摘要
目的分析急诊经导管主动脉瓣置换术(TAVR)应用于急性心力衰竭患者的临床疗效及远期预后的影响因素。方法回顾性研究2016年1月至2020年12月武汉亚洲心脏病医院行急诊TAVR的急性心力衰竭患者的临床资料,主要结局指标为在院全因死亡率,使用Kaplan-Meier曲线进行生存分析。结果共计19例患者行急诊TAVR,平均年龄为(73.9±4.7)岁,男15例(78.9%)。住院期间死亡3例,其中2例为心肺复苏术后在体外膜肺氧合和主动脉内球囊反搏辅助下行TAVR,术后因多器官功能衰竭死亡,另外1例于TAVR术中出现心搏骤停抢救无效死亡。16例患者好转出院,进入随访,随访时间3~46个月,平均随访时间为19个月,随访期内死亡4例,死亡率为25.0%。根据术前是否合并二尖瓣中度以上的反流分为两组进行分析发现,两组生存率比较,差异有统计学意义(P=0.028),合并二尖瓣中度以上反流患者的生存率更低。结论对于药物治疗无效、血流动力学不稳定的急性心力衰竭或心原性休克患者,急诊TAVR治疗具有一定可行性。同时合并二尖瓣反流的患者可能远期生存率更低。
Objective To identify outcomes of patients undergoing emergency transcatheter aortic valve replacement(TAVR)and determine prognostic factors of long-term outcomes.Methods Retrospective analysis was done of all emergency TAVR procedures in our center between January 2016 and December 2020.The main outcomes were the incidence of all-cause mortality in the hospital.Kaplan-Meier survival analysis was used to determine prognostic factors of long-term outcomes.Results A total of 19 patients underwent emergency TAVR.The mean age was(73.9±4.7)years and 78.9%was male.Three patients died during hospitalization,of whom 2 patients underwent TAVR with the assistance of ECMO and IABP after cardiopulmonary resuscitation,and died of multiple organ failure after the operation,and the other died of cardiac arrest during TAVR.Sixteen patients were discharged from the hospital.They were followed up for 3 to 46 months,with an average follow-up time of 19 months.During the follow-up period,4 patients died,with a mortality rate of 25.0%.Univariate analysis of risk factors for long-term outcomes was moderate/severe mitral regurgitation(P=0.028).Conclusions Emergency TAVR in extreme risk patients with acute decompensated heart failure or cardiogenic shock secondary to severe aortic valve disease is feasible and effective.Moderate/severe mitral regurgitation maybe the risk factors for long-term outcomes.
作者
刘洪艳
龙艳丽
郭卉
徐承义
王波
LIU Hong-yan;LONG Yan-li;GUO Hui;XU Cheng-yi;WANG Bo(Department of Cardiac Surgery,Wuhan Asia Heart Hospital,Wuhan 430000,China)
出处
《中国介入心脏病学杂志》
CSCD
2023年第1期33-38,共6页
Chinese Journal of Interventional Cardiology
关键词
经导管主动脉瓣置换
急性心力衰竭
疗效
二尖瓣反流
Transcatheter aortic valve replacement
Acute heart failure
Clinical outcomes
Mitral regurgitation
