使用J-Valve^(TM)系统经心尖导管主动脉瓣置换术治疗高危主动脉瓣关闭不全患者:1年随访中期结果

Transapical aortic valve implantation using J-Valve^(TM)system for high-risk patients with aortic regurgitation:mid-stage of 1 year follow-up

目的分析使用J-Valve^(TM)系统行经心尖主动脉瓣置换术(transapical aortic valve implantation,TA-TAVI)治疗高危主动脉瓣关闭不全患者的中期临床预后。方法回顾性收集2016年9月至2020年6月在浙江大学医学院附属第二医院连续收治的25例使用J-Valve^(TM)系统经心尖TAVI治疗的主动脉瓣关闭不全患者资料,分析总结术后全因病死率,不良事件发生率及心功能改善情况。结果25例中男19例,年龄范围为59~83岁,平均年龄(72.3±27.11)岁。经胸超声心动图检查评估重度主动脉瓣反流比例达88%,心功能(NYHA分级)Ⅲ-Ⅳ级占92%。患者最常合并的基础病为高血压(占68%),合并冠心病5例,既往心脏手术史3例,术前胸外科医师协会(the Society of Thoracic Surgeons,STS)评分为1.511%~27.674%,中位STS评分为4.27(2.914~6.033)%。手术均成功置入J-Valve瓣膜,无中转开胸。术后置入永久起搏器2例,CRRT 1例,中度及以上瓣周漏1例。手术早期疗效可观,不良事件发生率低,中期随访心功能及心室逆重构也有持续改善表现。结论对于高危主动脉瓣关闭不全患者使用J-Valve^(TM)系统行经心尖TAVI可获得较好的围手术期安全性及中期预后。

Objective To analysis the mid-stage prognosis of transapical aortic valve implantation(TA-TAVI)using J-Valve^(TM)system for the treatment of high-risk aortic regurgitation(AR)patients.Methods Data of 25 patients with aortic regurgitation who had underwent transapical aortic valve implantation using J-Valve^(TM)system were collected in the Second Affiliated Hospital of Medical College of ZheJiang University from September 2016 to June 2020.Analysis and summarize their postoperative all-cause mortality,the incidence of adverse events and the improvement in cardiac function.Results There were 25 patients,including 19 males,the age rage from 59-83 years,the average age was(72.3±27.11)years.The levels of aortic regurgitation was evaluated by transthoracic echocardiography preoperatively,showed that severe AR accounted for 88%.The New York Heart Association(NYHA)of grade 3 or above was 92%.The most common comorbidity was hypertension,accounted for 68%.Coronary heart disease and history of cardiac surgery was 5 and 3 relatively in this study.The Society of Thoracic Surgeons score before surgery was 1.511%-27.674%,the average of STS score was 4.27(2.914-6.033)%.Successful J-Valve implantation was obtained in all 25 cases,no conversion to thoracotomy.After surgery,2 patients required permanent pacemaker implantation,1 patient needed continuous renal replacement therapy(CRRT)due to acute kidney injury,1 occurred moderate or above paravalvular leak.The results showed good therapeutic effects in early-stage,low incidences of adverse events.The continued improvement of cardiac function and ventricular reverse remodeling could be observed in mid-stage.Conclusion In this study,we can summarize that high-risk patients with aortic regurgitation treated with transapical aortic valve implantation using J-Valve^(TM)system can acquire great perioperative safety and mid-stage prognosis.