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    经导管主动脉瓣置换术治疗老年重度主动脉瓣狭窄近中期疗效随访

    Effectiveness of transcatheter aortic valve replacement for elderly severe aortic stenosis: a short and mid-term follow-up analysis

    • 摘要: 目的 探讨经导管主动脉瓣置换术对老年重度主动脉瓣狭窄(AS)的即刻临床疗效,并观察患者的近中期随访结果。方法 选择2018年4月—2022年2月徐州医科大学附属医院重度钙化性AS患者12例,术前经多学科严格评估,选择国产主动脉瓣,行经导管主动脉瓣置换术(TAVR),术后定期随访患者心功能、不良事件等。结果 12例患者均成功完成TAVR,男5例,女7例,中位年龄为77岁,美国胸外科医师学会(STS)评分为(5.05±2.75)%,手术时长(187.91±36.65)min。术后心脏超声监测主动脉瓣跨瓣压差较术前明显下降(P<0.01)。围手术期轻度瓣周漏7例,心源性休克1例,急性左心衰1例,完全性左束支传导阻滞2例,穿刺处股动脉壁间血肿1例,股动静脉瘘1例,无瓣中瓣植入。2例TAVR术前行经皮冠状介入治疗术,包括1例药物球囊扩张,1例支架植入术。术后N末端B型利钠肽前体(NT-proBNP)下降,主动脉瓣开放面积增加,人工瓣膜启闭功能正常,平均跨瓣压力阶差显著下降,左心室收缩功能改善。随访中位时间为29个月,1例患者于术后2个月诊断为亚急性感染性心内膜炎,确诊20 d后死亡。其余无心肌梗死等主要心脏不良事件出现,堪萨斯城生活质量量表(KCCQ)评分较前升高(P<0.01),相关临床症状好转,生活质量改善。结论 老年重度AS患者行经导管主动脉瓣置换术,能够显著改善血流动力学参数和心功能。近中期随访显示患者临床症状改善,生活质量提高,具有较广泛的临床应用前景。

       

      Abstract: Objective To explore the immediate clinical effectiveness of transcatheter aortic valve replacement for severe aortic stenosis(AS) in elderly patients, and to evaluate short-and mid-term follow-up results.Methods A total of 12 patients with severe calcified AS who were admitted to the Affiliated Hospital of Xuzhou Medical University from April 2018 to February 2022 were enrolled. After rigorous preoperative evaluation, domestic aortic valves were selected for transcatheter aortic valve replacement(TAVR). After surgery, the cardiac function and adverse events were regularly recorded.Results All the patients successfully completed TAVR, including five men and seven women, with an median age of 77 years. The American College of Thoracic Surgeons(STS) score was(5.05±2.75) %. The operation time was(187.91±36.65) min. The difference of postoperative aortic valve cross-valve pressure significantly decreased(P<0.01). There were seven cases of perioperative slight paravalvular leakage, one case of cardiogenic shock, one case of acute heart failure, two cases of complete left bundle branch blocks, one case of interval femoral artery hematoma at puncture, and one femoral arteriovenous fistula, without middle valve implantation. Two patients underwent percutaneous coronary intervention before TAVR, including one case of drug balloon dilation and one case of stent implantation. After the levels of postoperative N-terminal pro-B-type natriuretic peptide(NT-proBNP) were reduced, the aortic valve opening increased, the artificial valve opening and closing function became normal, and the order difference of average transvalve pressures significantly decreased, and the left ventricular systolic function improved. The median follow-up visits were 29 months. One patient was diagnosed with subacute infective endocarditis two months after operation and died 20 days after diagnosis. No major adverse cardiac events such as myocardial infarction occurred in other patients. The score of the Kansas City Quality of Life scale(KCCQ) remarkably increased(P<0.01). The related clinical symptoms and the quality of life were improved.Conclusions Transcatheter aortic valve replacement in elderly patients with severe AS can significantly improve hemodynamic parameters and cardiac function. The short-and medium-term follow-up visits show that the clinical symptoms and quality of life of the patients are improved, which has a wide range of clinical application prospects.

       

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