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Received:September 05, 2023 Published Online:June 20, 2024
Received:September 05, 2023 Published Online:June 20, 2024
中文摘要: 目的 探讨经导管主动脉瓣置换术(TAVR)治疗不同心功能重度主动脉瓣狭窄(AS)患者的疗效。方法 回顾性分析2016年9月至2022年7月在新疆维吾尔自治区人民医院72例行TAVR的重度AS患者的临床资料。将左心室射血分数(LVEF)≥50%的重度AS患者纳入射血分数保留组(A组, n=44),将LVEF<50%的重度AS患者纳入射血分数降低组(B组, n=28)。观察两组患者TAVR术前及术后1天、3个月、12个月的有效瓣口面积(EOA)、平均跨瓣压差、左心室重构(LVR)指标;两组患者TAVR术前及术后3个月、12个月的6分钟步行实验距离(6-MWD);所有患者均随访至术后1年,观察心力衰竭(心衰)再住院情况。结果 两组患者术后1天的EOA、平均跨瓣压差均较术前显著改善,之后保持稳定;术后第1天,两组患者的LVR指标[左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室后壁厚度(LVPWT)、LVEF]均较术前明显改善(P<0.05)。在随访过程中,A组患者LVR指标保持相对稳定,B组患者的LVR指标改善则持续至随访结束;两组患者术后3个月的6-MWD均较术前显著改善,之后均保持稳定;A组和B组1年内心衰再住院率比较,差异无统计学意义(4.54% vs 21.43%, χ2=3.380, P=0.066)。结论 TAVR可有效解除不同射血分数重度AS患者左心室流出道的梗阻、提高活动耐量、促进左心室逆重构,对于射血分数保留的重度AS患者应该尽早进行干预。
中文关键词: 主动脉瓣狭窄 经导管主动脉瓣置换术 经导管介入治疗 心室重构 心力衰竭
Abstract:Objective To investigate the efficacy of transcatheter aortic valve replacement (TAVR) in treating patients with severe aortic stenosis (AS) of different levels of cardiac function. Methods A retrospective analysis was conducted on clinical data of 72 patients who underwent TAVR for severe AS at the Xinjiang Uygur Autonomous Region People's Hospital from September 2016 to July 2022. Patients with a left ventricular ejection fraction (LVEF) ≥50% were included in the preserved ejection fraction group (group A, n=44), while those with LVEF<50% were included in the reduced ejection fraction group (group B, n=28). The effective orifice area (EOA), mean transvalvular pressure gradient, and left ventricular remodeling (LVR) were observed in both groups preoperatively and postoperatively at 1 day, 3 months, and 12 months. The 6-minute walk distance (6-MWD) was measured preoperatively and postoperatively at 3 months and 12 months for both groups. All patients were followed up to one year postoperatively to observe the readmission rate due to heart failure. Results Both groups showed significant improvement in EOA and mean transvalvular pressure gradient on the first postoperative day, which remained stable thereafter. On the first postoperative day, LVR indicators [left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular posterior wall thickness (LVPWT), LVEF] improved significantly in both groups compared to preoperative values (P<0.05). During subsequent follow-ups, group A maintained a relatively stable state, while group B continued to show LVR until the end of the follow-up period. The 6-MWD at 3 months postoperatively improved significantly in both groups compared to preoperative values and remained stable thereafter. The readmission rate due to heart failure within one year between group A and group B showed no statistically significant difference (4.54% vs 21.43%, χ2=3.380, P=0.066). Conclusion TAVR can effectively alleviate obstruction of the left ventricular outflow tract in patients with severe AS and different ejection fractions, improve exercise tolerance, and promote left ventricular reverse remodeling. For patients with preserved ejection fraction and severe AS, intervention should be carried out as early as possible.
keywords: Aortic stenosis Transcatheter aortic valve replacement Transcatheter interventional treatment Ventricular remodeling Heart failure
文章编号: 中图分类号:R542.5+2 文献标志码:A
基金项目:新疆维吾尔自治区重点研发计划项目(2022B03009-3)
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