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1.
目的:探究256层螺旋CT在主动脉瓣膜病变经导管主动瓣膜植入术(TAVI)术前筛查中的应用效果。方法:选取43例主动脉瓣膜病变患者,采用256层螺旋CT进行TAVI术前筛查,根据主动脉及周围动脉情况选择合适的人工瓣膜。结果:主动脉周长、面积、直径提示的瓣膜型号不完全相符,43例患者中3例因主动脉瓣过大不适合行TAVI治疗,其余40例患者行TAVI治疗,最终8例置入26号人工瓣膜,20例置入29号人工瓣膜,12例置入32号人工瓣膜。36例患者成功置入人工瓣膜,术中仅存在少量瓣周漏;4例患者由于人工瓣膜置入较低,造成中等量瓣周漏,再次行较高位置人工瓣膜置入后,瓣周漏明显减少至微量或少量。结论:主动脉瓣膜病变患者TAVI术前行多层螺旋CT筛查,可准确选择人工瓣膜及手术入路,提高手术成功率,在临床治疗中具有重要意义。  相似文献   

2.
[摘要] 目的评价经导管主动脉瓣膜植入(transcatheter aortic valve implantation,TAVI)与常规主动脉瓣膜置换在高风险因素患者中应用的安全性及效果。 方法选择主动脉瓣狭窄患者80例,按手术方式分为常规组47例、小切口组18例和TAVI组15例。常规组采用常规开胸主动脉瓣膜置换手术,小切口组采用胸骨上段小切口主动脉瓣膜置换手术,TAVI组采用全身麻醉非体外循环下TAVI。比较3组患者手术效果及并发症发生情况。 结果小切口组24 h引流量明显少于常规组(P<0.01)。常规组和小切口组阻断时间差异无统计学意义(P>0.05)。小切口组手术时间、呼吸机辅助通气时间、重症监护室(intensive care unit,ICU)停留时间短于常规组,术中出血量少于常规组(P<0.01);TAVI组手术时间、呼吸机辅助通气时间、ICU停留时间短于常规组和小切口组,术中出血量少于常规组和小切口组,平均动脉压(mean artery pressure,MAP)变化值大于常规组和小切口组,住院费用多于常规组和小切口组(P<0.05或P<0.01)。3组并发症发生率差异无统计学意义(P>0.05)。 结论TAVI手术在治疗高风险因素的患者中较常规主动脉瓣膜置换手术安全性高,创伤小,并发症少,恢复快,值得临床推广应用。  相似文献   

3.
经导管主动脉瓣膜植入(TAVI)是一项近年发展起来用于无法耐受常规开胸手术治疗的患主动脉瓣膜狭窄患者的新技术.除了需要选择合适的患者外,手术径路的选择也是TAVI能否获得成功的关键.目前采用的TAVI手术径路包括:顺行法、逆行法、经心尖法、经锁骨下动脉法及直接经主动脉法,逆行法是目前最常采用的手术径路.采取何种手术径路需根据患者血管及主动脉根部的条件来合理选择.本文综述了这几种手术径路选择的标准、手术并发症,常规手术方法及最新临床资料统计结果,以有利于该项技术在我国开展.  相似文献   

4.
近年来微创心脏外科快速发展,在瓣膜外科中,以小切口及胸腔镜辅助瓣膜置换或成形为代表的微创手术技术,被越来越多的心脏外科医生接受并运用。TAVI手术被称之为"不需要开胸的换瓣手术",为高危主动脉瓣狭窄患者带来福音。随着技术的成熟,其适应证也逐渐扩大,也给传统的瓣膜外科带来严峻的挑战。心脏不停跳瓣膜手术具有良好的心肌保护效果,在瓣膜病的治疗中有很大的优势,尤其对重症瓣膜疾病手术仍然具有不可替代的优势。  相似文献   

5.
2002-2011,TAVI的10年回首 自2002年法国Cribier医生首次在人体进行了经导管主动脉瓣膜植入术(TAVI)后,在20022011年,全球约500 00例患者接受了TAVI治疗.近年来发表的大型TAVI研究结果也显示:TAVI成功率在93.8%~ 98.4%,30d生存率达82.2%~ 92.9%,1年生存率为76.1%~ 84.2%.在并发症发生率方面,除了心脏起搏器置入率较高外,其他都较低.  相似文献   

6.
目前,尽管严重主动脉狭窄的治疗指南仍以外科手术置换(surgical aortic valve replacement,SAVR)为治疗标 准,但随着大血管外科技术的不断发展,经导管主动脉瓣置换术(transcatheter aortic valve implantation,TAVI)逐渐成为 高危和禁忌SAVR患者的常规治疗措施。近年来各瓣膜厂商,包括国内医药公司,对瓣膜技术极力地推进,使得TAVI 技术取得了显著成效,加上其并发症也得到了有效控制,TAVI有望在治疗主动脉狭窄乃至关闭不全上取代传统术 式,应用前景可观。  相似文献   

7.
目的探讨主动脉瓣狭窄伴二尖瓣反流患者行经导管主动脉瓣植入术(TAVI)治疗后,二尖瓣反流改善的临床效果。方法回顾性研究2018年1月至11月于西京医院接受TAVI治疗高危主动脉瓣狭窄伴二尖瓣反流患者16例,患者心脏心功能分级(NYHA分级)均在Ⅲ级以上,行TAVI治疗后,观察患者术后瓣膜位置、跨瓣压差、瓣口面积、二尖瓣反流量变化情况。结果 TAVI术后1月,二尖瓣反流量由术前的(11.8±3.4) ml减少到术后(3.0±1.2) ml。结论 TAVI在治疗主动脉瓣狭窄的同时对二尖瓣反流具有改善作用。  相似文献   

8.
正经导管主动脉瓣置入术(TAVI)目前已经成为治疗外科手术高位的主动脉瓣狭窄(AS)患者的一种重要手段(AHA/ACCIa)。由于瓣膜钙化、瓣膜解剖的变异及不同类型的瓣膜设计,TAVI术后患者或多或少都会出现瓣周露(PVR),表现为不同程度的主动脉瓣反流(AR)。多项大型临床研究表明,术后AR的严重程度与患者预后直接相关,而且是重要预测因素之一。据文献报道,TAVI术后轻度AR的发生率在7%~70%,而中到重度的AR发生率在0%~24%。  相似文献   

9.
目的探究脑利钠肽治疗瓣膜与非瓣膜所致心力衰竭衰的疗效对比。方法选取我院2016年1月至2017年1月收治住院心力衰竭患者86例,根据病因的不同,分为瓣膜性与非瓣膜性心力衰竭两组,两组患者在原有治疗基础上均采用重组人脑利钠肽治疗,对比两组疗效。结果两组治疗后疗效对比:CRP评分、BNP评分均有下降,射血分数较前提高。且非瓣膜性心衰组的下降幅度明显高于瓣膜性心衰组(P0.05);非瓣膜性心衰组治疗后,患者的治疗总有效率与瓣膜性心衰组相比较无明显差异(P0.05)。结论在瓣膜与非瓣膜心衰患者中,采用重组人脑利钠肽均能取得良好的疗效,且在非瓣膜性心衰治疗中,患者的CRP、BNP改善效果更加显著,值得在临床上推广与应用。  相似文献   

10.
目的总结分析瓣膜性与非瓣膜性心脏病心力衰竭应用重组人脑利钠肽治疗的临床效果。方法以我院2016年3月至2017年7月收治的30例瓣膜性与30例非瓣膜性心脏病心力衰竭患者为研究对象,所有患者均采用重组人脑利钠肽治疗,回顾分析两组患者治疗的相关资料。结果在治疗后的CRP含量、BNP含量方面,非瓣膜性组优于瓣膜性组(P0.05),具有统计学意义,两组患者在治疗总有效率方面差异不明显(P0.05),不具有统计学意义。结论瓣膜性与非瓣膜性心脏病心力衰竭采用重组人脑利钠肽治疗,均可取得较好的治疗效果,但是非瓣膜性心脏病心力衰竭的CRP以及BNP改善更加明显。  相似文献   

11.
Transcatheter aortic valve implantation (TAVI) has become the standard of care for inoperable patients with symptomatic severe aortic stenosis (AS), and an alternative to open aortic valve replacement for patients at high surgical risk. TAVI has also been performed in several groups of patients with off-label indications such as severe bicuspid AS, and as a valve-in-valve therapy for a degenerated surgical bioprosthesis. Although TAVI with CoreValve® prosthesis is technically challenging, and global experience in the procedure is limited, the procedure could be a treatment option for well-selected patients with severe pure aortic regurgitation (AR). Herein, we report Asia''s first case of TAVI for severe pure AR in a patient who was at extreme surgical risk, with good clinical outcome at six months.  相似文献   

12.
Background Transcatheter aortic valve implantation (TAVI) has emerged as the treatment choice for non-operable patients with severe symptomatic aortic stenosis (AS) and may be a good alternative to sur...  相似文献   

13.
经导管主动脉瓣植入术(TAVI)是治疗主动脉瓣狭窄患者的新技术,适用于无法外科手术和外科高风险的主动脉瓣狭窄患者,其常规植入途径为股动脉和心尖。该文介绍1例92岁高龄患者,经股动脉途径植入主动脉瓣失败后,改由经主动脉途径植入的成功经验。  相似文献   

14.
目的 探讨超声心动图在主动脉瓣反流患者经心尖主动脉瓣植入(transcatheter aortic valve implantation, TAVI)术前、术中及术后的作用。方法 31例中-重度单纯主动脉瓣反流或以主动脉瓣反流为主的外科开胸手术高风险患者行经心尖TAVI术。术前经胸超声心动图(transthoracic echocardiograghy,TTE)评估主动脉瓣反流程度、测量主动脉根部相关指标、左室收缩功能;术中介入操作前经食管超声心动图 (transesophageal echocardiography,TEE)再次准确评估,瓣膜植入过程中TEE联合X光造影指导人工瓣膜植入、监测并发症,术后即刻评估有无瓣周反流及程度;术后1周、1月TTE随访人工瓣膜血流动力学参数、有无相关并发症、左室收缩功能。结果 31例患者中,29例成功完成经心尖TAVI术。术后微量或无瓣周反流23例,轻度瓣周反流6例。左室舒张期内径、左室质量指数术后1周较术前显著减小,术后1月进一步减小( P均<0.05),左室大小基本恢复正常;左室射血分数术后1周较术前降低( P<0.05),术后1月恢复至术前水平。结论 经心尖TAVI术对于外科开胸手术高风险的主动脉瓣反流患者是一种安全有效的治疗方式,超声心动图在TAVI术前筛查及测量、术中监测、引导和术后随访中起着不可或缺的作用。  相似文献   

15.
Transcatheter aortic valve implantation (TAVI) is a promising alternative to surgical aortic valve replacement for patients with symptomatic severe aortic stenosis (AS) who were deemed at a high surgical risk.This novel technique has kept evolving rapidly throughout the world in the past decade,but was not introduced to China until recently.Here we report our clinical experience in TAVI based on the largest cohort of Chinese patients in a single center.  相似文献   

16.

Background

The advent of transcatheter aortic valve implantation (TAVI) has broadened the management options for severe aortic stenosis. The indications for TAVI are narrow. Selecting those that will benefit most from this intervention warrants careful consideration and input from cardiologists, anaesthetists and cardiac surgeons familiar with TAVI and surgical aortic valve replacement (SAVR).

Aims

The aims of this paper were to assess the feasibility of establishing a high-risk aortic clinic in Ireland, and report stratification of the referred group into those suitable for SAVR, TAVI and conservative management.

Methods

Patient data was prospectively collected by a dedicated clinical nurse specialist. ANOVA was used to assess variance in means between groups. Analyses were performed using IBM SPSS v20 (Armonk, NY: IBM Corp.).

Results

A total of 105 patients were assessed. Eighty-five patients were deemed suitable for TAVI, 9 (10.5 %) died awaiting the procedure and a further 6 (7 %) declined intervention. Eleven (10.5 %) underwent conventional SAVR, 1 (0.9 %) a balloon valvuloplasty, 4 (3.8 %) entered surveillance and 4 (3.8 %) were declined treatment.

Conclusions

Establishment of a high-risk aortic clinic is feasible in the Irish context. The advent of TAVI has reduced the proportion of patients denied intervention to a minority. Despite being considered high risk, a number of patients were suitable candidates for SAVR. Measuring frailty continues to provide a challenge; a TAVI-specific frailty assessment tool would be advantageous to patient stratification.  相似文献   

17.
BackgroundAortic valve replacement (AVR) remains the gold standard treatment for symptomatic severe aortic stenosis (AS). For the past 10 years, transcatheter aortic valve implantation (TAVI) has been applied in patients with high surgical mortality and morbidity risks. The preliminary results of our TAVI patients are presented in this study.MethodsTen high-risk patients with severe AS, for AVR, were referred and accepted for TAVI in the 6 month period from May 2010 to October 2010. The patient age, logistic EuroSCORE, femoral arterial diameter, aorta annulus size, aorta valve area (AVA), mean aortic pressure gradient (MPG), as well as coronary angiography results were all collected. Six patients were treated via the transapical approach in March 2010, whereas the other four were treated with the transfemoral approach, according to their femoral artery diameter and arterial quality. This study focuses on the immediate, 1 month, 3 month, and 1 year results of TAVI.ResultsThe average age of the 10 patients receiving TAVI was 81.5 years. The mean calculated EuroSCORE was 28.3 ± 7.9%. The mean AVA was 0.61 ± 0.19 cm2. The MPG was 48 ± 16 mmHg. The surgical technical success achieved 100%. There was no reported moderate to severe postoperative paravalvular aortic regurgitation, permanent complete atrioventricular block, major access site complication, or embolic stroke. Chronic renal failure, which necessitated permanent hemodialysis, developed in 10% of the patients. One acute myocardial infarction and one case of pneumonia developed postoperatively. The AVA was increased by 251%, whereas the MPG was decreased by 80% at the 3 month follow-up. The 30-day mortality rate was 10%. The all-cause 1-year mortality rate was 20%.ConclusionThis new technique and device requires greater caution and needs more practice to accumulate sufficient experience. The studied patients were very fragile, due to old age and multiple comorbidities. Our results are similar to findings of multicenter trials. With careful patient screening and selection, TAVI can be a promising treatment for high-risk severe AS patients.  相似文献   

18.
  目的  探讨二尖瓣环位移斑点组织追踪技术(TMAD)在体外膜氧合(ECMO)辅助下经导管主动脉瓣植入(TAVI)治疗重症主动脉瓣狭窄(AS)患者的应用价值。  方法  对2019年9月—2021年3月在河南省胸科医院ECMO辅助下行TAVI手术的16例左室射血分数(LVEF)<25%重症AS患者进行回顾分析。统计分析该组患者TAVI治疗前、ECMO撤除后即刻、术后1个月斑点组织追踪参数[二尖瓣环平均位移(TMADmid)、二尖瓣环平均位移率(TMADmid%)、整体纵向收缩期峰值应变(GLS)]及常规超声心动图参数[LVEF、左心室舒张末期内径(LVEDd)、每搏输出量(SV)]的变化,分析斑点组织追踪技术对ECMO辅助下TAVI术后疗效的评价价值。  结果  本组患者TAVI术前、ECMO撤除后即刻、术后1个月斑点组织追踪参数TMADmid[(3.2±1.3)mm,(6.9±1.3)mm, (11.2±2.5)mm]、TMADmid%[(3.5±2.6)%,(7.0±3.8)%, (10.1±2.1)%]和GLS[(5.9±3.5)%,(8.9±2.7)%, (13.2±3.9)%]逐渐增高,组间差异均有统计学意义(均P < 0.05);术后1个月LVEF[(42.2±5.3)%]较术前[(22.2±5.5)%]及ECMO撤除后即刻[(23.8±2.5)%]升高, 差异有统计学意义(均P < 0.05);与术前LVEF相比,ECMO撤除后即刻LVEF升高,差异无统计学意义(P>0.05)。TMADmid、TMADmid%与GLS呈正相关关系(r=0.499、0.586,均P < 0.05)。  结论  二尖瓣斑点组织追踪技术可作为评价AS患者TAVI诊疗效果的敏感参考指标,ECMO辅助下TAVI治疗重症AS患者安全有效。   相似文献   

19.
Background  Transcatheter aortic valve implantation (TAVI) is a rapidly evolving strategy for therapy of aortic stenosis. We presented the procedural results and analyzed the death causes of 30-day mortality and clinical events in patients who underwent TAVI with Edwards prosthetic valves in University Hospital of Caen, France.
Methods  The patients with severe aortic stenosis but at high surgical risk or inoperable were considered as candidates for TAVI. Forty-eight patients undergoing TAVI from July 2010 to September 2011 were enrolled in this registry. The Edwards prosthetic valves were solely used in this clinical trial.
Results  Overall 48 patients underwent TAVI, 28 of which accepted TAVI by trans-femoral (TF) approaches, 20 by trans-apical approaches (TA). The aortic valve area (AVA) was (0.70±0.23) cm2, left ventricular ejection fraction (LVEF) was (57.4±17.6)%, Log EuroSCORE was (19.2±15.8)%, mean gradient was (47.0±16.6) mmHg. There were no significant differences between TF and TA groups in all these baseline parameters. Device success rate was 95.8%, and procedural success rate was 93.7% in total. Procedural mortality was 6.7% (3/48): two deaths in TA group (10%), and one death in TF group (3.6%). Forty-six Edwards valves were implanted: 10 Edwards Sapien and 36 Edwards XT. Procedure-related complications included cardiac tamponade in 2 cases (4.2%), acute myocardial infarction (AMI) in 1 case (2.1%), permanent pacemaker implantation in 1 case (2.1%), life-threatening and major bleeding in 3 cases; access site related major complication in 1 case, AKI stage 3 in 3 cases (6.3%), minor stroke in 1 case (2.1%). Thirty-day survival rate was 89.6%. There were 5 deaths in total (10.4%): 4 in TA group (20%) and 1 in TF group (3.6%).
Conclusion  The procedural success rate and 30-day mortality were acceptable in these high risk patients with Edwards prosthetic valves in the first 48 TAVI.
  相似文献   

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