“一站式”经心尖经导管主动脉瓣置换术联合二尖瓣缘对缘修复术治疗多瓣膜病变的早期疗效分析

Early efficacy of"one-stop"transapical transcatheter aortic valve replacement combined with mitral valve edge-to-edge repair in the treatment of multivalvular disease

目的探讨高危主动脉瓣病变合并重度二尖瓣反流患者采用“一站式”经心尖经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)联合经导管二尖瓣缘对缘修复术(transcatheter mitral valve edge-to-edge repair,TEER)的可行性及早期疗效。方法回顾性分析2022年8月—2023年10月于安徽医科大学第一附属医院心脏大血管外科接受“一站式”经心尖TAVR+TEER患者的临床资料。结果纳入5例患者,其中男3例、女2例,平均年龄(66.6±1.8)岁。主动脉瓣关闭不全合并二尖瓣反流4例,主动脉瓣狭窄伴关闭不全合并二尖瓣反流1例。所有患者均顺利完成经心尖TAVR+TEER,术后即刻超声心动图结果提示均无轻度以上瓣周漏和二尖瓣反流,人工瓣膜位置和功能良好。术后7 d,5例患者复查超声心动图提示人工瓣膜无移位,二尖瓣夹无脱落,瓣叶无损伤。术后1个月随访结果显示4例患者心功能得到不同程度的改善,1例患者因多器官功能衰竭死亡。1例患者出院后2个月余突发脑血管意外死亡,其余3例患者术后3个月随访超声心动图结果提示未出现轻度以上瓣周漏和二尖瓣反流,患者术后心功能及日常生活能力明显改善。结论对于高危主动脉瓣病变合并重度二尖瓣反流的多瓣膜病变,“一站式”经心尖TAVR+TEER早期疗效和安全性良好,具备可行性。

Objective To investigate the feasibility and early efficacy of transapical transcatheter aortic valve replacement(TAVR)combined with transcatheter mitral valve edge-to-edge repair(TEER)in patients with high-risk aortic valve lesions combined with severe mitral regurgitation.Methods The clinical data of patients who underwent"one-stop"transapical TAVR+TEER in our hospital from August 2022 to October 2023 were retrospectively analyzed.Results Five patients were collected,including 3 males and 2 females with a mean age of 66.6±1.8 years.Four patients had aortic valve insufficiency combined with mitral regurgitation and one had aortic valve stenosis and insufficiency combined with mitral regurgitation.All patients successfully completed transapical TAVR+TEER,and the immediate postoperative echocardiographic results revealed that none of them had more than mild perivalvular leakage and mitral regurgitation,and the prosthetic valves were in good position and function.At 1 week postoperatively,echocardiographic results showed 5 patients with no displacement of the prosthetic valve,detachment of the mitral clip,or damage to the leaflets.At 1 month postoperatively,cardiac function was improved to varying degrees in 4 patients,and 1 patient died of multiorgan failure.At 2 months postoperatively,1 patient died of cerebrovascular accident,and at 3 months postoperatively the echocardiographic results of the remaining 3 patients revealed that there was no more than mild perivalvular leakage or mitral regurgitation,and the patients'postoperative cardiac function and daily life ability were significantly improved.Conclusion In high-risk aortic valve lesions combined with severe mitral regurgitation,"onestop"transapical TAVR+TEER is feasible with favorable early efficacy and safety.