摘要
目的探讨经颈动脉途径行经导管主动脉瓣置换术（TAVR）治疗重度主动脉瓣狭窄的安全性和有效性。方法纳入2015年11月至2017年2月在复旦大学附属中山医院经颈动脉途径行TAVR的症状性重度主动脉瓣狭窄患者（存在外科手术禁忌证或手术风险高危，且不适合经股动脉途径行TAVR）9例，对其临床资料进行回顾性分析。术后对患者进行随访，观察TAVR治疗重度主动脉瓣狭窄的有效性及安全性。结果9例患者中，男性4例，年龄（75.7±8.7）岁，美国胸外科医师协会（STS）评分为（7.9±1.6）%。患者均经左颈动脉途径行TAVR。1例患者在术中发生瓣膜脱落，转行外科手术，其余患者均完成TAVR。2例患者术中因出现Ⅲ度房室传导阻滞，而植入永久起搏器。1例患者术中出现心脏骤停，胸外按压后生命体征恢复稳定。1例患者缝合左颈动脉后造影显示左颈总动脉严重狭窄，术后无神经功能损伤的临床表现。患者随访时间为术后（30±3）d，均未发生不良事件。患者的改良Rankin量表评分均为0分。超声心动图显示，8例成功行TAVR的患者主动脉瓣瓣膜均无反流；主动脉瓣跨瓣压差由术前的（63.0±19.2）mmHg（1 mmHg=0.133 kPa）降低至术后的（18.1±4.9）mmHg（P〈0.001）；轻度瓣周漏4例，无中度以上瓣周漏。术后纽约心脏协会（NYHA）心功能分级较术前改善（术前Ⅱ级2例、Ⅲ级4例、Ⅳ级3例，术后Ⅰ级5例、Ⅱ级4例，P=0.006）。左心室射血分数由术前的（55.9±13.1）%升高至术后的（60.4±10.0）%（P=0.030）。结论初步经验表明，对主动脉瓣狭窄患者经颈动脉行TAVR安全、有效。
ObjectiveTo investigate the safety and efficacy of transcatheter aortic valve replacement（TAVR） through transcarotid approach for patients with severe aortic valve stenosis.MethodsThe clinical data of 9 symptomatic severe aortic valve stenosis patients who had high or prohibitive risk for surgery and not suitable for TAVR through femoral artery access,and thus received TAVR through transcarotid approach in our hospital from November 2015 to February 2017 were retrospectively analyzed.The patients were followed up to observe the safety and efficacy of the procedure.ResultsThere were 4 male and 5 female patients in this cohort, and age was （75.7±8.7） years old. The Society of Thoracic Surgery （STS） scores were （7.9±1.6）%. All patients were treated by left carotid artery approach. One patient experienced valve dislodgement during the procedure and received surgery, and TAVR procedure was successful in the rest 8 patients. Two patients were implanted with permanent pacemaker because of third degree atrioventricular block during the procedure.One patient had cardiac arrest during the procedure and recovered after external chest compression.One patient developed severe carotid stenosis,and there was no clinical manifestation of nerve function deficit after the procedure. All patients were followed up at （30±3） days after the procedure, and there were no adverse events. The modified Rankin scale score was 0. Echocardiography examination showed that the tranvalvular mean gradient was reduced from （63.0±19.2）mmHg（1 mmHg=0.133 kPa） on baseline to （18.1±4.9）mmHg（P〈0.001）, 4 cases had mild paravalvular leakage, and there was no moderate or severe paravalvular leakage.The NYHA classes was significantly improved at 30 days when compared with before the procedure（2 cases class Ⅱ, 4 cases class Ⅲ,3 cases class Ⅳ before the procedure,and 5 cases classⅠ, 4 cases class Ⅱ after the procedure, P=0.006） , and left ventricular ejection fraction increased from （55.9±13.1）% to （60.4±10.0）% （P=0.030）.ConclusionOur initial experience indicates that transcarotid TAVR is safe and effective for patients with severe aortic valve stenosis.
作者
潘文志
周达新
张晓春
张蕾
魏来
葛均波
Pan Wenzhi, Zhou Daxin, Zhang Xiaochun, Zhang Lei, Wei Lai, Ge Junbo(Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, Chin)
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2018年第3期198-202,共5页
Chinese Journal of Cardiology
基金
上海市科委产学研项目(16441908100)
复旦大学附属中山医院优秀青年培养计划(2015ZSYXQN25)
关键词
主动脉瓣狭窄
治疗结果
经导管主动脉瓣置换术
Aortic valve stenosis
Treatment outcome
Transcatheter aortic valve replacement
