经导管主动脉瓣植入术治疗重度主动脉瓣狭窄

Transcatheter aortic valve implantation for treating severe aortic stenosis

目的观察经导管主动脉瓣植入术(TAVI)治疗重度主动脉瓣狭窄(AS)的效果。方法回顾性收集18例接受TAVI的重度AS患者,记录TAVI即刻成功率,观察治疗过程中及治疗后相关并发症;随访记录治疗后1、3个月瓣膜功能及心血管事件。结果18例实施TAVI成功。对3例AS合并冠心病患者行一站式TAVI+经皮冠状动脉介入治疗,对2例冠状动脉阻塞高风险患者通过“烟囱”或“开窗”技术加以预保护。1例顽固性心力衰竭患者接受体外膜氧合器辅助下TAVI;1例尿毒症患者于TAVI前、后接受血液透析。TAVI即刻成功率100%(18/18)。TAVI过程中1例发生心脏压塞而转外科治疗;1例因中度瓣周漏而植入另1枚瓣膜。治疗后3例存在轻度瓣周漏,1例因三度房室传导阻滞而植入永久性心脏起搏器。未见严重并发症。治疗后即刻及1、3个月,超声心动图显示主动脉瓣口流速[(203.47±70.65)、(219.64±67.49)、278.00(188.50,289.00)cm/s]和跨瓣压差[(17.16±14.05)、0(0,20.50)、12.00(0,32.50)mmHg]均较治疗前[470.50(428.75,553.25)cm/s、79.50(53.25,112.50)mmHg]降低(P均<0.05)。治疗后3个月内无死亡、卒中、急性冠脉综合征及新发房颤等严重心血管事件发生。结论TAVI治疗重度AS安全,且短期疗效好。

Objective To observe the effect of transcatheter aortic valve implantation(TAVI)for treating severe aortic stenosis(AS).Methods Data of 18 patients with severe AS who underwent TAVI were retrospectively analyzed.The immediately success rate of TAVI was recorded,and the intraoperative and postoperative complications were observed.The valve function was evaluated,and cardiovascular events during 1 month’and 3 months’following-up period after treatment were recorded.Results Among 18 cases,3 patients with coronary heart disease were treated with one-step TAVI+percutaneous coronary intervention(PCI),2 with high risk of coronary artery occlusion were treated under“chimney”or“windowing”stent pre-protection,1 with refractory heart failure was treated with TAVI under protection of extracorporeal membrane oxygenator(ECMO),while 1 case with uremia underwent hemodialysis on the day before TAVI and the day of TAVI after interventional procedures.The immediate operation success rate of TAVI was 100%(18/18).During treatment,1 case was transferred to surgery due to cardiac tamponade,another valve implantation was performed in 1 case since moderate perivalvular leakage after implantation of the first valve.Mild perivalvular leakage was found in 3 cases after treatment.Implantation of permanent pacemaker was performed in 1 patient for third degree atrioventricular block.No other serious complication occurred.Immediately,1 month and 3 months after treatment,aortic orifice flow rate([203.47±70.65],[219.64±67.49],278.00[188.50,289.00]cm/s)and pressure gradient([17.16±14.05],0[0,20.50],12.00[0,32.50]mmHg)showed by echocardiography decreased compared to those before treatments(470.50[428.75,553.25]cm/s,79.50[53.25,112.50]mmHg)(all P<0.05).No severe cardiovascular event,such as death,stroke,acute coronary syndrome nor new onset atrial fibrillation occurred within 3 months after treatment.Conclusion TAVI was safe for treating severe AS with good short-term efficacy.