经皮冠状动脉介入与经导管主动脉瓣置换术一站式手术的应用

Application of single-stage PCI followed by TAVR procedure in severe aortic stenosis complicated with coronary heart disease

目的探讨重度主动脉瓣狭窄(AS)合并冠心病患者采用经皮冠状动脉介入(PCI)与经导管主动脉瓣置换(TAVR)一站式手术的可行性及远期效果。方法本研究为回顾性研究,纳入了5例从2020年1月至2021年8月在我中心完成PCI+TAVR一站式手术的患者,收集患者基线信息、术前超声心动图、主动脉CTA及术后超声心动图资料,出院后1年对患者情况进行随访。结果本研究纳入的5例患者中位年龄77岁,1例患者为女性,中位胸外科医师学会(STS)风险评分为8.25%。术前中位主动脉瓣平均跨瓣压差54mmHg,中位主动脉瓣峰值流速4.7m/s,中位左室舒张末期内径52mm,中位射血分数60%。术中所有患者均先行PCI后再经股动脉全麻下行TAVR。其中4例处理了前降支靶病变,1例处理了回旋支靶病变。术后复查超声心动图提示中位主动脉平均跨瓣压差10mmHg,中位主动脉瓣峰值流速2.2m/s,中位左心室舒张末期内径49mm,中位左室射血分数60%,均无严重主动脉反流及瓣周漏。术后随访1年显示1例患者因房室传导阻滞行永久起搏器置入,无死亡、卒中、心梗、再住院等心脏不良事件发生。结论对于重度AS合并冠心病患者,PCI+TAVR一站式手术的远期效果和安全性良好,具备可行性。

Objective To investigate the feasibility and long-term efficacy of single-stage percutaneous coronary intervention(PCI)followed by transcatheter aortic valve replacement(TAVR)procedure for patients with severe aortic stenosis(AS)complicated with coronary artery disease.Methods This retrospective study included 5 patients who underwent single-stage PCI+TAVR procedure in our center from January 2020 to August 2021.Baseline information,preoperative echocardiography,aortic CTA and postoperative echocardiography data were collected.All patients were followed up one year after discharge.Results The median age of the 5 patients included in this study was 77 years,and 1 patient was female.The median Society of Thoracic Surgeons(STS)risk score was 8.25%.The median value of mean preoperative aortic transvalvular pressure gradient was 54 mmHg,the median peak aortic valve flow rate was 4.7 m/s,the mean left ventricular end-diastolic diameter was 52 mm,and the mean ejection fraction was 60 mm.All patients underwent TAVR via transfemoral access with artery general anesthesia following PCI.Four patients with anterior descending target lesions and one with circumflex target lesions were treated.Postoperative echocardiography showed that the median value of mean aortic transvalvular pressure gradient was 10 mmHg,the median peak aortic valve velocity was 2.2 m/s,the median left ventricular end-diastolic diameter was 49 mm,and the median left ventricular ejection fraction was 60%.No severe aortic regurgitation or perivalvular leakage was observed.One year of follow-up showed that 1 patient underwent permanent pacemaker implantation due to atrioventricular block,and no adverse cardiac events such as death,stroke,myocardial infarction or rehospitalization occurred.Conclusion In patients with severe AS complicated with coronary heart disease,single-stage PCI+TAVR procedure which has good long-term efficacy and safety is feasible.