新疆医科大学学报

目的总结应用经皮导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)治疗主动脉瓣狭窄(aortic stenosis,AS)的初步经验。方法收集新疆医科大学第一附属医院心脏中心2016年3月-2017年12月实施TAVR的10例AS患者,分析10例患者的手术效果及并发症,并总结手术经验。结果 10例患者均完成手术,顺利出院。术后患者主动脉瓣跨瓣压差从(93.68±20.24)mmHg降至(14.94±3.41)mmHg;心导管测量从(87.40±25.08)mmHg降至(5.80±2.77)mmHg(1 mmHg=0.133 kPa)。氨基末端B型利钠肽前体(NT-proBNP)从(4 130.00±3 891.41)ng/L降至(1 552.90±1 065.15)ng/L。心输出量从(5.17±0.71)L/min提升至(5.66±0.92)L/min。左室射血分数(LVEF值)从(53.40±12.98)%提升至(56.54±8.89)%。2例患者出现肝素诱导的血小板减少症;2例患者出现一过性心律失常(短阵室速、阵发性房颤)。给于对症治疗后,均好转出院。1年电话或住院随访,均无心脏主要不良事件(Major Adverse Cardiovascular Events,MACEs)发生。结论应用TAVR治疗高龄、重度AS患者,安全有效,其疗效有待进一步验证。

Objective To summarize the preliminary experience of transcatheter aortic valve replacement(TAVR) in the treatment of aortic stenosis(AS). Methods 10 patients with AS who underwent TAVR from March 2016 to December 2017 in the First Affiliated Hospital of Xinjiang Medical University had been analyzed retrospectively. To analyze operative results and complications of 10 patients, and summarize the experience of operation. Results 10 patients underwent TAVR and were discharged. Postoperative the cardiac ultrasound estimated aortic valve pressure gradient decreased from(93.68±20.24) mmHg to(14.94±3.41) mmHg; The cardiac catheterization estimated aortic valve pressure gradient decreased from(87.40±25.08) mmHg to(5.80±2.77) mmHg(1 mmHg=0.133 kPa). N-terminal pro-brain natriuretic peptide(NT-proBNP) decreased from(4 130.00±3 891.41) ng/L to(1 552.90±1 065.15) ng/L. The cardiac output was increased from(5.17±0.71) L/min to(5.66±0.92) L/min. The left ventricular ejection fraction(LVEF) increased from(53.40±12.98)% to(56.54±8.89)%. 2 patients had heparin-induced thrombocytopenia; 2 patients had transient arrhythmia(non-sustained ventricular tachycardia, paroxysmal atrial fibrillation), after symptomatic treatment, were improved and discharged. After one year follow-up, there were no major adverse cardiac events(MACE). Conclusion Preliminary experience showed that the application of TAVR in the treatment of elderly patients with severe AS is safe and effective, and its efficacy needs further verification.