经导管主动脉瓣置换术在重度主动脉瓣狭窄合并主动脉瓣关闭不全患者中的应用

Application of transcatheter aortic valve replacement in treatment of severe aortic stenosis patients complicated with aortic insufficiency

目的分析经导管主动脉瓣置换术(TAVR)在重度主动脉瓣狭窄合并中重度主动脉瓣关闭不全患者中的应用。方法选取18例诊断为重度主动脉瓣狭窄合并中重度主动脉瓣关闭不全的住院患者为A组,另选取22例同期诊断为单纯重度主动脉瓣狭窄或仅合并轻度主动脉瓣关闭不全患者为B组,均行TAVR术。随访6个月,比较2组基本资料、术后经胸超声心动图结果以及随访期间死亡率、出血情况等临床不良事件发生率等。结果A组患者平均主动脉瓣环内径、二叶式畸形患者比率、升主动脉内径高于B组,钙化积分低于B组,差异有统计学意义(P<0.05)。2组手术入路、选择瓣膜尺寸及植入瓣中瓣率等比较,差异均无统计学意义(P>0.05)。2组术后即刻和术后6个月的跨主动脉瓣流速、主动脉瓣平均跨瓣压差以及术后6个月的左心室舒张末内径均低于术前,术后6个月的左心室射血分数高于术前,差异有统计学意义(P<0.05)。B组术后即刻、术后6个月的瓣周漏发生率低于A组,差异有统计学意义(P<0.05)。2组术后即刻、术后6个月的并发症发生率比较,差异无统计学意义(P>0.05)。结论对于重度主动脉瓣狭窄合并中重度主动脉瓣关闭不全患者,TAVR术后能有效降低平均跨瓣压差,改善心功能,但瓣周漏发生率明显增加,且多为微量或轻度瓣周漏。

Objective To analyze the application of transcatheter aortic valve replacement(TAVR)in treatment of severe aortic stenosis patients complicated with moderate to severe aortic insufficiency.Methods A total of 18 patients diagnosed as severe aortic stenosis complicated with moderate to severe aortic insufficiency were selected as group A,22 patients diagnosed as simple severe aortic stenosis or only complicated with mild aortic insufficiency in the same period were selected as group B,and all of them were treated with TAVR.All the patients were followed up for 6 months,and the basic data,postoperative transthoracic echocardiography results and clinical adverse events such as mortality and bleeding during follow up were compared between the two groups.Results The average aortic annulus diameter,the proportion of patients with bilobar malformation and the ascending aortic diameter in the group A were significantly higher than those in group B,while the calcification score was significantly lower than that in group B(P<0.05).There were no significant differences in surgical approach,valve size and valve implantation rate between the two groups(P>0.05).The transaortic velocity and mean transaortic pressure difference immediately after operation and 6 months after operation as well as left ventricular end diastolic diameter at 6 months after operation were significantly lower than those before operation in both groups,while the left ventricular ejection fraction at 6 months after operation was significantly higher than that before operation(P<0.05).The incidence rates of perivalvular leakage in the group B immediately after operation and 6 months after operation were significantly lower than that in the group A(P<0.05).There were no significant differences in the incidence rates of complications immediately after operation and 6 months after operation between the two groups(P>0.05).Conclusion For severe aortic stenosis patients complicated with moderate to severe aortic insufficiency,TAVR can effectively reduce the mean transaortic pressure difference and improve cardiac function,but the incidence of perivalvular leakage significantly increase,and most of them are slight or mild perivalvular leakage.