经导管主动脉瓣置换术冠状动脉阻塞风险预防的单中心研究

A single-center study of risk prevention of coronary artery occlusion after transcatheter aortic valve replacement

目的探讨经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)冠状动脉(冠脉)阻塞风险的有效预防策略。方法收集2016年1月—2024年1月于河北医科大学第二医院行TAVR患者的围手术期资料,回顾性分析TAVR术后患者冠脉阻塞事件的发生情况。结果共行TAVR 385例,其中经外周入路321例,经心尖入路64例;冠脉高风险72例,术中行冠脉保护26例(“烟囱”支架2例、冠脉开口支架开窗20例、冠脉保护性导丝或支架预置入4例),应用冠脉风险较低的J-Valve瓣膜17例,其余病例经进一步风险评估初步排除冠脉风险,未予冠脉保护或行相应处理;术后冠脉阻塞发生1例(0.3%)。结论冠脉阻塞是经导管主动脉瓣置换术后极为严重的并发症,虽整体发生水平不高,但致死性极强。对于冠脉高风险TAVR病例,预防重于补救,术前详尽研判、术中充分保护意义重大。围手术期内方法合理、策略得当可有效降低TAVR相关冠脉阻塞事件的发生,提高整体手术的成功率。

Objective To explore the effective prevention strategy of transcatheter aortic valve replacement(TAVR)and summarize the relevant experience.Methods The perioperative data of TAVR patients in the Second Hospital of Hebei Medical University from 2016 to 2024 were collected,and the occurrence of coronary artery occlusion events in patients after TAVR was retrospectively analyzed.Results A total of 385 cases of TAVR were treated,including 321 cases via peripheral approach and 64 cases via apical approach.There were 72 high-risk cases with coronary artery,26 cases received coronary artery protection during the operation(2 cases with"chimney"stent,20 cases with coronary opening stent window opening,and 4 cases with coronary protective guide wire or stent prepositioning),17 cases received J-Valve valve with low coronary risk,and the remaining cases were preliminatively excluded by further risk assessment without coronary artery protection or corresponding treatment.Postoperative coronary artery obstruction occurred in 1 case,and the incidence of coronary artery obstruction was 0.3%.Conclusion Coronary artery occlusion is a very serious complication after transcatheter aortic valve replacement.Although the overall incidence is not high,it is extremely fatal.For high-risk coronary TAVR cases,prevention is more important than remedy,and detailed preoperative investigation and adequate protection during operation are of great significance.In the perioperative period,reasonable methods and proper strategies can effectively reduce the occurrence of TAVR-related coronary artery obstruction events and improve the overall success rate of surgery.