉瓣狭窄患者经导管主动脉瓣置换与外科主动脉瓣置换术的短期临床疗效分析

Short-term clinical efficacy of transcatheter aortic valve replacement and surgical aortic valve replacement in high-risk patients with aortic stenosis

目的:比较经导管主动脉瓣置换术(TAVR)和外科主动脉瓣置换术(SAVR)在治疗主动脉瓣狭窄(AS)围术期内的心功能、瓣周漏、主动脉瓣跨瓣流速等相关指标的变化。方法:回顾性选取2017年12月至2020年4月,于郑州市第七人民医院院接受TAVR术的40例患者及SAVR术的40例患者。对其围术期内临床表现、LVEF、主动脉瓣过瓣流速、LVEDD、LVESD、瓣周漏等进行比较和分析。观察主动脉瓣狭窄患者接受TAVR及SAVR治疗后后围术期内疗效。结果:TAVR组对比SAVR组,死亡,LVESD,LVEDD的比较,差异均无统计学意义(P>0.05)。术后舒张期主动脉瓣反流面积、主动脉瓣过瓣流速、瓣周漏比较差异有统计学意义(P<0.05)。结论:对于进行外科手术的高危AS的患者,虽然TAVR相对于SAVR瓣周漏的发生率高,但并未增加围手术期死亡率,编者建议对于不能接受SAVR的高危AS患者且TAVR技术相对成熟的条件下选择TAVR。对于能接受SAVR的高中低危AS患者,编者建议选择SAVR,因其较TAVR瓣周漏发生率显著降低且并未增加围手术期死亡。

Objective: To compare the changes of cardiac function, perivalvular leakage, and aortic valve cross valve velocity between transcatheter aortic valve replacement(TAVR) and surgical aortic valve replacement(SAVR) during the perioperative period. Methods: This study is a retrospective study, which selected 40 patients who received TAVR in Zhengzhou Seventh People′s Hospital from December 2017 to April 2020 and 40 patients who underwent SAVR.The perioperative clinical manifestations, LVEF, flow rate of aortic valve, internal diameter of left ventricular endosperm, internal diameter of left ventricular endosperm, and number of valve leakage cases were compared and analyzed.To observe the perioperative efficacy of patients with aortic stenosis after receiving TAVR and SAVR. Results: Compared with SAVR group, there were no statistically significant differences in death rate, LVEDD and LVESD TAVR group(P > 0.05).There were statistically significant differences in the diastolic aortic regurgitation area(cm), the flow rate of aortic valve passing, and the number of perivalve leakage cases(P< 0.05). Conclusions: For high-risk AS patients undergoing surgery, although the incidence of PERIoperative leakage of TAVR was higher than that of SAVR, it did not increase the perioperative mortality. The authors suggested that TAVR should be selected for high-risk AS patients who could not accept SAVA and under the condition of relatively mature TAVR technology.For patients with high, medium and low risk AS who could receive SAVR, the authors suggested choosing SAVR, because SAVR significantly reduced the incidence of perioperative valve leakage compared with TAVR and did not increase the perioperative mortality.