摘要
目的:探讨过渡性经皮球囊主动脉瓣成形术(PBAV)治疗危重主动脉瓣狭窄患者的临床应用经验。方法:回顾性分析2011-03至2017-03在阜外医院行PBAV的37例暂不适宜行瓣膜置换术的危重主动脉瓣狭窄患者,年龄(74±12)岁。观察患者临床及解剖特点、手术有效及安全性,并进行随访。结果:本组患者基线外科风险高心功能差,二叶式主动脉瓣占比约50%,瓣叶钙化程度重[钙化体积CT值850(HU850)=(856.0±658.2)mm3]。术中参考瓣环上平均内径选择球囊,术后7天主动脉瓣瓣口面积从(0.37±0.10)cm2增大至(0.87±1.10)cm2,主动脉瓣平均跨瓣压差从(55.1±22.9)mm Hg(1 mm Hg=0.133 k Pa)降至(44.8±17.8)mm Hg(P<0.001),左心室射血分数从(35.8±14.3)%增加到(41.0±12.2)%(P<0.001)。术后住院期间发生死亡4例,1例安装永久起搏器,1例主动脉瓣重度反流。术后平均随访(16.5±11.1)个月,共有13例(35.1%)患者过渡到外科或经导管瓣膜置换术治疗。结论:对于暂不宜行外科主动脉瓣置换术和经导管主动脉瓣置换术(TAVR)的危重主动脉瓣狭窄患者,PBAV可取得良好的早期临床结果,有望成为过渡性治疗手段,对于中国二叶式主动脉瓣比例高,瓣叶钙化重特点,采用瓣环上内径选择较小球囊安全有效。
Objectives： To explore the clinical experience for a bridge therapy of percutaneous balloon aortic valvuloplasty（PBAV） in treating the patients with severe aortic stenosis（AS）.Methods： A total of 37 patients with severe AS who were not suitable for surgical valvular replacement received PBAV in our hospital from 2011-03 to 2017-03 were retrospectively studied. The patient＇s mean age was（74±12） years, their clinical and anatomical features, efficacy and safety of operation were observed and the outcomes were evaluated by follow-up study.Results： Patients presented the high surgical risk and worse cardiac function, 50% of them had bicuspid leaflet morphology with severe calcification [HU850=（856.0±658.2） mm3]. Balloon size was chosen by the intra-operative supraannular diameters; at 7 days after operation, aortic valve orifice area（AVOA） was increased from（0.37±0.10） cm2 to（0.87±1.10） cm2, the mean trans-aortic valve gradient pressure decreased form（55.1±22.9） mm Hg to（44.8±17.8） mm Hg, P〈0.001 and LVEF elevated form（35.8±14.3） % to（41.0±12.2） %, P〈0.001. There were 4 patients died in hospital, 1 received permanent pacemaker and 1 developed severe aortic valve regurgitation. The patients were followed-up for（16.5±11.1）months after operation, 13/37（35.1%） patients were in transition to surgical or transcatheter aortic valve replacement（TAVR）.Conclusions： PBAV may have good early clinical efficacy in severe AS patients who were not suitable for surgical valvular replacement and TAVR; PBAV could be expected to become a bridge therapy, smaller supra-annular diameter was safe and effective for patients having bicuspid leaflet with severe calcification.
作者
王墨扬
宋光远
裴汉军
王媛
张倩
牛冠男
周政
张昊
张文佳
王建德
吕滨
吴永健
乔树宾
杨跃进
高润霖
WANG Mo-yang;SONG Guang-yuan;PEI Han-jun;WANG Yuan;ZHANG Qian;NIU Guan-nan;ZHOU Zheng;ZHANG Hao;ZHANG Wen-jia;WANG Jian-de;LV Bin;WU Yong-jian;QIAO Shu-bin;YANG Yue-jin;GAO Run-lin(Department of Cardiology, National Center for Cardiovascular Disease and Fuwai Hospital, CAMS and PUMC, Beijing （ 100037）, China)
出处
《中国循环杂志》
CSCD
北大核心
2018年第4期336-340,共5页
Chinese Circulation Journal
基金
中国医学科学院医学与健康科技创新工程(2017-I2M-3-002)
