瓣膜植入深度对单纯主动脉瓣反流患者行经导管主动脉瓣置换术后围术期心功能影响

Effect of valve implantation depth on perioperative cardiac function after transcatheter aortic valve replacement among patients with simple aortic regurgitation

目的 探讨瓣膜植入深度对单纯主动脉瓣反流(aortic regurgitation, AR)患者行经导管主动脉瓣置换术(transcatheter aortic valve replacement, TAVR)后早期心功能变化情况及围术期并发症的影响。方法 选择2021年9月-2023年3月本院收治的TAVR治疗的主动脉瓣重度反流的患者30例作为研究对象,根据覆膜支架下缘距无冠瓣距离分为两组,瓣膜植入深度为0~6 mm患者有21例(Ⅰ组),瓣膜植入深度>6 mm患者有9例(Ⅱ组);分别测量俩组患者术前及术后2周超声心动图指标,同时追踪患者围术期并发症情况。通过对比研究,分析TAVR手术瓣膜植入深度对患者术后早期心功能及围术期并发症的影响。结果 两组患者术前各项基线临床资料差异均无统计学意义(P>0.05)。与术前比较,两组患者术后2周左房舒张末期内径(LAD)明显减小、左室舒张末期内径(LVEDD)明显减小、室间隔厚度(IVST)明显变薄、左室射血分数(LVEF)明显增高,差异具均有统计学意义(P<0.05);两组患者术后2周主动脉瓣口峰值流速(AV Vmax)减低,三尖瓣反流面积(TR area)有所减小,但差异没有统计学意义(P>0.05)。Ⅰ组患者术后二尖瓣反流面积(MR area)明显减小,差异有统计学意义(P<0.05);Ⅱ组患者术后二尖瓣反流面积稍增大,差异无明显统计学意义(P>0.05)。两组患者术中TEE指标,左室流出道内径、主动脉瓣环前后径、升主动脉内径、左冠状动脉及右冠状动脉开口高度比较差异均无统计学意义(P>0.05);两组患者二尖瓣幕帘宽度比较,差异有统计学意义(P<0.05)。两组患者术后围术期并发症比较,Ⅱ组患者发生瓣周漏及传导障碍比例更高,差异具有统计学意义(P<0.05);两组患者在瓣中瓣、起搏器植入、脑卒中、股动脉夹层、肺部感染等发病率方面差异无统计学意义(P>0.05)。结论 单纯主动脉瓣反流患者TAVR术后早期心功能已具有明显改善,手术成功率较高,此类患者接受TAVR治疗安全有效。瓣膜植入深度对患者围术期并发症有影响,瓣膜植入过深会增加瓣周漏及传导障碍发生率,可能导致二尖瓣反流程度有加重趋势。

Objective To investigate the effect of valve implantation depth on early cardiac function changes and perioperative complications among patients with simple aortic regurgitation(AR)after transcatheter aortic valve replacement(TAVR).Methods Thirty patients with severe aortic valve regurgitation who underwent TAVR in the First Affiliated Hospital of Wannan Medical College from September 2021 to March 2023 were included in the study.The patients were divided into 2 groups according to the distance of the lower edge of the overlapping stent from the aortic valve,21 patients with valve implantation depth of 0mm-6mm(group I)and 9 patients with valve implantation depth over 6mm(group II).The echocardiographic indexes were measured preoperative and 2 weeks postoperative in both groups,and the patients were also followed up for perioperative complications.The effect of valve implantation depth on early postoperative cardiac function and perioperative complications was analyzed in a comparative study.Results The differences in the preoperative baseline clinical data between the two groups were not statistically significant(P>0.05).Compared with the preoperative period,the left atrial end-diastolic diameter(LAD),left ventricular end-diastolic diameter(LVEDD),interventricular septal thickness(IVST)and left ventricular ejection fraction(LVEF)were significantly reduced,and the differences were statistically significant(P<0.05).The peak velocity of the aortic valve orifice(AV Vmax)decreased and the tricuspid regurgitation area(TR area)decreased in both groups 2 weeks after surgery,but the differences were not statistically significant(P>0.05).In group I,the postoperative mitral regurgitation area(MR area)was significantly reduced,with a statistically significant difference(P<0.05);in group II,the postoperative mitral regurgitation area was slightly increased,with no statistically significant difference(P>0.05).The intraoperative TEE indices,left ventricular outflow tract internal diameter,anterior and posterior aortic annulus diameter,ascending aortic internal diameter,left coronary artery and right coronary artery opening height were not statistically significant between the two groups(P>0.05);the difference in mitral curtain width was statistically significant between the two groups(P<0.05).When comparing the postoperative perioperative complications between the two groups,patients in group II had a higher proportion of perivalvular leaks and conduction disturbances,and the difference was statistically significant(P<0.05);there was no statistically significant difference between the two groups in the incidence of valve-in-valve,pacemaker implantation,stroke,femoral artery entrapment and pulmonary infection(P>0.05).Conclusions Patients with simple aortic regurgitation already have significant improvement in cardiac function early after TAVR,the success rate of the procedure is high,and these patients are safe and effective for TAVR treatment.The depth of valve implantation has an impact on the perioperative complications of patients,and too deep a valve implantation increases the incidence of perivalvular leakage and conduction disturbances,which may lead to a tendency to worsen the degree of mitral regurgitation.