摘要
目的评估和比较经股动脉入路经导管主动脉瓣置换术(TF-TAVR)治疗不同瓣环大小的单纯主动脉瓣反流(PAR)患者的手术成功率及短期临床预后。方法本研究为单中心回顾性研究,选取2019年9月至2023年9月在复旦大学附属中山医院接受TF-TAVR治疗的症状性PAR患者。基于术前CT结果,将所有患者分为3组:A组(主动脉瓣环周长<80 mm)、B组(80 mm≤主动脉瓣环周长<85 mm)和C组(主动脉瓣环周长≥85 mm)。主要终点为手术成功率和术后30 d全因死亡事件,次要终点事件为TAVR相关并发症。结果本研究共纳入PAR患者61例,其中A组27例,B组21例,C组13例。总体手术成功率为82.0%,术后30 d全因死亡率为3.3%。C组患者的手术成功率明显更低(P=0.012),其中转外科和瓣中瓣置入率明显更高(P=0.022和P=0.040)。在次要终点事件方面,3组患者在大出血事件、主要血管并发症、脑卒中、心肌梗死、新发心房颤动、植入新的起搏器、冠状动脉阻塞和术后中重度瓣周漏方面比较,差异均无统计学意义(均P>0.05)。结论主动脉瓣环周长是影响手术成功率的关键因素之一,主动脉瓣环周长<85 mm的PAR患者可能更适合行TF-TAVR。
Objective To evaluate and compare the success rate and short-term clinical prognosis of transfemoral transcatheter aortic valve replacement(TF-TAVR)for patients with pure aortic regurgitation(PAR)of different annulus sizes.Methods This study is a single center retrospective study,selecting symptomatic PAR patients who received TF-TAVR treatment at Zhongshan Hospital Fudan University from September 2019 to September 2023.Based on preoperative CT results,all patients were divided into three groups:Group A(aortic annulus circumference<80 mm),Group B(80 mm≤aortic annulus circumference<85 mm),and Group C(aortic annulus circumference≥85 mm).The primary endpoint was success rate and 30d all-cause mortality, while the secondary endpoint was TAVR related complications. Results A total of 61 PAR patients were included in this study, including 27 in Group A, 21 in Group B, and 13 in Group C. The overall success rate is 82.0%, and the 30 d all-cause mortality rate is 3.3%. The success rate of Group C patients was significantly lower (P=0.012), with higher rates of conversion to surgery and valve-in-valve implantation (P=0.022 and P=0.040). In terms of secondary endpoint events, there were no significant differences among the three groups in major bleeding events, major vascular complications, stroke, myocardial infarction, newly developed atrial fibrillation, implantation of new pacemakers, coronary artery occlusion, and postoperative moderate to severe perivalvular leakage (all P>0.05). Conclusions The circumference of the aortic valve annulus is a key factor aff ecting the success rate of TF-TAVR in PAR, and PAR patients with an aortic valve annulus circumference less than 85mm may be more suitable for TF-TAVR.
作者
洪楠超
陈莎莎
张源
张晓春
潘文志
周达新
葛均波
HONG Nan-chao;CHEN Sha-sha;ZHANG Yuan;ZHANG Xiao-chun;PAN Wen-zhi;ZHOU Da-xin;GE Jun-bo(Department of Cardiology,Zhongshan Hospital,Fudan University,Research Unit of Cardiovascular Techniques and Devices,Chinese Academy of Medical Sciences,Shanghai 200032,China;National Clinical Research Center for Interventional Medicine,Shanghai 200032,China)
出处
《中国介入心脏病学杂志》
CSCD
2024年第5期244-249,共6页
Chinese Journal of Interventional Cardiology
基金
国家重点研发计划项目(2020YFC2008100)
上海市启明星计划扬帆专项项目(22YF1443400)。
关键词
经导管主动脉瓣置换术
主动脉瓣反流
经股动脉
主动脉瓣环
Transcatheter aortic valve replacement
Aortic valve regurgitation
Transfemoral
Aortic valve annulus
