Efficacy of transcatheter aortic valve replacement on severe aortic regurgitation
Objective To explore the efficacy and safety of transcatheter aortic valve replacement(TAVR)in the treatment of severe aortic regurgitation.Methods Fifty-eight patients with severe aortic regurgitation underwent TAVR in Henan Provincial Chest Hospital from April 1,2020 to July 30,2022.All patients received multi-slice spiral CT scan before operation,and were divided into valvular calcification group(n=19)and non-valvular calcification group(n=39).The operation success rate,operative time,length of ICU stay,length of hospital stay,postoperative length of mechanical ventilation,valve-in-valve implantation,conversion to surgical operation or cardiopulmonary bypass,extracorporeal membrane oxygenation,and perioperative adverse events as perivalvular leakage,pericardial tamponade,coronary artery obstruction,pacemaker implantation,stroke and death were compared between two groups.Echocardiography was performed before and 30 d after operation,and the left ventricular ejection fraction(LVEF),left ventricular end-diastolic dimension(LVEDD)and rates of medium to larger mitral and tricuspid regurgitation were compared between two groups.Results In 58 patients,52 patients were successfully operated,with a success rate of 89.66％.The postoperative mechanical ventilation time was shorter in valvular calcification group[(4.42±1.97)d]than that in non-valvular calcification group[(11.83±9.19)d](t=2.454,P=0.018),the incidence of valve-in-valve implantation was lower in valvular calcification group(0)than that in non-valvular calcification group(10.26％)(x2=2.084,P=0.044),and there were no significant differences in the operative time,length of ICU stay,length of total hospital stay,operation success rate,and rates of conversion to surgical operation,cardiopulmonary bypass,extracorporeal membrane oxygenation,perivalvular leakage,pericardial tamponade,coronary artery obstruction,pacemaker implantation,stroke and death between two groups(P＞0.05).LVEFs,LVEDDs and rates of medium to larger mitral regurgitation in valvular calcification group and non-valvular calcification group were lower after operation[(48.95±12.24)％,(50.49±10.10)％;(54.16±10.11),(50.95±8.64)mm;10.53％,15.38％]than those before operation[(54.00±11.31)％,(55.67±10.66)％;(59.42±9.35),(59.53±9.13)mm;42.11％,35.90％](P＜0.05),and there were no significant differences in the rates of medium to larger tricuspid regurgitation in valvular calcification group and non-valvular calcification group after operation(15.79％,15.38％)than those before operation(21.05％,20.51％)(P＞0.05).There were no significant differences in the LVEF,LVEDD,and rates of medium to larger mitral and tricuspid regurgitation both before and after operation between two groups(P＞0.05).Conclusion TAVR can effectively reduce the LVEDD,and reduce mitral regurgitation,with a good short-term efficacy and few adverse reactions in severe aortic regurgitation patients with or without valvular calcification.
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