经导管主动脉瓣置换术在老年二叶式主动脉瓣狭窄中的应用探讨

Application of Transcatheter Aortic Valve Replacement in Elderly Bicuspid Aortic Stenosis

目的比较经导管主动脉瓣置换术(TAVR)在老年二叶式主动脉瓣(BAV)与三叶式主动脉瓣(TAV)狭窄的近期疗效预后,并探讨TAVR在老年BAV狭窄中的应用价值。方法回顾性分析2016年3月至2021年3月行TAVR治疗的有症状重度主动脉瓣狭窄(AS)的患者50例,根据主动脉CTA划分为为TAV组(29例),BAV组(21例),进行为期6个月的定期随访,并定义联合终点事件为全因死亡及TAVR相关并发症的复合事件,分析比较两组间联合终点事件的发生率、主动脉根部形态学特点、术前术后超声心动图相关指标及手术的有效性和安全性。结果两组患者基线资料及术前血流动力学相关指标的差异比较均无统计学意义(P>0.05),随访发现两组患者术后血流动力学指标均较前明显改善,组间差异亦无统计学意义(P>0.05),且两组联合终点事件发生率差异比较无统计学意义(P>0.05),Kaplan-Meier曲线亦显示该联合终点事件的发生风险在两组间无统计学差异(P>0.05)。结论对于外科手术具有高危风险或禁忌的BAV狭窄患者,在近期疗效预后方面较TAV狭窄患者未见明显差异,故BAV患者行TAVR亦是安全有效的,进一步拓宽了TAVR的适应症,但该结论仍需要多中心大样本研究的定期随访进一步验证。

Objective To compare the short-term efficacy and prognosis of transcatheter aortic valve replacement(TAVR)in elderly two-leaflet aortic valve(BAV)and tri-leaf aortic valve(TAV)stenosis,and to explore the application of TAVR in elderly BAV stenosis Value.Methods A retrospective analysis of 50 patients with symptomatic severe aortic stenosis(AS)who underwent TAVR treatment in our hospital from March 2016 to March 2021 were divided into the TAV group(29 cases)according to the aortic CTA.The BAV group(21 cases)was followed up for a period of 6 months,and the combined endpoint was defined as a composite event of all-cause death and TAVR-related complications.The incidence of combined endpoint events and aortic roots between the two groups were analyzed and compared Morphological characteristics,preoperative and postoperative cardiac ultrasound valve related characteristics,and the effectiveness and safety of the operation.Results There was no statistically significant difference in baseline data and preoperative hemodynamic indicators between the two groups of patients(P>0.05).Follow-up showed that the postoperative hemodynamic indicators of the two groups were significantly improved compared with before,and there was a difference between the groups.It was also not statistically significant(P>0.05),and the difference in the incidence of the combined endpoint event between the two groups was not statistically significant(P>0.05).The Kaplan-Meier curve also showed that the risk of the composite event was not statistically significant between the two groups Difference(P>0.05).Conclusion For patients with high-risk or contraindicated BAV stenosis in surgical procedures,there is no significant difference in short-term efficacy and prognosis compared with TAV stenosis.Therefore,TAVR is also safe and effective for BAV patients,which further broadens the indications of TAVR,but the conclusion is still It needs to be further verified by regular follow-up of multi-center and large-sample studies.