单纯经导管主动脉瓣置换术治疗重度主动脉瓣反流合并重度二尖瓣反流的单中心回顾性研究

Clinical effect of transcatheter aortic valve replacement on severe aortic regurgitation combined with severe mitral regurgitation: A single-center retrospective study

目的探讨单纯经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)治疗重度主动脉瓣反流(aortic regurgitation,AR)合并重度二尖瓣反流(mitral regurgitation,MR)的临床疗效。方法回顾性分析2018年3月—2021年9月因重度AR合并重度MR于广东省人民医院心外科行经导管主动脉瓣置换术13例患者的临床资料,其中男10例、女3例,平均年龄(72.54±2.35)岁,对比患者术前与术后超声心动图结果。结果手术成功率100.00%,手术时间(118.15±11.42)min,术中出血量100.00(75.00,250.00)mL,术后住院时间9.00(4.50,11.00)d,无术中死亡和中转开胸。随访时间10.00(6.50,38.50)个月,2例轻中度AR,6例轻度AR,5例无AR;同时重度MR在没有积极干预的情况下反流量仍显著减少(P=0.001),4例轻中度MR,9例轻度MR。术后随访左心房直径[46.00(41.00,52.50)mm vs.35.00(34.00,41.00)mm,P<0.001]、左心室收缩末期内径[45.00(36.00,56.00)mm vs.35.00(28.00,39.00)mm,P=0.002]及左心室舒张末期内径[(62.62±2.40)mm vs.(51.08±2.49)mm,P<0.001]均较术前呈下降趋势。结论对于经选择的重度AR合并重度MR患者,单纯行TAVR治疗AR的同时也能改善合并的MR。

Objective To determine the clinical efficacy of transcatheter aortic valve replacement(TAVR)for severe aortic regurgitation(AR)combined with severe mitral regurgitation(MR).Methods The clinical data of 13 patients who underwent TAVR due to severe AR combined with severe MR from March 2018 to September 2021 in our hospital were retrospectively analyzed,including 10 males and 3 females with a mean age of 72.54±2.35 years.The echocardiographic findings of all patients were compared preoperatively and postoperatively.Results Surgeries were performed successfully in all patients without intraoperative death or conversion to sternotomy.The operation time was 118.15±11.42 min,intraoperative blood loss was 100.00(75.00,250.00)mL,and the length of hospital stay after surgery was 9.00(4.50,11.00)d.The mean follow-up duration was 10.00(6.50,38.50)months,during which there were 2 patients with mild to moderate AR,6 with mild AR,and 5 with no AR;meanwhile,severe MR decreased significantly(P=0.001)even without active intervention,including 4 mild to moderate MR and 9 mild MR patients.Compared to preoperative indexes,the left atrial diameter[46.00(41.00,52.50)mm vs.35.00(34.00,41.00)mm,P<0.001],left ventricular end-systolic diameter[45.00(36.00,56.00)mm vs.35.00(28.00,39.00)mm,P=0.002]and left ventricular enddiastolic diameter(62.62±2.40 mm vs.51.08±2.49 mm,P<0.001)showed a decreasing trend during the follow-up.Conclusion In selected patients with severe AR combined with severe MR,TAVR alone improves AR and combined MR at the same time.