二叶式主动脉瓣疾病患者经心尖经导管主动脉瓣置换术后院内结局分析

Transapical transcatheter aortic valve replacement in bicuspid aortic valve patients:Inhospital outcomes

目的比较经心尖经导管主动脉瓣置换术(transapical transcatheter aortic valve replacement,TATAVR)治疗二叶式主动脉瓣(bicuspid aortic valve,BAV)和三叶式主动脉瓣(tricuspid aortic valve,TAV)患者的院内结局。方法连续性纳入2014年7月—2020年7月在四川大学华西医院使用J-Valve TM瓣膜行TA-TAVR的患者(包括BAV和TAV患者)。分析患者的临床结果。结果共纳入354例患者,其中BAV患者75例、TAV患者279例,男229例、女125例,平均年龄(72.2±6.0)岁。手术过程中无死亡发生,总技术成功率97.7%,全因住院死亡率为1.4%。20例(26.7%)BAV患者和46例(16.5%)TAV患者术后即刻出现轻度及以上瓣周漏;无BAV患者需植入永久起搏器,13例(4.7%)TAV患者术后需植入永久起搏器,总需起搏器植入率为3.7%;1例(1.3%)BAV患者和7例(2.5%)TAV患者术后出现急性肾损伤;1例(1.3%)BAV患者和1例(0.4%)TAV患者出现围手术期心肌梗死。BAV患者和TAV患者术后平均住院时间分别为(7.6±3.6)d和(8.6±6.1)d。BAV和TAV患者主要院内结局和次要院内结局差异均无统计学意义(P>0.05)。结论BAV患者与TAV患者结局类似,且不良临床结局发生率低。本研究为BAV占比较高的中国人群实施TA-TAVR提供了初步临床证据。

Objective To compare the in-hospital outcomes of transapical transcatheter aortic valve replacement(TA-TAVR)for bicuspid aortic valve(BAV)patients and tricuspid aortic valve(TAV)patients.Methods Patients(including BAV and TAV patients)who underwent TA-TAVR with the J-Valve^(TM)in West China Hospital from July 2014to July 2020 were included consecutively.The clinical outcomes of the patients were analyzed.Results A total of 354patients were included in the study,75 in the BAV group and 279 in the TAV group.There were 229 males and 125females with a mean age of 72.2±6.0 years.No death occurred during the procedure,and the overall technical success rate was 97.7%.The all-cause in-hospital mortality rate was 1.4%.Twenty(26.7%)patients with BAV and 46(16.5%)patients with TAV had mild or higher perivalvular leaks immediately after the procedure.No patients with BAV required permanent pacemaker implantation postoperatively,while 13(4.7%)TAV patients required permanent pacemaker implantation,with an overall pacemaker implantation rate of 3.7%.One(1.3%)BAV patient and 7(2.5%)TAV patients developed acute kidney injury postoperatively.One(1.3%)BAV patient and 1(0.4%)TAV patient developed perioperative myocardial infarction.The average postoperative hospital stay was 7.6±3.6 d for BAV patients and 8.6±6.1 d for TAV patients.There was no statistical difference in primary or secondary in-hospital outcomes between BAV and TAV patients(P>0.05).Conclusion Compared to TAV patients,BAV patients have similar in-hospital outcomes,with a low incidence of adverse clinical outcomes,which provides preliminary evidence for its implementation in Chinese patients with a high proportion of BAV.