单纯主动脉瓣关闭不全患者行经股动脉经导管主动脉瓣置换术与外科主动脉瓣置换术的短期疗效分析
Short-term efficacy analysis of transfemoral transcatheter aortic valve replacement and traditional surgical aortic valve replacement in patients with incomplete aortic valve closure alone
王华君 1张航 1苏彤 1廖红娟 1陈子英 1石凤梧 1马千里 1刘苏 1安景辉1
作者信息
- 1. 050004 河北省石家庄市,河北医科大学第二医院心脏大血管外科
- 折叠
摘要
目的 对比分析经股动脉经导管主动脉瓣置换术与外科主动脉瓣置换术治疗单纯主动脉瓣关闭不全患者的近期临床疗效.方法 回顾性分析2022年5月-2023年9月于河北医科大学第二医院心脏大血管外科接受治疗的55岁以上的单纯主动脉瓣关闭不全(PAR)患者的临床资料,共102例,其中行经股动脉经导管主动脉瓣置换术(TF-TAVR)46例,行外科主动脉瓣置换术(SAVR)56例.对两组患者术前及术后的相关数据进行比较,并记录随访1个月经胸超声心动图的结果.结果 TF-TAVR组(46例)较SAVR组(56例)患者平均年龄更高(P＜0.05),STS评分更高(P＜0.001),左心室射血分数(LVEF)更低(P＜0.001).两组患者性别、体重指数(BMI)及术前心功能分级、左心室舒张末期内径(LVEDD)、左心房舒张末期内径(LAEDD)、术前合并基础疾病无显著差异(P＞0.05).两组患者术后心功能较术前均有明显改善,LVEF均较术前升高,LVEDD较术前减小,LAEDD较术前无显著差异.两组患者在术后改善患者心功能及LVEDD上对比无显著差异.TF-TAVR组术后呼吸机辅助呼吸时间、术后ICU监护时间及术后住院时间较SAVR组显著缩短[(11.06±4.25)h 比(20.25±8.17)h,(1.67±0.98)d 比(2.92±1.08)d,(6.07±2.26)d 比(9.90±2.16)d,P＜0.001].TF-TAVR组术后心律失常发生率较SAVR组高.两组患者在术后肺部感染、重症肺炎、胸腔积液的发生率也无显著差异,两组患者术后均未出现脑卒中.虽然TF-TAVR组在轻度、中度瓣周漏/瓣中漏的发生率较SAVR组高,但均未出现中度及以上的瓣周漏/瓣中漏.TF-TAVR组术后无死亡病例,SAVR组有2例死亡病例,两组术后死亡率无显著差异.结论 TF-TAVR与SAVR治疗≥55岁PAR患者的早期有效性及安全性方面无显著差异,但TF-TAVR术后呼吸机辅助呼吸时间、术后ICU监护时间及术后住院时间较SAVR组显著缩短,是治疗≥55岁PAR患者的有效方法.
Abstract
Objective To compare and analyze the short-term clinical effect of transcatheter femoral aortic valve replacement and surgical aortic valve replacement in patients with simple aortic insufficiency.Methods The clinical data of 102 patients over 55 years old with simple aortic insufficiency(PAR)who were treated in the Department of Cardiac Great Vascular Surgery,Second Hospital of Hebei Medical University from May 2022 to September 2023 were retrospectively analyzed.Among them,46 patients underwent femoral transcatheter aortic valve replacement(TF-TAVR),and the other 56 underwent surgical aortic valve replacement(SAVR).The preoperative and postoperative data of the two groups were compared,and the results of 1 month follow-up period echocardiography were recorded.Results Compared with the SAVR group,the TF-TAVR group had higher mean age(P＜0.05),higher STS score(P＜0.001)and lower left ventricular ejection fraction(LVEF)(P＜0.001).There were no significant differences in gender,body mass index(BMI),preoperative cardiac function grade,left ventricular end-diastolic diameter(LVEDD),left atrial end-diastolic diameter(LAEDD)and preoperative underlying diseases between the two groups(P＞0.05).The postoperative cardiac function was significantly improved in both groups;the LVEF was higher than that before the surgery;the LVEDD was lower than that before surgery;and the LAEDD had no significant difference.There were no significant differences in postoperative improvement of cardiac function and LVEDD between the two groups.The time of ventilator-assisted breathing,postoperative ICU monitoring and postoperative hospitalization in the TF-TAVR group were significantly shorter than those in the SAVR group[(11.06±4.25)h vs.(20.25±8.17)h,(1.67±0.98)d vs.(2.92±1.08)d,(6.07±2.26)d vs.(9.90±2.16)d,P＜0.001].The incidence of arrhythmia in the TF-TAVR group was higher than that in the SAVR group.There was no significant difference in the incidence of postoperative pulmonary infection,severe pneumonia and pleural effusion between the two groups;and no stroke occurred both in the two groups.Although the incidence of mild and moderate perivalvular leakage/in-valvular leakage in the TF-TAVR group was higher than that in the SAVR group,moderate or above perivalvular leakage/in-valvular leakage did not occur in the TF-TAVR group.There was no postoperative death in the TF-TAVR group and there were 2 deaths in the SAVR group,but there was no significant difference in postoperative mortality between the two groups.Conclusion The early efficacy and safety of TF-TAVR and SAVR are similar in the treatment of PAR patients ≥55 years old,but the postoperative ventilator assisted breathing time,postoperative ICU monitoring time and postoperative hospitalization time after TF-TAVR are significantly shorter.
关键词
单纯主动脉瓣关闭不全/经股动脉经导管主动脉瓣置换术/外科主动脉瓣置换术/疗效对比Key words
Simple aortic valve insufficiency/Transfemoral transcatheter aortic valve replacement/Surgical aortic valve replacement/Efficacy comparison引用本文复制引用
基金项目
河北省医学科学研究课题(2023)(20230440)
出版年
2024
NETL
NSTL
万方数据