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经导管主动脉瓣置换术治疗二叶式主动脉瓣重度狭窄患者的短期疗效分析
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Abstract:
目的：评估二叶式主动脉瓣(BAV)重度狭窄患者行经导管主动脉瓣置换术(TAVR)治疗前后心脏结构、心功能变化及手术相关不良事件发生情况，探讨其短期疗效。方法：本研究分析了2017年9月至2022年9月于青岛大学附属烟台毓璜顶医院行TAVR手术的主动脉瓣重度狭窄患者。按瓣叶形态分为BAV组与三叶式主动脉瓣(TAV)组，比较2组患者临床资料、术前超声心动图资料。术后随访1个月，分别在术后1周和1月时，比较2组患者手术前与术后超声心动图参数，并进一步对2组间超声心动图参数的变化值进行比较。同时比较2组间患者术后6月内不良事件发生情况。结果：共71例主动脉瓣重度狭窄患者接受TAVR，其中BAV组17例，TAV组54例。BAV组患者年龄偏小，高血压、心房颤动患病率低于TAV组(P均 < 0.05)。2组间余临床资料比较差异无统计学意义(P均 > 0.05)。左室舒张末期内径(LVEDD)、主动脉瓣跨瓣峰值压差(AVPG)、主动脉瓣峰值血流速度(Vmax)、左室射血分数(LVEF)、中度及以上瓣膜反流比率等在2组间差异无统计学意义(P均 > 0.05)。术后随访1个周时，2组患者AVPG和Vmax均低于治疗前，LVEF均高于治疗前(P均 < 0.05)。２组间AVPG和Vmax较术前下降值、LVEF较术前上升值比较差异均无统计学意义(P均 > 0.05)。术后随访1个月时，2组患者LVEDD、AVPG和Vmax均低于治疗前，LVEF均高于治疗前(P均 < 0.05)。２组间LVEDD、AVPG和Vmax较术前下降值、LVEF较术前上升值比较差异均无统计学意义(P均 > 0.05)。在围术期，BAV组死亡1例，TAV组死亡2例。随访6个月，2组随访期间均无死亡病例，2组间血管并发症、III度房室传导阻滞、切口愈合不良等不良事件发生率比较差异无统计学意义(P均 > 0.05)。结论：TAVR可明显改善BAV组患者的心脏结构及左室功能，短期临床疗效与TAV组相似，且术后发生不良事件的风险无明显增加。
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