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摘要: 目的 探讨经导管主动脉瓣植入术(TAVI)经股动脉治疗单纯主动脉瓣关闭不全(AR)患者的可行性。方法 回顾性分析术者自2018年5月21日—2022年1月31日完成的27例经股动脉TAVI手术治疗AR患者,男12例,女15例,年龄49~84岁,平均(72.50±3.07)岁。患者术前心电图示窦性心律,无传导系统疾病,二尖瓣或三尖瓣均无器质性改变,且术前超声心动图均显示重度AR。术前通过超声心动图测得其主动脉瓣反流束宽度,以判断主动脉反流程度。所有患者均经股动脉行TAVI手术。结果 所有患者成功植入自膨胀支架瓣膜,复查彩超提示人工瓣膜功能良好,未见明显瓣周漏,升主动脉内人工支架血流通畅;无术中死亡病例,未出现术中中转开胸手术病例,瓣中瓣植入3例,永久起搏器植入3例,全部患者治愈出院,术后住院天数5~12 d。结论 TAVI手术经股动脉用于单纯AR患者的治疗是可行的,术后早期效果满意。
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关键词:
- 主动脉瓣关闭不全 /
- 经导管主动脉瓣植入术 /
- 经导管主动脉瓣置换术 /
- 经股动脉 /
- 瓣周漏
Abstract: Objective To investigate the feasibility of transcatheter aortic valve implantation(TAVI) via the femoral artery in patients with pure aortic regurgitation(AR).Methods From May 21, 2018 to January 31, 2022, 27 patients with pure AR underwent TAVI via femoral artery were analyzed retrospectively. The patient's preoperative electrocardiogram showed sinus rhythm, no conduction system disease, no organic changes in the mitral valve or tricuspid valve, and preoperative echocardiography showed severe AR. The width of the aortic valve regurgitation beam was measured by echocardiography before surgery in order to judge the degree of aortic regurgitation. All patients underwent TAVI through the femoral artery.Results All patients were successfully implanted with self-expanding stent-valve. Repeat color Doppler ultrasound showed that the artificial valve function was good, no obvious paravalvular leakage was found, and the artificial stent in the ascending aorta had smooth blood flow. There was no intraoperative death, and no intraoperative conversion to thoracotomy occurred. Among the surgical cases, 3 cases were implanted with valve-in-valve, and 3 cases were implanted with permanent pacemaker. All patients were cured and discharged, and the postoperative hospital stay was 5 to 12 days.Conclusion TAVI operation through the femoral artery is feasible for the treatment of patients with pure AR, and the early postoperative effect is satisfactory. -
[1] Ibrahim ME, Bavaria JE, El-Hamamsy I. A biological approach to aortic valve disease: durability and survival[J]. Nat Rev Cardiol, 2020, 17(12): 754-756. doi: 10.1038/s41569-020-00446-8
[2] Greco R, Muretti M, Jin X, et al. Aortic valve repair techniques: an early UK experience[J]. Open Heart, 2019, 6(2): 1-5.
[3] 谭启明, 于波, 秦良光, 等. 经胸微创封堵手术与传统外科手术治疗室间隔缺损术后并发症的Meta分析[J]. 中国全科医学, 2018, 21(8): 944-950. doi: 10.3969/j.issn.1007-9572.2017.00.071
[4] 王圣, 任培军, 陈现杰, 等. 不同治疗方式对高龄钙化性主动脉瓣重度狭窄患者预后的影响[J]. 临床心血管病杂志, 2019, 35(6): 540-543. https://lcxb.chinajournal.net.cn/WKC/WebPublication/paperDigest.aspx?paperID=cc046ca4-5150-49bf-a88b-f4ad53f9a5ec
[5] Musumeci F, Lio A, Montalto A, et al. Minimally invasive treatment of multiple valve disease: A modified approach through a right lateral minithoracotomy[J]. J Card Surg, 2020, 35(1): 135-139. doi: 10.1111/jocs.14339
[6] 王旭, 罗新锦, 王跃堂, 等. 经股动脉经导管主动脉瓣置换术治疗单纯主动脉瓣关闭不全[J]. 中国心血管病研究, 2020, 18(4): 321-324. doi: 10.3969/j.issn.1672-5301.2020.04.007
[7] Anwaruddin S, Desai ND, Szeto WY, et al. Self-expanding valve system for treatment of native aortic regurgitation by transcatheter aortic valve implantation(from the STS/ACC TVT Registry)[J]. Am J Cardiol, 2019, 124(5): 781-788. doi: 10.1016/j.amjcard.2019.05.045
[8] Pasupati S, Devlin G, Davis M, et al. Transcatheter solution for pure aortic insufficiency[J]. JACC Cardiovasc Imaging, 2014, 7(3): 315-318. doi: 10.1016/j.jcmg.2013.11.006
[9] 孙艳丹, 李昱茜, 孟欣, 等. 三维经食管超声心动图在二叶式主动脉瓣狭窄经导管主动脉瓣置入术中的应用研究[J]. 临床心血管病杂志, 2022, 38(5): 360-364. https://lcxb.chinajournal.net.cn/WKC/WebPublication/paperDigest.aspx?paperID=5693ca52-bb8c-4cf9-a15f-928c02e855c1
[10] 刘路路, 石峻, 钱宏, 等. 经导管主动脉瓣置换术治疗单纯主动脉瓣反流的研究进展[J]. 中国胸心血管外科临床杂志, 2019, 26(12): 1266-1270. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXYX201908002.htm
[11] 陈翔. 经导管主动脉瓣置换术的新进展[J]. 临床心血管病杂志, 2021, 28(8): 566-569. https://lcxb.chinajournal.net.cn/WKC/WebPublication/paperDigest.aspx?paperID=29bc37df-3305-4aad-8d47-c9e7000ff153
[12] 丁鹏, 徐臣年, 杨剑. 经导管主动脉瓣置换术治疗单纯性主动脉瓣关闭不全新进展[J]. 中国介入心脏病学杂志, 2019, 27(12): 707-710. doi: 10.3969/j.issn.1004-8812.2019.12.007
[13] Roy DA, Schaefer U, Guetta V, et al. Transcatheter aortic valve implantation for pure severe native aortic valve regurgitation[J]. J Am Coll Cardiol, 2013, 61(15): 1577-1584. doi: 10.1016/j.jacc.2013.01.018
[14] 袁中祥. TAVI手术的现状与展望[J]. 外科研究与新技术, 2014, 3(2): 88-91. https://www.cnki.com.cn/Article/CJFDTOTAL-TJYE201402004.htm
[15] 罗一纯, 刘路路, 石峻, 等. 应用J-Valve瓣膜经导管主动脉瓣置换术治疗高危单纯主动脉瓣反流多中心研究早期临床结果[J]. 中国胸心血管外科临床杂志, 2019, 26(8): 737-743. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXYX201908002.htm
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