“All in One”技术在“一站式”经导管主动脉瓣置换术联合经皮冠状动脉介入治疗术中的应用

Application of“All in One”technique in the concomitant transcatheter aortic valve replacement and percutaneous coronary interventions

目的总结“All in One”技术在“一站式”经导管主动脉瓣置换术联合经皮冠状动脉介入治疗(PCI)中应用的初步经验。方法连续收集2021年7月至2022年9月首都医科大学附属北京安贞医院心脏瓣膜病介入中心在“一站式”经导管主动脉瓣置换术联合PCI中应用“All in One”技术的患者27例进行回顾性分析,总结临床资料、影像学资料、手术操作、住院和出院随访期间主要不良心脑血管事件的发生情况。结果27例患者平均年龄(74.1±7.8)岁;男15例,女12例;平均美国胸外科医师协会评分(6.02±3.25)%;主动脉瓣重度狭窄22例,单纯主动脉瓣重度反流5例;三叶式主动脉瓣20例,二叶式主动脉瓣7例。术前平均跨主动脉瓣血流速度(4.2±1.2)m/s,跨主动脉瓣平均压差(52.1±13.3)mmHg。所有患者均置入药物洗脱支架,其中左主干病变4例,多支血管病变11例,平均置入支架数量(1.8±0.9)枚,应用冠状动脉斑块旋磨术1例。所有患者在PCI术后均置入自膨胀瓣膜,术中无死亡、心肌梗死、脑卒中、急诊转外科手术、血管并发症发生,1例患者行瓣中瓣手术,无中重度瓣周反流。住院期间无死亡、心肌梗死、脑卒中、血管并发症发生,1例患者行永久起搏器植入术。平均随访(7.8±3.7)个月,无死亡、脑卒中及肾功能恶化发生,3例患者因胸闷复查冠状动脉造影,均未发现明显冠状动脉狭窄。结论在“一站式”经导管主动脉瓣置换术联合PCI中应用“All in One”技术是安全可行的。

Objective To summarize the preliminary experience of the application of“All in One”technique in the concomitant transcatheter aortic valve replacement(TAVR)and percutaneous coronary intervention(PCI).Methods We collected 27 patients who underwent the“All in One”technique in the concomitant transcatheter aortic valve replacement and percutaneous coronary intervention at the Intervention Center of Valvular Heart Disease of Beijing Anzhen Hospital from July 2021 to September 2022 for retrospective analysis,and summarized the clinical data,imaging data,and the occurrence of major adverse cardiac events during hospitalization and discharge followup.Results Of the 27 patients,15 were male and 12 were female.The mean age was(74.1±7.8)years,with a mean Society of Thoracic Surgeons(STS)risk score of(6.02±3.25)%.Among them,20 were tricuspid aortic valve,7 were bicuspid aortic valve,and 5 were pure aortic regurgitation.The mean preoperative peak velocity was(4.2±1.2)m/s,and the mean gradient was(52.1±13.3)mmHg.All patients were implanted with drug-eluting stents,including 4 cases of left main lesions and 11 cases of multi-vessel lesions,with an average number of(1.8±0.9)stents implanted and 1 case was treated with rotational atherectomy,and there was no complication during PCI.All patients were implanted with self-expanding valves after PCI without intraoperative death,myocardial infarction,stroke,emergency conversion to surgery,or vascular complications,and one patient underwent a valve-invalve procedure,there was no moderate to severe perivalvular leak.There was no death,myocardial infarction,stroke,or vascular complication during hospitalization,and one patient was treated with a permanent pacemaker.During the follow-up period[mean(7.8±3.7)months];there was no death or stroke.Coronary angiography for chest tightness in 3 patients showed no obvious stenosis.Conclusions It is safe and feasible to utilize the“All in One”technique in the concomitant TAVR and PCI.