经导管主动脉瓣置换术治疗重度主动脉瓣狭窄的单中心经验总结

Experience of transcatheter aortic valve replacement for severe aortic stenosis in single center

目的:探讨重度主动脉瓣狭窄(AS)患者经导管主动脉瓣置换术(TAVR)的安全性及有效性。方法:回顾性连续收集2017年12月—2023年12月中山市人民医院进行TAVR的89例重度AS患者基线特征、影像学评估、围手术期及术后随访的结果,并进行经验性总结。结果:平均年龄74.0(69.5,80.0)岁,美国胸外科协会(STS)评分4.45%(3.19%,6.49%);二叶式主动脉瓣为46例(51.69%)。所有患者接受全身麻醉,以股动脉作为血管入路,自膨式瓣膜与球扩式瓣膜分别为82例(92.13%)、7例(7.87%)。技术成功率为97.75%,器械成功率为94.38%。术后纽约心脏病协会(NYHA)心功能分级Ⅲ及Ⅳ级者比例下降(68.54%vs 3.37%,P<0.001),N末端脑钠肽前体明显下降,左心室舒张末期内径改善,主动脉瓣峰值跨瓣压差下降,主动脉瓣峰值跨瓣流速下降。围手术期并发症以瓣周漏最为常见为48例(53.93%),轻、中、重度瓣周漏所占比例分别为34.83%、15.73%、3.37%。新发房室传导阻滞13例(14.44%),新发完全性左束支传导阻滞19例(21.35%),需植入永久起搏器者8例(8.99%);发生心包填塞者6例(6.74%);手术入路主要血管并发症3例(3.37%);造影剂诱发急性肾损伤9例(10.11%);急性缺血性脑卒中1例(1.12%)。术后平均随访时间为(23.55±18.08)个月,全因死亡为10例(11.24%)。其余患者生活质量均得到明显改善。结论:TAVR改善重度AS患者的生存率及生活质量,具有良好的安全性及有效性。

Objective To investigate the safety and efficacy of transcatheter aortic valve replacement(TAVR)in patients with severe aortic stenosis(AS).Methods The baseline characteristics,imaging evaluation,perioperative and postoperative follow-up results of 89 patients with severe AS who underwent TAVR in Zhongshan People's Hospital from December 2017 to December 2023 were retrospectively collected,and summarized.Results The mean age was 74.0(69.5,80.0)years,and the American Society for Thoracic Surgery(STS)score was 4.45%(3.19%,6.49%).Bicuspid aortic valve disease was found in 46 cases(51.69%).All patients received general anesthesia and femoral artery was used as the vascular approach.The 82 patients(92.13%)had self-dilatation valve and 7 patients(7.87%)had spherical dilatation valve.The technical success rate was 97.75%,and the instrument success rate was 94.38%.The proportion of patients with New York Heart Association(NYHA)gradeⅢandⅣdecreased after surgery(68.54%vs 3.37%,P<0.001),the N-terminal brain natriuretic peptide prebody decreased significantly,the left ventricular end-diastolic diameter improved,the peak trans-valve pressure decreased,and the peak trans-valve flow rate decreased.Perivalvular leakage was the most common complication in 48 cases(53.93%),and the proportion of mild,moderate and severe perivalvular leakage were 34.83%,15.73%and 3.37%,respectively.There were 13 cases(14.44%)of new atrioventricular block,19 cases(21.35%)of new complete left bundle branch block,and 8 cases(8.99%)of patients needed permanent pacemaker implantation.Pericardial tamponade occurred in 6 cases(6.74%).There were 3 cases(3.37%)of major vascular complications of surgical approach.Contrast media-induced acute kidney injury was in 9 cases(10.11%);Acute ischemic stroke occurred in 1 case(1.12%).The mean follow-up time was(23.55±18.08)months,and 10 cases(11.24%)died of all causes.The quality of life of other patients was significantly improved.Conclusion TAVR is safe and effective in improving the survival rate and quality of life in patients with severe aortic stenosis.