摘要
目的:探讨经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)治疗主动脉瓣狭窄患者的安全性和有效性。方法:连续入选本中心前40例行TAVR的主动脉瓣狭窄患者。观察终点指标包括手术成功率、并发症、术后30d随访结果等。结果:患者男性27例,女性13例;年龄67~87岁,平均年龄(78.3±5.0)岁。手术成功率100%;与术前相比,术后患者平均主动脉瓣跨瓣压差明显下降[(10.77±3.90)mmHg vs(61.80±18.62)mmHg,P<0.001],平均瓣口面积增加[(1.80±0.24)cm^2 vs(0.65±0.17)cm^2,P<0.001],美国纽约心脏病学会(NYHA)心功能分级改善(1.80±0.62 vs2.95±0.75,P<0.001)。术后1d发生瓣周漏13例(12例轻度、1例中度),急性右冠状动脉堵塞1例,瓣膜脱落及脑梗死1例,顽固性心包积液、心包填塞1例。术后30d死亡1例(2.5%),因心脏传导异常置入永久性心脏起搏器4例(10%)。结论:单中心、前40例TAVR结果显示,TAVR对我国外科手术禁忌或高危的主动脉瓣狭窄患者有较好的安全性及有效性。
Objective:To evaluate the safety and efficacy of transcatheter aortic valve replacement(TAVR)in 40 patients with aortic valve stenosis in our center.Methods:Totally 40 consecutive patients who underwent TAVR in our center were enrolled.The endpoints included success rate of operation,complications,follow-up results 30 days after operation,etc.Results:There were 27 males and 13 females with mean age of(78.3±5.0)years old.The success rate of operation was 100%.After operation,the mean aortic valve pressure gradient decreased significantly([10.77±3.90]mmHg vs[61.80±18.62]mmHg,P<0.001),while the mean flap area increased significantly([1.80±0.24]cm 2 vs[0.65±0.17]cm 2,P<0.001).The NYHA class was significantly improved(1.80±0.62 vs 2.95±0.75,P<0.001)after TAVR.One day after operation,there were 13 with paravalvular regurgitation(12 of mild cases and 1 of moderate case),1 with acute occlusion of right coronary artery,1 with valve dislodgement then ischemic stroke,and 1 with intractable pericardial effusion and pericardial tamponade.In the 30-day follow-up,the mortality rate was 2.5%(1 patient)and the incidence of permanent cardiac pacemaker for abnormal cardiac conduction was 10%(4 patients).Conclusions:TAVR is safe and effective for aortic stenosis patients with high-risk or surgical contradication in our country.
作者
李明飞
潘文志
张蕾
张晓春
周达新
葛均波
LI Ming-fei;PAN Wen-zhi;ZHANG Lei;ZHANG Xiao-chun;ZHOU Da-xin;GE Jun-bo
出处
《中国临床医学》
2018年第1期5-8,共4页
Chinese Journal of Clinical Medicine
基金
上海市科委产学研项目子课题(14DZ1941500)
上海市科委科技创新行动计划生物医药领域科技支撑项目(16441908100)~~
关键词
主动脉瓣狭窄
经导管主动脉瓣置换术
瓣周漏
aortic valve stenosis
transcatheter aortic valve replacement
paravalvular regurgitation
