超声心动图在经导管主动脉瓣置换术中的应用价值

目的探讨超声心动图在主动脉瓣膜病变患者经导管主动脉瓣置换术(TAVR)的术前评估、术中监测及术后随访中的应用价值。方法回顾性分析我院收治的32例行TAVR的主动脉瓣膜病变患者的临床资料,分为单纯主动脉狭窄患者13例(Ⅰ组),单纯主动脉瓣反流患者6例(Ⅱ组),主动脉瓣狭窄合并反流患者13例(Ⅲ组)。分析各组术前多层计算机断层扫描(MSCT)对主动脉根部结构测值、术前及术后1个月超声心动图参数的差异,以及术中情况、术后并发症发生情况。结果32例患者术中均经股动脉植入瓣膜,并应用经食管超声心动图(TEE)监测,其中2例于TEE引导下行房间隔穿刺逆行跨主动脉瓣,4例采用瓣中瓣手术。术前实时三维经食管超声心动图(RT-3D TEE)与MSCT测得的主动脉瓣环最大径、最小径、面积、周长,以及左、右冠状动脉开口高度比较,差异均无统计学意义。术后即刻TEE评估:少至中量瓣周漏4例,少量瓣周漏9例,微量瓣周漏5例,无瓣周漏14例。经胸超声心动图结果显示,与术前比较,Ⅰ组术后1个月主动脉瓣峰值流速(AV Vmax)、主动脉瓣平均跨瓣压差(AVPGmean)、室间隔厚度(IVST)、左室后壁厚度(PWT)均减小,左室射血分数(LVEF)增大,差异均有统计学意义(均P<0.05);Ⅱ组术后1个月主动脉瓣反流面积(AR area)、主动脉瓣缩流径(AR width)及左室舒张末期内径(LVEDD)均减小,差异均有统计学意义(均P<0.05);Ⅲ组术后1个月AV Vmax、AVPGmean、AR area、AR width、IVST、PWT、LVEDD均减小,LVEF增大,差异均有统计学意义(均P<0.05)。术后随访死亡1例,行永久起搏器植入4例。结论超声心动图在不同类型的主动脉瓣膜病变患者TAVR的术前评估、术中监测及术后随访中均具有重要作用,可为TAVR的疗效评估及预后判断提供依据。     

超声心动图在经导管主动脉瓣置换术中的应用进展

近年来经导管主动脉瓣置换术（TAVR）快速发展,其已成为外科主动脉瓣置换术禁忌、高中风险主动脉狭窄患者的一线治疗方案。影像支持是该术式成功实施的重要保证,超声心动图具有实时、无创、无辐射等优点,在TAVR患者术前评估、术中监测及术后随访中均发挥着重要作用。本文就超声心动图在TAVR中的应用进展进行综述。     

三维经食管超声心动图在心尖入路经导管主动脉瓣置换术中的应用价值

目的 探讨三维经食管超声心动图（3D-TEE）在经心尖入路的经导管主动脉瓣置换术（TA-TAVR）中的应用价值。方法 连续选取行TA-TAVR植入J-Valve瓣膜的患者44例,所有患者均于全身麻醉下,应用3D-TEE评估主动脉根部结构及瓣叶病变,引导J-Valve输送系统进入左室并释放人工瓣膜,术后即刻评价手术效果及术后并发症。结果 在3D-TEE实时监测引导下,42例患者成功植入J-Valve瓣膜,成功率95.45%。3D-TEE预测人工瓣膜型号与实际植入瓣膜型号的符合率为72.72%,术后即刻瓣周反流的发生率为33.33%,左室射血分数无明显变化。结论 3D-TEE可在TA-TAVR中提供重要的引导作用,并即刻评价手术效果及并发症,具有重要的临床价值。     

二维、三维经食管超声心动图在经导管主动脉瓣植入术中的应用价值

目的探讨二维、三维经食管超声心动图在经导管主动脉瓣植入术（TAVI）中的应用价值。 方法对2010年5月至2015年10月在复旦大学附属中山医院行TAVI的11例重度主动脉瓣狭窄[主动脉瓣狭窄口面积<1.0 cm²,主动脉瓣口最大流速>4 m/s,平均跨瓣压差>40 mmHg（1 mmHg=0.133 kPa）]和1例人工生物主动脉瓣中重度反流患者术前均行常规经胸超声心动图检查及二维、三维经食管超声心动图检查（2DTEE、3DTEE）,术中二维、三维经食管超声心动图监测,术后常规经胸超声心动图随访。采用Pearson相关分析分析3DTEE与计算机断层扫描（MDCT）评价主动脉瓣环最大值、最小值、瓣环面积以及狭窄口面积的相关性及3DTEE、MDCT与连续性方程评价狭窄口面积的相关性。 结果所有患者均成功植入人工生物主动脉瓣,其中1例患者术中发现心脏压塞合并升主动脉夹层分离,经心包穿刺以及升主动脉夹层分离保守治疗3 d后突发心脏压塞死亡。所有患者MDCT与3DTEE评价主动脉瓣环最大径、最小径、瓣环面积及狭窄口面积的相关性均较好（r=0.98、0.97、0.97、0.99,P均<0.01）;术前连续性方程测量的主动脉狭窄口面积与MDCT及3DTEE评价结果的相关性均很好（r值均为0.99,P均<0.01）。 结论2DTEE、3DTEE能快速、准确地定量主动脉瓣环的大小及评价主动脉的解剖结构,能实时引导和监测经导管主动脉瓣植入及其并发症。     

经食管超声心动图在牛心包主动脉瓣置换术中的应用

目的 评价术中经食管超声心动图（IOTEE）在牛心包主动脉瓣置换术中的应用价值。方法 回顾性分析拟施行牛心包主动脉瓣置换术的106例患者,分别于体外循环前采用IOTEE测量和术中解剖测量主动脉瓣环径、主动脉窦部和主动脉窦管交界直径、主动脉瓣叶有效高度（eH）。结果 术前拟行牛心包主动脉瓣置换术106例患者,其中8例经IOTEE术前补充诊断后修改手术方式被排除。余98例均接受牛心包主动脉瓣置换术。98例IOTEE首要诊断与手术诊断符合率为100%,5例（5/98,5.10%）IOTEE次要诊断与手术诊断不相符。98例患者体外循环前IOTEE提示瓣叶数目与术中探查符合率100%、瓣叶穿孔符合率80.00%,瓣叶赘生物符合率85.71%、老年退行性钙化符合率100%、风湿性病变符合率100%。体外循环前IOTEE测量的主动脉瓣环径、主动脉窦部和主动脉窦管交界直径、eH与术中实际测量结果相关性良好（r均>0.8,P均<0.05）。结论 IOTEE对于评估牛心包主动脉瓣置换术的可行性、指导选择手术方案和预估手术效果有重要意义。     

超声心动图用于心尖入路经导管主动脉瓣植入术

目的 评价超声心动图用于心尖入路经导管主动脉瓣植入术(TAVI)的价值.方法 纳入23例接受J-Valve TAVI的主动脉瓣疾病患者,根据主要疾病,将其中20例非重度主动脉瓣狭窄(AS)合并中度以上主动脉瓣反流(AR)者分为AS组(n=10)及AR组(n=10).术前行经胸超声心动图(TTE),术中全程以经食管超声心...     

超声心动图在经心尖主动脉瓣人工瓣膜植入术治疗主动脉瓣狭窄患者中的应用价值CSCD

目的探讨超声心动图在经心尖主动脉瓣人工瓣膜植入术(TAAVI)治疗主动脉瓣狭窄患者中的应用价值。方法选择2014年6月至2015年3月中国医学科学院阜外心血管病医院收治的接受TAAVI治疗的15例重度主动脉瓣狭窄患者。分别于术前、出院时、术后1个月、术后3~6个月采用超声心动图评估左心室舒张末内径、左心房内径及左心室射血分数、主动脉有效瓣口面积、平均跨瓣压差。采用单因素方差分析分别比较术前、出院时、术后1个月、术后3~6个月患者左心室舒张末期内径、左心房内径、左心室射血分数、主动脉瓣有效瓣口面积、平均跨瓣压差,进一步组间两两比较采用LSD-t检验。结果入选15例患者术前超声心动图显示为重度主动脉瓣狭窄,平均有效瓣口面积(0.55±0.28)cm2,术前平均跨瓣压差为(58.93±14.96)mm Hg(1 mm Hg=0.133 k Pa)。1例患者术中超声示中量瓣周漏,重新放置瓣膜顺利。出院时、术后1个月、术后3~6个月患者左心室舒张末内径、左心房内径及左心室射血分数与术前比较差异均无统计学意义。除1例患者其他原因死亡外,术后超声随访结果示所有患者人工瓣膜位置均正常,7例患者探及瓣周1~2 mm反流。与术前比较,患者出院时及术后1个月、术后3~6个月主动脉瓣有效瓣口面积均增加,平均跨瓣压差均下降,且差异均有统计学意义(t=6.619、7.357、6.401,P均<0.001;t=9.523、9.687、5.932,P均<0.001)。结论术前经过超声心动图严格筛选,TAAVI治疗严重主动脉瓣狭窄患者效果良好。超声心动图在术中评估及术后随访中具有非常重要作用。     

实时经食管三维超声心动图在牛心包主动脉瓣置换术中的应用

目的评价术中实时经食管三维超声心动图(RT-3D-TEE)在牛心包主动脉瓣置换术中的应用价值。方法对66例接受牛心包主动脉瓣置换术患者,分别于体外循环前采用术中实时经食管二维超声心动图(RT-2D-TEE)和RT-3D-TEE探查主动脉瓣并测量相关参数,与术中探查结果及直视测量参数进行对比,观察超声测量主动脉瓣参数与术中测量结果的相关性,评价瓣叶损坏程度。分别于术后1、6个月随访观察主动脉相关参数及瓣膜功能情况。结果 RT-2D-TEE和RT-3D-TEE首要诊断与术中探查结果符合率均为100%;5例RT-2D-TEE次要诊断与术中探查存在差异(符合率92.42%,61/66),其中2例RT-3D-TEE次要诊断亦与术中探查存在差异(符合率96.97%,64/66)。RT-2D-TEE与RT-3D-TEE对主动脉瓣瓣叶数目、瓣叶穿孔、瓣叶赘生物及风湿性主动脉瓣损害与术中探查结果高度一致,RT-3D-TEE诊断符合率更高。RT-2D-TEE所测主动脉瓣环径、主动脉窦部和主动脉窦管交界直径、有效高度(eH)测值低于与RT-3D-TEE测值和术中实测结果(P均<0.05);RT-3D-...     

经胸和多平面经食道超声心动图定量诊断主动脉瓣狭窄

为评价多平面经食道超声心动图（ＭＴＥＥ）定量诊断主动脉瓣狭窄（ＡＳ）的可行性和可靠性，在３２例成年ＡＳ患者中应用经胸超声心动图（ＴＴＥ）测量了主动脉瓣的瓣口面积（ＡＶＡ－ＴＴＥ），最大瞬时压差（ＰＰＧ）和平均压差（ＭＰＧ），应用ＭＴＥＥ测量了瓣口面积（ＡＶＡ－ＴＥＥ），并对手术治疗的患者直接测量了其瓣口面积（ＡＶＡ－ＯＰＥ）。结果显示：①ＡＶＡ－ＴＥＥ与ＡＶＡ－ＴＴＥ、ＡＶＡ－ＴＥＥ与ＡＶＡ－ＯＰＥ以及ＡＶＡ－ＴＴＥ与ＡＶＡ－ＯＰＥ间均高度相关（ｒ分别为０．９１、０．９４、０．９１），ＡＶＡ－ＴＴＥ显著高估ＡＶＡ－ＯＰＥ（Ｐ值＜０．０５）；②ＭＴＥＥ对预测重度ＡＳ（ＡＶＡ≤０．７５ｃｍ２）的敏感性和特异性均为１００％；③ＰＰＧ、ＭＰＧ与ＡＶＡ－ＴＴＥ和ＡＶＡ－ＴＥＥ间仅呈中度负相关（ｒ＝－０．７３～－０．７６），而与ＡＶＡ－ＯＶＥ间无相关关系。表明对于ＡＳ的定量诊断，ＭＴＥＥ具有高度的可行性和可靠性，而跨瓣压差存在明显的限制性。     

经导管主动脉瓣置换术前实时三维经食管超声自动测量主动脉瓣环径

目的 探讨经导管主动脉瓣置入术（TAVR）中应用实时三维经食管超声心动图（3D-TEE）自动测量主动脉瓣环的可行性与准确性。方法 对21例拟接受TAVR患者于术前分别采用3D-TEE和多排CT（MDCT）测量主动脉瓣环面积、周长、最大径和最小径。对比3D-TEE测值与MDCT测值间的差异及相关性,记录3D-TEE自动测量主动脉瓣环参数所需的时间。结果 3D-TEE所测主动脉瓣环面积为（445.74±62.60）mm²,周长为（76.16±5.30）mm,最大径为（26.29±1.97）mm,最小径为（21.40±1.68）mm,MDCT测值分别为（456.85±75.70）mm²、（77.17±5.90）mm、（26.76±2.83）mm、（20.98±1.76）mm。MDCT与3D-TEE所测主动脉瓣环面积、周长、最大径及最小径差异均无统计学意义（P均>0.05）。3D-TEE与MDCT所测主动脉瓣环面积、周长、最大径、最小径均呈高度相关（r=0.89、0.91、0.85、0.79,P均<0.01）。采用3D-TEE自动测量主动脉瓣相关径线所需时间为（1.54±0.21）min。结论 3D-TEE自动测量主动脉瓣环能准确、快速获得主动脉瓣环相关径线,可作为替代MDCT的影像学方法。     

Recent advances in transcatheter aortic valve replacement for high-risk patients

Aortic stenosis is the most common valvular heart disease of old age. Patients with severe aortic stenosis who develop symptoms have a very poor prognosis without valve intervention. Surgical aortic valve replacement has historically been the only treatment option for these patients. However a significant minority are considered inoperable or at high surgical risk and therefore are refused or decline surgery. In recent years, transcatheter aortic valve replacement has emerged as an alternative treatment option in these high-risk patients. The aim of this review is to summarize the current role of transcatheter aortic valve replacement in contemporary clinical practice including recent advances in technological and procedural aspects and then discuss future directions.     

超声心动图在二叶式主动脉瓣及其并发症诊治中的应用价值

目的探讨超声心动图在二叶式主动脉瓣(BAV)及其相关并发症诊治中的应用价值。 方法研究对象为2017年1月至10月于复旦大学附属中山医院心脏超声诊断科行超声心动图检查并诊断为BAV的患者,共120例,回顾性分析其超声及临床特点。选取孤立性主动脉瓣狭窄(AS)患者35例,依据美国心脏协会(AHA)/美国心脏病学会(ACC)标准,以平均跨瓣压差为标准分为轻度AS(<20 mmHg)(1 mmHg＝0.133 kPa)6例,中度AS(20～39 mmHg)17例,和重度AS(≥40 mmHg)12例,并比较BAV合并轻中度AS患者与合并重度AS患者的临床及超声特征。 结果120例BAV患者年龄为18～82岁,男性75例,平均年龄为(51.11±15.46)岁;女性45例,平均年龄为(55.84±13.81)岁,男女患者之间年龄差异无统计学意义(t＝－1.69,P>0.05)。19例(15.8%)患者为单纯BAV而无相关并发症,101例(84.2%)患者均存在不同程度的并发症。35例(29.2%)并发AS,平均年龄为(60.17±13.54)岁,16例(13.3%)并发主动脉瓣反流(AR),平均年龄为(46.44±15.28)岁,并发AR者年龄小于并发AS者(t＝－3.23,P<0.05)。30例患者(25.0%)并发升主动脉扩张,平均年龄(54.83±10.11)岁;另有20例患者(16.7%)同时合并1种及以上并发症。共有27例患者(22.5%)接受手术治疗;12例合并重度AS的患者中有9例接受手术治疗,其中1例为经导管主动脉瓣置换术(TAVI)。并发重度AS者室间隔厚度[(12.80±2.20)mm]及左室后壁厚度[(11.90±1.97)mm]较轻中度AS者增厚[(9.96±1.40)mm,(9.30±1.02)mm; t＝－4.49,Z＝－3.39,均P<0.05]。 结论BAV合并各种并发症的患者比例高,合并严重并发症而需接受外科或心脏介入手术治疗的患者比例亦高,超声心动图对这部分患者有极大的监测价值。     

Ascending aortic dilatation rate after transcatheter aortic valve replacement in patients with bicuspid and tricuspid aortic stenosis: A multidetector computed tomography follow-up study

BACKGROUND: Current data is lacking about the progression of ascending aortic dilatation after transcatheter aortic valve replacement (TAVR) in aortic stenosis (AS) patients with bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV). This study aims to assess the ascending aortic dilatation rate (mm/year) after TAVR in patients with BAV versus TAV using a multidetector computed tomography (MDCT) follow-up and to determine the predictors of ascending aortic dilatation rate.METHODS: Severe AS patients undergoing TAVR from March 2013 to March 2018 at our center with MDCT follow-ups were included. BAV and TAV were identified using baseline MDCT. Baseline and follow-up MDCT images were analyzed, and the diameters of ascending aorta were measured. Study end point is ascending aortic dilatation rate (mm/year). Furthermore, factors predicting ascending aortic dilatation rate were also investigated.RESULTS: Two hundred and eight patients were included, comprised of 86 BAV and 122 TAV patients. Five, 4, 3, 2, and 1-year MDCT follow-ups were achieved in 7, 9, 30, 46, and 116 patients. The ascending aortic diameter was significantly increased after TAVR in both BAV group (43.7±4.4 mm vs. 44.0±4.5 mm; P<0.001) and TAV group (39.1±4.8 mm vs. 39.7±5.1 mm; P<0.001). However, no difference of ascending aortic dilatation rate was found between BAV and TAV groups (0.2±0.8 mm/year vs. 0.3±0.8 mm/year, P=0.592). Multivariate linear regression revealed paravalvular leakage (PVL) grade was independently associated with ascending aortic dilatation rate in the whole population and BAV group, but not TAV group. No aortic events occurred during follow-ups.CONCLUSION: Ascending aortic size continues to grow after TAVR in BAV patients, but the dilatation rate is mild and comparable to that of TAV patients. PVL grade is associated with ascending aortic dilatation rate in BAV patients post-TAVR.     

超声心动图评价二瓣化主动脉瓣瓣膜功能

目的 探讨超声心动图在二瓣化主动脉瓣病理生理进展评价中的应用,分析二瓣化主动脉瓣各年龄瓣膜病变的程度.方法 回顾性分析135例二瓣化主动脉瓣患者超声资料及病例资料,结合临床资料分析患者病程进展中瓣膜功能的变化.结果 二瓣化主动脉瓣关闭不全最常见,本组资料中为68例(50%),单纯狭窄仅19例(14%).狭窄并关闭不全者29例(22%),瓣膜功能正常者19例(14%).各年龄组内主动脉瓣病变均以关闭不全多见.病程晚期的手术患者各年龄组内主动脉病变亦均以关闭不全为主.结论 超声心动图能对主动脉瓣的病变作出早期诊断.二瓣化主动脉瓣最常见的瓣膜病变是主动脉瓣关闭不全.     

Ten-year experience with transcatheter and surgical aortic valve replacement in Finland

Aim: We investigated the outcomes of transcatheter (TAVR) and surgical aortic valve replacement (SAVR) in Finland during the last decade.

Methods: The nationwide FinnValve registry included data from 6463 patients who underwent TAVR or SAVR with a bioprosthesis for aortic stenosis from 2008 to 2017.

Results: The annual number of treated patients increased three-fold during the study period. Thirty-day mortality declined from 4.8% to 1.2% for TAVR (p?=?.011) and from 4.1% to 1.8% for SAVR (p?=?.048). Two-year survival improved from 71.4% to 83.9% for TAVR (p?<?.001) and from 87.2% to 91.6% for SAVR (p?=?.006). During the study period, a significant reduction in moderate-to-severe paravalvular regurgitation was observed among TAVR patients and a reduction of the rate of acute kidney injury was observed among both SAVR and TAVR patients. Similarly, the rate of red blood cell transfusion and severe bleeding decreased significantly among SAVR and TAVR patients. Hospital stay declined from 10.4?±?8.4 to 3.7?±?3.4 days after TAVR (p?<?.001) and from 9.0?±?5.9 to 7.8?±?5.1 days after SAVR (p?<?.001).

Conclusions: In Finland, the introduction of TAVR has led to an increase in the invasive treatment of severe aortic stenosis, which was accompanied by improved early outcomes after both SAVR and TAVR.

Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT03385915

• Key Messages

• This study demonstrated that the introduction of transcatheter aortic valve replacement has led to its widespread use as an invasive treatment for severe aortic stenosis.

• Early and 2-year survival after transcatheter and surgical aortic valve replacement has improved during past decade.

• Transcatheter aortic valve replacement has fulfilled its previously unmet clinical needs and has surpassed surgical aortic valve replacement as the most common invasive treatment for aortic stenosis.

     

Anemia and risk of periprocedural cerebral injury detected by diffusion-weighted magnetic resonance imaging in patients undergoing transcatheter aortic valve replacement

BACKGROUND: Anemia is prevalent in patients undergoing transcatheter aortic valve replacement(TAVR) and has been linked to impaired outcomes after the procedure. Few studies have evaluated the impact of anemia and new ischemic lesions post TAVR.METHODS: We prospectively enrolled 158 patients who received TAVR in our center. Anemia was defined according to the World Health Organization criteria as hemoglobin <12 g/dL in women and <13 g/dL in men. All patients underwent diffusion-weighted magnetic resonance imaging(DW-MRI) procedure before and within 4–7 days after TAVR. RESULTS: Anemia was present in 85(53.8%) patients who underwent TAVR, and 126(79.7%) patients had 718 new DW-MRI positive lesions with a mean of 4.54±5.26 lesions per patient. The incidence of new ischemic lesions was 81.2% in patients with anemia versus 78.1% in patients without anemia(P=0.629). Moreover, anemic patients had bigger total volume/lesions in the anterior cerebral artery/middle cerebral artery(ACA/MCA) and MCA regions compared to the non-anemic patients(31.89±55.78 mm³ vs. 17.08±37.39 mm³, P=0.049;and 54.54±74.72 mm³ vs. 33.75±46.03 mm³, P=0.034). Anemia was independently associated with the volume/lesion in the ACA/MCA(β=16.796, 95% confidence interval [95% CI] 2.001 to 31.591, P=0.026) and in the MCA zone(β=0.020, 95% CI 0.001 to 0.040, P=0.041). CONCLUSIONS: Patients with pre-procedural anemia may have bigger total volume/lesions in the ACA/MCA and MCA regions compared to the non-anemic patients. Whether the consequences of bigger total volume/lesions impact neurological and cognitive outcomes remains to be investigated.     

经心尖途径经导管主动脉瓣置换术救治单纯性主动脉瓣重度反流1例

目的 探讨经心尖途径经导管主动脉瓣置换术治疗单纯性主动脉瓣关闭不全的可行性.方法 回顾性分析2016年9月8日浙江大学医学院附属第二医院心脏中心开展的浙江省首例经心尖途径经导管主动脉瓣置换术的术前评估、术中操作以及患者术后情况.结果 患者严格进行术前评估,术中行全身麻醉、气管插管,透视下定位后第五肋间小切口进胸,打开心包,选择心尖裸区预置荷包,穿刺后导入超滑泥鳅导丝跨过主动脉瓣到达降主动脉,导入J-Valve输送系统逐步释放,经食道超声心动图评估主动脉瓣反流从术前的大量到瓣膜释放后无反流,撤出瓣膜输送系统,手术成功结束.术后患者症状明显缓解,出现Ⅰ度房室传导阻滞,未发生死亡、心肌梗死、心包填塞、动脉夹层等并发症.结论 经心尖途径经导管主动脉瓣置换术是安全可行的,患者的远期预后还有待进一步观察.     

基于单中心经导管主动脉瓣置换术治疗主动脉瓣狭窄初步临床疗效分析

目的:探讨经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)治疗主动脉瓣狭窄患者的安全性和有效性。方法:连续入选本中心前40例行TAVR的主动脉瓣狭窄患者。观察终点指标包括手术成功率、并发症、术后30d随访结果等。结果:患者男性27例,女性13例;年龄67~87岁,平均年龄(78.3±5.0)岁。手术成功率100%;与术前相比,术后患者平均主动脉瓣跨瓣压差明显下降[(10.77±3.90)mmHg vs(61.80±18.62)mmHg,P0.001],平均瓣口面积增加[(1.80±0.24)cm~2 vs(0.65±0.17)cm~2,P0.001],美国纽约心脏病学会(NYHA)心功能分级改善(1.80±0.62 vs2.95±0.75,P0.001)。术后1d发生瓣周漏13例(12例轻度、1例中度),急性右冠状动脉堵塞1例,瓣膜脱落及脑梗死1例,顽固性心包积液、心包填塞1例。术后30d死亡1例(2.5%),因心脏传导异常置入永久性心脏起搏器4例(10%)。结论:单中心、前40例TAVR结果显示,TAVR对我国外科手术禁忌或高危的主动脉瓣狭窄患者有较好的安全性及有效性。