摘要
目的探讨经股动脉经导管主动脉瓣置换术(transfemoral transcatheter aortic valve replacement,TF-TAVR)治疗高危单纯主动脉瓣反流(pure aortic regurgitation,PAR)患者的早期临床安全性及有效性。方法回顾性分析2018年1月—2022年10月在武汉亚洲心脏病医院和武汉亚心总医院接受TAVR治疗的PAR患者的临床资料。根据手术方式将患者分为TF-TAVR组和经心尖经导管主动脉瓣置换术(transapical transcatheter aortic valve replacement,TA-TAVR)组。分析两组患者的临床资料。结果纳入54例PAR患者,其中男34例、女20例,平均年龄(74.43±6.87)岁,TF-TAVR组25例,TA-TAVR组29例。与TA-TAVR组相比,TF-TAVR组术前N末端B型利钠肽前体值更低[808.50(143.50,2937.00)pg/mL vs.2245.00(486.30,7177.50)pg/mL,P=0.015]、左心室舒张末期直径[(56.00±6.92)mm vs.(63.07±10.23)mm,P=0.005]和窦管交界直径[(32.47±4.41)mm vs.(37.65±8.08)mm,P=0.007]更小,差异均有统计学意义。两组住院期间无死亡病例;术后1个月随访,仅TF-TAVR组1例死亡(脑出血);术后3个月随访,TF-TAVR组新增死亡2例(1例心源性猝死,1例多脏器功能衰竭),TA-TAVR组无死亡病例;术后6个月随访,TF-TAVR组无新增死亡病例,TA-TAVR组新增死亡1例(死亡原因不明确)。两组随访期内全因死亡率和累积生存率差异均无统计学意义(P>0.05)。随访期内TF-TAVR组新发高度房室传导阻滞比例为36.0%,TA-TAVR组为10.3%,差异有统计学意义(P=0.024)。两组瓣周漏(≥中度)、瓣中瓣、置入第2枚瓣膜、瓣膜移位、脑血管事件、主要血管并发症、完全性左束支传导阻滞、新植入永久起搏器和中转外科手术等并发症发生率差异均无统计学意义(P>0.05)。但TF-TAVR组完全性左束支传导阻滞和新植入永久起搏器发生率较高,分别为56.0%和40.0%。结论与TA-TAVR比较,TF-TAVR治疗高危PAR患者可行,其术后早期安全性及有效性与TA-TAVR相当。
Objective To assess early clinical safety and efficacy of transfemoral transcatheter aortic valve replacement(TF-TAVR)for pure aortic regurgitation(PAR).Methods The clinical data of PAR patients who underwent TAVR in Wuhan Asia Heart Hospital and Wuhan Asia General Hospital from January 2018 to October 2022 were retrospectively analyzed.Patients were divided into a TF-TAVR group and a transapical transcatheter aortic valve replacement(TA-TAVR)group.The clinical data of the patients were analyzed.Results A total of 54 patients were enrolled,including 34 males and 20 females with an average age of 74.43±6.87 years.The preoperative N-terminal pro-Btype natriuretic peptide level was lower[808.50(143.50,2937.00)pg/mL vs.2245.00(486.30,7177.50)pg/mL,P=0.015],and the left ventricular end-diastolic diameter(56.00±6.92 mm vs.63.07±10.23 mm,P=0.005)and sinus junction diameter(32.47±4.41 mm vs.37.65±8.08 mm,P=0.007)were smaller in the TF-TAVR group.There was no death in the two groups during the hospitalization.Only 1 new death within postoperative 1 month in the TF-TAVR group(cerebral hemorrhage).A total of 2 new deaths in the TF-TAVR group(1 patient of sudden cardiac death and 1 of multiple organ failure),and there was no death in the TA-TAVR group within postoperative 3 months.There was 1 new death in the TA-TAVR group(details unknown),and there was no death in the TF-TAVR group within postoperative 6 months.There was no statistical difference between the two groups in the all-cause mortality and the cumulative survival rate during the follow-up period(P>0.05).The incidence of high atrioventricular block was 36.0%in the TF-TAVR group and 10.3%in the TA-TAVR group(P=0.024).There were no significant differences between the two groups in the perivalvular leakage(≥moderate),valve in valve,a second valve implantation,valve migration,cerebrovascular events,major vascular complications,complete left bundle branch block,new permanent pacemaker implantation or transferring to surgery(P>0.05).However,the incidence rates of
作者
车波
徐承义
徐文杰
孙梦琪
何同达
鄢华
宋丹
CHE Bo;XU Chengyi;XU Wenjie;SUN Mengqi;HE Tongda;YAN Hua;SONG Dan(Wuhan Asia Heart Hospital,Wuhan,430022,P.R.China;Wuhan Asia General Hospital,Wuhan,430056,P.R.China)
出处
《中国胸心血管外科临床杂志》
CSCD
北大核心
2024年第8期1164-1173,共10页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
