经股动脉TAVI治疗单纯主动脉瓣关闭不全的病例分析

Transfemoral TAVI in the treatment of pure aortic regurgitation

目的:探讨经导管主动脉瓣植入术(TAVI)经股动脉治疗单纯主动脉瓣关闭不全(AR)患者的可行性。方法:回顾性分析术者自2018年5月21日—2022年1月31日完成的27例经股动脉TAVI手术治疗AR患者,男12例,女15例,年龄49~84岁,平均(72.50±3.07)岁。患者术前心电图示窦性心律,无传导系统疾病,二尖瓣或三尖瓣均无器质性改变,且术前超声心动图均显示重度AR。术前通过超声心动图测得其主动脉瓣反流束宽度,以判断主动脉反流程度。所有患者均经股动脉行TAVI手术。结果:所有患者成功植入自膨胀支架瓣膜,复查彩超提示人工瓣膜功能良好,未见明显瓣周漏,升主动脉内人工支架血流通畅;无术中死亡病例,未出现术中中转开胸手术病例,瓣中瓣植入3例,永久起搏器植入3例,全部患者治愈出院,术后住院天数5~12 d。结论:TAVI手术经股动脉用于单纯AR患者的治疗是可行的,术后早期效果满意。

Objective:To investigate the feasibility of transcatheter aortic valve implantation(TAVI)via the femoral artery in patients with pure aortic regurgitation(AR).Methods:From May 21,2018 to January 31,2022,27 patients with pure AR underwent TAVI via femoral artery were analyzed retrospectively.The patient’s preoperative electrocardiogram showed sinus rhythm,no conduction system disease,no organic changes in the mitral valve or tricuspid valve,and preoperative echocardiography showed severe AR.The width of the aortic valve regurgitation beam was measured by echocardiography before surgery in order to judge the degree of aortic regurgitation.All patients underwent TAVI through the femoral artery.Results:All patients were successfully implanted with self-expanding stent-valve.Repeat color Doppler ultrasound showed that the artificial valve function was good,no obvious paravalvular leakage was found,and the artificial stent in the ascending aorta had smooth blood flow.There was no intraoperative death,and no intraoperative conversion to thoracotomy occurred.Among the surgical cases,3 cases were implanted with valve-in-valve,and 3 cases were implanted with permanent pacemaker.All patients were cured and discharged,and the postoperative hospital stay was 5 to 12 days.Conclusion:TAVI operation through the femoral artery is feasible for the treatment of patients with pure AR,and the early postoperative effect is satisfactory.