经导管主动脉瓣置换术在心功能衰竭主动脉瓣狭窄患者中的应用

目的：探讨经导管主动脉瓣置换术治疗心功能衰竭主动脉瓣狭窄患者的有效性和安全性。方法：回顾性分析阜外医院2019年1月至2020年12月行TAVR手术的主动脉瓣狭窄患者142例。结果： 围手术期内共有2例（1.4%）患者中转外科手术，重度心功能衰竭组1例（17%），中度心功能衰竭组1例（3.0%），有显著的统计学差异（p＜0.01）。术后使用ECMO辅助循环2例（1.4%），重度心功能衰竭组1例（17%），中度心功能衰竭组1例（3.0%），有显著的统计学差异（p＜0.01）。术中使用体外循环辅助1例（0.70%），死亡1例（0.70%），均发生于中度心功能衰竭组，术中左室破裂1例（0.70%），术后致残性脑卒中1例（0.70%），均发生于正常心功能组，三组无明显的统计学差异。术后外周血管并发症4例（2.8%），术后起搏器植入11例（7.7%），三组无明显的统计学差异。结论：经导管主动脉瓣置换术是治疗心功能衰竭的主动脉狭窄患者的有效及安全的治疗方法。

Outcomes of Transcatheter Aortic Valve Replacement in Patients With Aortic Stenosis and Left Ventricular Dysfunction

Objective: To investigate the efficacy and safety of transcatheter aortic valve replacement in the treatment of aortic stenosis in patients with heart failure. Methods: 142 patients with aortic stenosis who underwent TAVR in Fuwai Hospital from January 2019 to December 2020 were retrospectively analyzed. Results: During the perioperative period, 2 cases (1.4%) were converted to surgery, 1 case (17%) in severe heart failure group and 1 case (3.0%) in moderate heart failure group, with significant difference (P < 0.01). ECMO was used in 2 cases (1.4%), 1 case (17%) in severe heart failure group and 1 case (3.0%) in moderate heart failure group, with significant difference (P < 0.01). There were 1 case (0.70%) with cardiopulmonary bypass and 1 case (0.70%) died in the moderate heart failure group, 1 case (0.70%) with left ventricular rupture during operation and 1 case (0.70%) with post-operative disabled stroke, all of which occurred in the normal heart function group. There was no significant difference among the three groups. There were 4 cases (2.8%) with peripheral vascular complications and 11 cases (7.7%) with pacemaker implantation. There was no significant difference among the three groups. Conclusion: transcatheter aortic valve replacement is an effective and safe method for the treatment of aortic stenosis in patients with heart failure.