经胸主动脉瓣球囊成形术治疗猪主动脉瓣狭窄安全性研究

目的与经皮主动脉瓣球囊成形术进行比较,评价经胸主动脉瓣球囊成形术治疗主动脉瓣狭窄的优势和缺点。方法建立3个月龄小猪主动脉瓣狭窄模型,其主动脉瓣压差均〉30mm Hg;20头模型猪随机分为经胸组与经皮组各10头,分别行经胸及经皮主动脉瓣球囊成形术,比较2组主动脉瓣压差下降值、放射线暴露时间、病死率、外周血管损伤发生率、起搏器使用率及主动脉后壁损伤率。结果经胸组术前、术后主动脉瓣压差（（42.6±2.9）、（14.4±2.6）mm Hg）与经皮组（（43.9±3.6）、（15.7±3.1）mm Hg）比较差异均无统计学意义（P〉0.05）,2组术后主动脉瓣压差均较术前明显降低,差异均有统计学意义（P〈0.01）;经胸组放射线暴露时间、病死率、外周血管损伤发生率、起搏器使用率（（6.8±2.5）min、0、0、0）低于经皮组（（11.9±4.2）min、40%、40%、100%）（P〈0.05）,经升主动脉置入传统动脉鞘管后主动脉后壁损伤率（80%）明显高于经皮组（0）（P〈0.01）。结论经胸主动脉瓣球囊成形术在放射线暴露时间、病死率、外周血管损伤发生率、起搏器使用率等方面具有优势,但主动脉后壁损伤发生率高。

Security of transthoracic aortic balloon valvuloplasty for aortic stenosis in pig models

Objective To evaluate the advantages and disadvantages of transthoracic aortic balloon valvuloplasty by comparing with percutaneous aortic balloon valvuloplasty for aortic stenosis.Methods Twenty 3-month-old pigs were randomly divided into two groups,with 10 pigs in each group,with aortic pressure gradient30mm Hg after being prepared aortic stenosis models.These two groups underwent transthoracic aortic balloon valvuloplasty or percutaneous aortic balloon valvuloplasty respectively,and were compared the decline of aortic valve pressure gradient,radiation exposure time,fatality,the incidence of peripheral vascular injury,pacemaker utilization and the incidence of aortic wall injury.Results The aortic valve pressure gradients before and after operation were（42.6±2.9）and（14.4±2.6）mm Hg in transthoracic group,showing no significant differences in comparsion with those in percutaneous group（（43.9±3.6）and（15.7±3.1）mm Hg）（P〈0.05）,and decreased significantly after operation in both two groups（P〈0.01）.The radiation exposure time was shorter,and the fatality,the incidence of peripheral vascular injury,and pacemaker utilization rate were lower in transthoracic group（（6.8±2.5）min,0,0,0）than those in percutaneous group（（11.9±4.2）min,40%,40%,100%））（P〈0.05）.The incidence of aortic wall injury was 80%after implanting the traditional sheath through the ascending aorta,significantly higher than that in percutaneous group（0）（P〈0.01）.Conclusion Transthoracic aortic balloon angioplasty has the advantages in radiation exposure time,fatality,the incidence of peripheral vascular injury,and pacemaker utilization,but the incidence of aortic wall injury is high.