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摘要: 目的 探讨心肺转流(CPB)在一站式经导管主动脉瓣置换(TAVR)+经皮冠状动脉介入治疗(PCI)中的应用，并总结相关经验。方法 收集2016年1月—2024年5月于河北医科大学第二医院行一站式TAVR+PCI患者的临床资料，根据术中是否计划应用CPB将患者分为CPB组和非CPB组，并对两组的围手术期资料进行回顾性分析。结果 共纳入患者52例，其中CPB组40例，非CPB组12例；CPB组术中建立而未开放CPB的有35例，建立且开放CPB的有5例(CPB的实际应用率为12.5%)。50例患者完成手术，2例(3.8%)患者术中死亡(均在非CPB组)。术中实施经外周TAVR 48例，经心尖TAVR 2例；术中PCI成功开通单支冠状动脉狭窄38例，开通两支冠状动脉狭窄12例。50例患者术后临床症状均较术前存在不同程度的改善。两组在中转开胸、瓣中瓣置入、中度及以上瓣周反流、新发传导阻滞、低心排综合征等并发症发生率方面差异无统计学意义。两组在术后呼吸机辅助时间、ICU监护时间、术后住院时间方面差异无统计学意义。结论 CPB在一站式TAVR+PCI中的应用可获得满意的临床疗效，值得进一步尝试和推广。
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关键词:
- 经导管主动脉瓣置换术 /
- 经皮冠状动脉介入治疗 /
- 心肺转流
Abstract: Objective To explore the role of cardiopulmonary bypass(CPB) in transcatheter aortic valve replacement(TAVR). The application of TAVR + percutaneous coronary intervention(PCI), and the relevant experience were summarized.Methods Clinical data of patients undergoing one-stop TAVR+PCI in the Second Hospital of Hebei Medical University from January 2016 to May 2024 were collected, and the patients were divided into CPB group and non-CPB group according to whether CPB was used during the operation, and the perioperative data of the two groups were retrospectively analyzed.Results There were 40 cases in the CPB group and 12 in the non-CPB group. In the CPB group, there were 35 cases in which CPB was established but not opened, and 5 cases in which CPB was established and opened(the actual application rate of CPB was 12.5%). Fifty patients completed surgery, and 2 patients(3.8%) died intraoperatively(all in the non-CPB group). Perioperative TAVR was performed in 48 cases and transapical TAVR in 2 cases. Intraoperative PCI successfully opened single coronary artery stenosis in 38 cases and double coronary artery stenosis in 12 cases. The clinical symptoms of all the 50 patients were improved to different degrees after operation. There was no significant difference in the incidence of complications such as conversion to thorax opening, midvalve insertion, moderate or above perivalvular regurgitation, new conduction block and low cardiac production syndrome between the two groups. There was no significant difference between the two groups in postoperative ventilator assistance time, ICU monitoring time and postoperative hospitalization time.Conclusion The application of CPB in one-stop TAVR+PCI can obtain satisfactory clinical efficacy. -
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表 1 一般资料
Table 1. General data
例(%), X±S 项目 CPB组(40例) 非CPB组(12例) P值 性别 0.918 男 24(60.0) 7(58.3) 女 16(40.0) 5(41.7) 年龄/岁 73.05±5.835 67.083±3.728 0.002 术前合并基础疾病 35(87.5) 3(25.0) ＜0.001 术前NYHA心功能分级 ＜0.001 Ⅲ 1(2.5) 10(83.3) Ⅳ 39(97.5) 2(16.7) 术前左室射血分数/% 43.117±6.531 57.417±5.145 ＜0.001 需开通冠脉数量 0.361 1支 28(70.0) 10(83.3) 2支 12(30.0) 2(16.7) 
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表 2 术后资料
Table 2. Data after operation
例(%), X±S 项目 CPB组(40例) 非CPB组(12例) P值 术后呼吸机辅助时间/h 5.320±4.946 5.283±4.798 0.982 术后ICU监护时间/d 0.530±0.512 0.583±0.515 0.753 术后住院时间/d 4.595±0.825 4.450±0.481 0.566 术后并发症 中转开胸 0 0 “瓣中瓣”置入 0 0 中量及以上瓣周漏 0 0 新发传导阻滞 6(15) 2(16.7) 0.888 低心排综合征 0 0 血管并发症 0 0
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| 引用本文: |
张航, 王华君, 石凤梧, 等. 心肺转流在一站式TAVR+PCI中的应用[J]. 临床心血管病杂志, 2024, 40(12): 1012-1015. doi: 10.13201/j.issn.1001-1439.2024.12.012
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| Citation: |
ZHANG Hang, WANG Huajun, SHI Fengwu, et al. Application of cardiopulmonary bypass in one-stop TAVR+PCI[J]. J Clin Cardiol, 2024, 40(12): 1012-1015. doi: 10.13201/j.issn.1001-1439.2024.12.012
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