经心尖途径经导管主动脉瓣置换术治疗主动脉瓣关闭不全的早期疗效分析

Early outcome of transapical transcatheter aortic valve replacement for aortic insufficiency

目的探讨经心尖经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)治疗主动脉瓣关闭不全的早期疗效。方法回顾性纳入2020年10月—2022年10月在安徽医科大学第一附属医院心脏大血管外科行经心尖TAVR的主动脉瓣病变患者,其中主动脉瓣狭窄患者作为A组,单纯主动脉瓣关闭不全患者作为B组,分析术后早期心功能改善及手术并发症情况。结果共纳入56例患者,其中男32例、女24例,平均年龄(73.34±5.10)岁。A组31例,B组25例。两组患者在年龄、性别、身高、体重、高血压、冠状动脉粥样硬化性心脏病、外周血管病史、慢性阻塞性肺疾病、肾功能不全、心功能分级方面差异均无统计学意义(P>0.05)。两组患者在植入永久起搏器、中转外科开胸手术、植入瓣中瓣、瓣周漏方面差异也无统计学意义(P>0.05)。与术前相比,两组患者术后30 d的左室舒张末期内径、左室射血分数、合并中度及以上二尖瓣反流、中度及以上三尖瓣反流均有显著改善(P<0.05),但组间比较差异均无统计学意义(P>0.05)。结论使用介入瓣膜(J-Valve)经心尖途径TAVR治疗主动脉瓣关闭不全患者早期效果显著,能显著改善心功能并减少功能性瓣膜反流。

Objective To assess the early outcome of transapical transcatheter aortic valve replacement(TAVR) for patients with aortic insufficiency.Methods The patients with aortic valvular disease who underwent transapical TAVR from October 2020 to October 2022 in the Department of Cardiac and Vascular Surgery,the First Affiliated Hospital of Anhui Medical University were enrolled in the current retrospective study.The patients with aortic stenosis were assembled in a group A,and the patients with aortic insufficiency were assembled in a group B.The improvements of heart function and complications were assessed for the two groups.Results A total of 56 patients were enrolled,including 32 males and 24 females with an average age of 73.34±5.10 years.There were 31 patients in the group A and 25patients in the group B.There was no statistical difference between the two groups in the age,gender,height,weight,hypertension,coronary artery disease,peripheral vascular disease,chronic obstructive pulmonary disease,renal disorder or classification of heart function(P>0.05).Also,there was still no statistical difference in the rate of permanent peacemaker implants,emergent open surgery,valve re-implants,or perivalvular leakage(P>0.05).After TAVR,the left ventricular diastolic diameter,left ventricular ejection fraction,complicated moderated mitral and tricuspid regurgitation were significantly improved in both groups compared with preoperative findings(P<0.05);however,there was no statistical difference in these parameters between groups(P>0.05).Conclusion Interventional valve(J-Valve)in the treatment of patients with aortic insufficiency through transapical TAVR significantly improves cardiac function and reduces functional valve regurgitation.