摘要
目的:探讨经导管封堵外科主动脉瓣置换术后瓣周漏的有效性和安全性。方法:回顾性分析2010年3月至2020年3月在上海交通大学医学院附属胸科医院心内科接受经导管封堵外科主动脉瓣置换术后瓣周漏患者67例,均为外科高危或不愿意接受外科治疗者。分析并总结经导管封堵瓣周漏的手术成功率、住院与随访期间并发症及相关心血管事件的发生情况。结果:67例患者的平均年龄(53.4±22.5)岁,男性占55.2%。其中单纯主动脉瓣置换术28例,主动脉根部带瓣置换术2例,主动脉瓣联合二尖瓣置换术37例。16例置入主动脉生物瓣,余者置入机械金属瓣。中位美国胸外科医师协会死亡风险预测(STS-PROM)评分和欧洲心脏手术风险评估系统(EuroSCORE)Ⅱ评分分别为5.7%(3.1%,9.9%)和7.6%(5.8%,11.7%)。经导管封堵瓣周漏成功率为83.6%(56/67),1年生存率为98.5%。住院期间发生的与瓣周漏封堵主要相关事件为术后溶血,发生率为14.9%(10/67),1例因溶血进行性加重致急性肝肾功能衰竭死亡;另1例因主动脉瓣周置入封堵器后影响左心室流出道,转外科手术。平均随访(13.0±0.8)个月,患者NYHA心功能分级改善,超声心动图提示封堵术后左心室舒张末期和收缩末期内径均较术前明显缩小(P均<0.05)。结论:经导管封堵主动脉瓣瓣周漏在高危患者中可替代外科手术,并可减少反流,改善临床症状和心功能。溶血是围术期及随访期主要并发症。
Objectives:To assess the clinical efficacy and safety of transcatheter closure of aortic paravalvular leak(PVL)postsurgical aortic valve replacement.Methods:This retrospective study included 67 patients who underwent transcatheter closure of aortic PVL post-surgical aortic valve replacement at the Shanghai Chest Hospital between March 2010 and March 2020.We analyzed and summarized procedural success rate,and incidence of complications and related cardiac events during hospitalization and follow-up.Results:The mean age of included patients was(53.4±22.5)years,and 55.2%were male.Single surgical aortic valve replacement was performed in 28 cases,2 cases underwent Bentall procedure,the other 37 cases underwent double valve implantation in this cohort.16 cases were implanted with biological aortic prosthetic valves,while the others with mechanical valves.The median Society of Thoracic Surgeons-Predicted Risk of Mortality(STS-PROM)score and European System for Cardiac Operative Risk Evaluation(EuroSCORE)Ⅱscore were 5.7%(3.1%,9.9%)and 7.6%(5.8%,11.7%),respectively.Technical success rate of transcatheter closure of PVL was 83.6%,and the 1-year survival rate was 98.5%.Device-mediated hemolysis incidence during hospitalization was 14.9%(10/67)and was the major complication in this study,and 1 case died of hepatic and renal failure caused by worsening severe hemolysis.Another patient was transferred to emergency cardiac surgery due to left ventricular outflow tract obstruction induced by the implanted perivalvular occluder.During a mean followup period of 13.0±0.8 months,NYHA cardiac function classification was improved,left ventricular end-diastolic and endsystolic dimensions measured by echocardiography were significantly reduced compared to pre-procedure levels(all P<0.05).Conclusions:As an alternative to surgery,transcatheter closure of aortic paravalvular prosthetic regurgitation can lead to durable symptom relief and improve cardiac function in selected patients with high operative risk.It is notable that deviceme
作者
王小蕾
潘欣
于杰
王承
李艳杰
邢超凡
马兰
沈玲红
何奔
WANG Xiaolei;PAN Xin;YU Jie;WANG Cheng;LI Yanjie;XING Chaofan;MA Lan;SHEN Linghong;HE Ben(Department of Cardiology,Shanghai Chest Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200030,China;Department of Cardiology,Yantai Mountain Hospital,Yantai 264000,China)
出处
《中国循环杂志》
CSCD
北大核心
2023年第4期441-447,共7页
Chinese Circulation Journal
关键词
瓣周漏
主动脉瓣
介入治疗
随访
paravalvular leak
aortic valve
transcatheter repair
follow-up
