经导管主动脉瓣置入术对重度主动脉瓣狭窄合并不同程度二尖瓣返流患者的影响

Effect of transcatheter aortic valve implantation on severe aortic stenosis complicated with mitral regurgitation of different degrees

目的分析经导管主动脉瓣置入术(TAVI)对主动脉瓣狭窄(AS)合并不同程度二尖瓣返流(MR)患者的影响。方法回顾性选取2020年4月至2023年5月就诊于河南省胸科医院重度主动脉瓣狭窄并行TAVI手术的患者180例,按照患者是否合并MR及MR严重程度分为A组(无返流+轻度返流)、B组(中度+重度返流)。比较两组术前与术后心脏结构及功能的变化,以及TAVI手术在两组患者中的效果差异。结果两组患者术后主动脉瓣最大跨瓣压差即主瓣峰压差(AVPG)、主动脉瓣跨瓣峰流速即主瓣峰流速(AVPV)较术前均有改善(P<0.05),但其改善在两组之间差异无统计学意义(P>0.05)。合并二尖瓣中重度返流组左心房内径(LAD)[39.00(37.00,42.00)mm]、左室舒张末期内径(LVEDD)[47.00(41.00,58.00)mm]、二尖瓣返流面积(MR)[2.90(2.40,4.70)cm^(2)]及NT-ProBNP[2567.80(1196.87,3344.90)pg/mL]均低于术前[41.00(38.00,48.00)mm]、[55.00(44.00,60.00)mm]、[7.60(5.10,11.00)cm^(2)]、[4649.05(2132.54,9333.30)pg/mL],差异有统计学意义(P<0.05),术后左心室射血分数(LVEF)50.00(42.00,61.00)高于术前45.00(35.00,62.00),差异有统计学意义(P<0.05)。结论TAVI可用于AS合并不同程度MR患者的治疗,合并中重度MR的患者依然可以从中受益。

Objective To study the effect of transcatheter aortic valve implantation(TAVI)on severe aortic stenosis(AS)complicated with mitral regurgitation(MR)of different degrees.Methods Retrospectively,66 patients with severe aortic stenosis and TAVI surgery in Henan Provincial Chest Hospital from April 2020 to June 2022 were included and divided into group A(no regurgitation+mild regurgitation)and group B(moderate+severe regurgitation)according to presence or absence of MR as well as its severity.The changes in cardiac structure and function before and after operation and the effects of TAVI were compared between the two groups.Results The aortic valve peak gradient and aortic valve peak velocity in the two groups after operation were significantly improved compared with those before surgery(P<0.05),but there was no statistical difference between the two groups(P>0.05).In the moderate and severe mitral regurgitation group,the left atrial diameter[39.00(37.00,42.00)mm],left ventricular end diastolic diameter[47.00(41.00,58.00)mm],mitral regurgitation[2.90(2.40,4.70)cm^(2)]and NT-ProBNP[2567.80(1196.87,3344.90)pg/mL]were significantly lower than those before operation[41.00(38.00,48.00)mm],[55.00(44.00,60.00)mm],[7.60(5.10,11.00)cm^(2)],[4649.05(2132.54,9333.30)pg/mL](P<0.05),and LVEF was higher than before surgery[50.00(42.00,61.00)vs.45.00(35.00,62.00),P<0.05].Conclusion TAVI can be used for the treatment of patients with AS combined with MR of different degrees and it is beneficial for patients with moderate to severe mitral regurgitation as well.