经导管主动脉瓣置换术治疗重度主动脉瓣狭窄的初步临床疗效分析

目的:总结经导管主动脉瓣置换术(TAVR)治疗重度主动脉瓣狭窄(AS)的初步临床经验。方法:纳入2018年10月-2019年10月于我院接受TAVR治疗的重度AS患者21例,分析其临床资料、手术效果及并发症情况。结果:患者平均年龄(73.71±8.91)岁,男9例,女12例。手术成功率为100%,术后即刻主动脉瓣跨瓣压差较术前明显下降[(7.71±5.32) mmHg∶(100.19±30.13) mmHg,1 mmHg=0.133 kPa,P<0.01]。术中联合ECMO支持1例,联合经导管二尖瓣球囊扩张1例,联合经皮冠状动脉支架植入术(PCI)1例,瓣中瓣植入2例。术后消化道出血1例,永久性起搏器植入2例,发热2例,急性脑梗死1例,轻度瓣周漏11例,股动脉穿刺点处假性动脉瘤1例,临时起搏器置入处皮下血肿1例,死亡1例。术后30 d患者症状及心脏超声指标均改善。结论:TAVR治疗外科手术禁忌或高危重度主动脉瓣狭窄相对安全、有效。     

主动脉瓣重度狭窄经导管主动脉瓣置换术后患者围术期效果观察

目的:探讨主动脉瓣重度狭窄患者经股动脉导管主动脉瓣置换术(TAVR)治疗前后围术期内心功能及主动脉瓣压差、跨瓣流速的变化情况。方法:本研究为回顾性研究,选取2017年9月至2019年6月,在郑州市心血管病医院接受TAVR的27例主动脉瓣狭窄患者。对经TAVR治疗前、术后1d、7 d、1个月患者的临床症状、BNP、LVEF、最大跨瓣血流速度、主动脉瓣最大跨瓣压差进行分析,观察主动脉瓣重度狭窄患者接受TAVR治疗后围术期内疗效。结果:与术前相比,患者术后临床症状、心功能NYHA分级明显改善。患者BNP、主动脉瓣最大跨瓣压差、最大跨瓣流速下降明显,在术后1 d,差异有统计学意义(均P<0. 01);术后LVEF值明显上升,术后7 d可显现,差异有统计学意义,在心功能<50%的患者中,术后1 d差异有统计学意义(P<0. 05)。结论:TAVR治疗主动脉瓣重度狭窄临床疗效确切,在围术期即可迅速缓解临床症状、改善心功能、降低BNP值、提高LVEF。合并LVEF下降的主动脉瓣重度狭窄的患者接受TAVR治疗后患者心功能改善效果更明显。     

主动脉瓣重度狭窄患者经导管主动脉瓣置换术的安全性和有效性分析

目的探讨主动脉瓣重度狭窄患者接受经导管主动脉瓣置换术(TAVR)治疗的有效性和安全性。方法回顾性选取2017年9月至2019年12月接受TAVR的主动脉瓣重度狭窄患者36例。收集患者的人口学、实验室检查、影像辅助检查等全部临床资料,对手术过程、成功率、并发症以及手术前后超声心动图结果等进行分析。结果患者平均年龄(72.42±6.14)岁,瓣膜置入成功率100%。与术前相比,术后第1天的脑钠肽、主动脉瓣最大跨瓣压差、主动脉瓣跨瓣流速差异均有统计学意义(均P<0.01),术后6个月随访左心室射血分数、左心室舒张末期内径及左心室收缩末期内径都有显著改善(均P<0.01)。并发症方面,住院期间1例(2.8%)患者因三度房室传导阻滞行永久性起搏器植入;术后1周有2例(5.6%)患者存在轻度瓣周漏(<2mm),术后6个月随访时只有1例(2.8%)患者存在轻度瓣周漏;术后6个月随访时1例(2.8%)患者缺血性卒中。结论主动脉瓣重度狭窄患者行TAVR治疗有较好的安全性和有效性,可有效改善左心室重塑。     

高危重度主动脉瓣狭窄经颈动脉途径行经导管主动脉瓣置换术治疗的安全性和有效性

目的分析高危主动脉瓣重度狭窄患者经颈动脉途径行经导管主动脉瓣置换术(TAVR)治疗的安全性和有效性。方法选择2017年9月～2019年2月于北京阜外医院、空军军医大学西京医院、南昌大学第二附属医院、大连医科大学第一附属医院、北京医院经颈动脉途径TAVR的症状性重度主动脉瓣疾病患者21例,男性13例,年龄58～91(72.8±8.5)岁。对入选患者临床资料、手术方法及效果进行回顾性分析。结果 21例患者中,12例接受全麻手术,9例在局麻下完成手术。20例患者经右颈动脉途径TAVR,1例经左颈动脉行TAVR治疗。置入Venus A瓣膜20例,VitaFlowⅡ瓣膜1例。其中1例患者出现颈动脉血肿,经局部处理后,血肿吸收好转,其余患者手术过程顺利。21例患者均完成术后随访,其中2例患者出现Ⅲ度房室传导阻滞,行永久起搏器置入术。患者术后随访(30±7)d,均未发生短暂性脑缺血发作、脑卒中、血管并发症、心肌梗死、瓣周漏等不良事件。术后超声心动图显示,未见中量及以上反流;且术后1个月LVEF较术前明显改善[(61.44±6.48)%vs (51.90±13.17)%,P0.05];术后1周和术后1个月平均跨瓣压差较术前明显下降[(14.90±8.03)mm Hg(1mm Hg=0.133kPa)vs (59.48±22.43)mm Hg,P0.01;(13.11±8.45)mm Hg vs (59.48±22.43)mm Hg,P0.01]。结论对不适合行股动脉入路的患者以及主动脉瓣病变复杂,尤其是严重钙化、二叶式主动脉瓣患者、既往曾行二尖瓣瓣膜置换术的症状性重度主动脉瓣狭窄患者,实施经颈动脉途径TAVR安全有效。     

经导管主动脉瓣置换术治疗老年主动脉瓣狭窄的安全性和有效性

目的 探讨经导管主动脉瓣置换术(TAVR)在中国老年主动脉瓣狭窄(AS)患者中的安全性和有效性.方法 选取行手术治疗的AS患者132例,其中行外科主动脉瓣置换术(SAVR)手术患者8例(SAVR组);行TAVR手术患者124例(TAVR组).观察两组围术期临床结果.结果 围术期内出现1例(0.76％)死亡及1例(0.7...     

重度主动脉瓣狭窄患者经导管主动脉瓣置换术对功能性二尖瓣反流的影响

目的:探讨重度主动脉瓣狭窄(AS)患者行经导管主动脉瓣置换术(TAVR)后,超声心动图参数及功能性二尖瓣反流(FMR)的转归情况,以及影响FMR预后的相关因素.方法:回顾性分析2017年6月至2020年7月,首都医科大学附属北京安贞医院收治的142例接受TAVR治疗的重度AS合并FMR患者,分析基线信息,比较手术前后超...     

预置脑保护装置下经导管主动脉瓣置换术治疗合并左心室血栓的主动脉瓣狭窄一例

1 临床资料 患者男性,70岁,因反复胸闷、气促加重于2020年7月28日急诊入院.既往史:高血压,最高达186/110 mmHg(1 mmHg=0.133 kPa);急性心肌梗死,冠状动脉支架术后1年;肺气肿. 入院查体:胸骨右缘第2肋间闻及收缩期Ⅳ级杂音.辅助检查:血N末端B型利钠肽原水平为 7859.1 pg/m...     

经导管主动脉瓣置换术对主动脉瓣狭窄患者肾功能的影响

目的探讨经导管主动脉瓣置换术(TAVR)对主动脉瓣狭窄患者术后肾功能的影响。方法本研究为单中心回顾性研究。连续入选2014年10月至2019年10月在复旦大学附属中山医院行TAVR治疗的主动脉瓣狭窄患者。依据术前1 d肾小球滤过率(eGFR)将纳入患者分为4组:>90 ml·min^-1·1.73m^-2组、>60~90 ml·min^-1·1.73m^-2组、>30~60 ml·min^-1·1.73m^-2组和≤30 ml·min^-1·1.73m^-2组。术后72 h再次检测eGFR,按照术后肾功能变化将患者分为急性肾功能恢复(AKR)组、急性肾脏损伤(AKI)组和肾功能无变化组。其中AKR定义为TAVR术后72 h的eGFR值增加>基线值的25%,AKI定义为TAVR术后72 h的eGFR值降低>基线值的25%。比较各组的相关临床资料,并采用多因素logistic回归分析TAVR术后肾功能变化的影响因素。结果本研究共纳入217例因主动脉瓣狭窄行TAVR治疗的患者,年龄(76.7±7.4)岁,其中女性86例,胸外科医师学会评分为(9.5±5.8)分。>90 ml·min^-1·1.73m^-2组(n=19)、>60~90 ml·min^-1·1.73m^-2组(n=116)、>30~60 ml·min^-1·1.73m^-2组(n=70)和≤30 ml·min^-1·1.73m^-2组(n=12)术后达AKR者所占比例分别为0、30.2%(35/116)、58.6%(41/70)和75.0%(9/12);共3例(1.4%)患者发生AKI,其中>30~60 ml·min^-1·1.73m^-2组2例,>60~90 ml·min^-1·1.73m^-2组1例。eGFR<60 ml·min^-1·1.73m^-2患者中AKI发生率为2.4%(2/82)。纳入的217例患者中,AKR组85例(39.2%)、AKI组3例(1.4%)、肾功能无变化组129例(59.4%)。3组的体重指数(BMI)、术前左心室舒张末期内径(LVEDD)和术前eGFR分布差异有统计学意义(P均<0.05)。多因素logistic回归分析显示,BMI(OR=5.54,95%CI 1.04~29.58,P=0.045)、术前LVEDD(OR=1.22,95%CI 1.09~1.38,P=0.001)及术前eGFR(OR=2.23,95%CI 2.04~2.55,P=0.004)是术后非AKR的危险因素。结论TAVR术后绝大多数患者表现为肾功能不变或者改善,TAVR术后肾功能的变化与BMI及术前LVDD、eGFR相关。     

经导管主动脉瓣置换术在高龄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高龄主动脉瓣狭窄患者的有效性和安全性.方法 回顾性分析2019年1月至2020年12月于中国医学科学院阜外心血管病医院行TAVR手术的主动脉瓣狭窄患者142例.其中年龄≥80岁患者22例为高龄老年组,65≤年龄<80岁患者120例为老年组,比较2组围手术期结果.采用SPSS 20.0软...     

经导管主动脉瓣植入术治疗重度主动脉瓣狭窄患者的初步经验

目的分享经导管主动脉瓣植入术（TAVI）治疗重度主动脉瓣狭窄患者的经验。方法分析已完成TAVI患者的基线特征、术后血流动力学变化情况及临床结果。结果 2012年4月至2014年3月共36例患者于四川大学华西医院进行TAVI,平均年龄（73.9±7.2）岁,其中男24例（66.7%）,平均欧洲心脏手术风险回归评分为（20.6±9.9）%。25例（69.4%）患者主动脉瓣叶形态呈二叶式畸形。TAVI成功35例（97.2%）,4例（11.1%）需植入第2枚瓣膜。术后主动脉瓣平均跨瓣压差下降至（10.5±5.7）mmHg（1 mmHg=0.133 kPa）,2例残余瓣周漏接近中度。术后30 d内死亡1例（2.8%）,脑卒中2例（5.6%）。10例（27.8%）患者因出现Ⅲ度房室传导阻滞而植入了永久起搏器。中位随访时间323 d,除2例患者分别于术后374 d和680 d死于恶性肿瘤外,其余患者均保持无症状生存。结论对于不适合进行外科手术的二叶式和三叶式主动脉瓣重度狭窄患者,TAVI是可行、安全和有效的。     

Left ventricular remodeling after aortic valve replacement]

The aim of the study was the assessment of left ventricular (LV) systolic function and left ventricular mass following aortic valve replacement (AVR) due to aortic valve stenosis as well as the influence of regression of LV hypertrophy in patients with normal and impaired LV systolic function prior to surgery. 74 patients with severe aortic valve stenosis (29 female, 45 male, mean age 66 +/- 18 years) were divided into 2 groups according to LV ejection fraction (EF): Group 1 with EF > 50% (n = 40); Group 2 with EF < or = 50% (n = 34). Furthermore, patients were differentiated into a group A without (n = 53) and a group B with aortic regurgitation (< or = II degrees, n = 21). All patients were examined by transthoracic echocardiography before and 1 month after surgery. There was a significant decrease of LV enddiastolic and endsystolic volume indices following AVR in group 2 and group B. Patients with preoperatively lower EF (group 2) showed an increase in LV ejection fraction from 39 +/- 10% before AVR to 47 +/- 11% after AVR (p < 0.001), whereas patients with preoperative normal EF (group 1) showed a significant decrease in EF (from 62 +/- 8% to 57 +/- 10%, p < 0.05). Also patients with combined aortic valve disease before AVR had an increase of EF after surgery (from 45 +/- 14% to 56 +/- 14%, p < 0.03). There were significant decreases of interventricular septum thickness and LV posterior wall thickness in group 1 and group A, whereas a significant decrease of LV enddiastolic diameter index was noted only in group B. Improvement of the NYHA functional class could be demonstrated in group 2 from 2.8 +/- 0.7 before to 2.2 +/- 0.6 after AVR, as well as in group B from 2.9 +/- 0.7 before to 1.9 +/- 0.7 after surgery. In conclusion, patients with impaired LV function or combined aortic valve disease showed a significant improvement of left ventricular systolic function after AVR, while patients with normal LV function presented a slight decrease of EF. There was a significant regression of left ventricular muscle mass in all groups independent of the left ventricular functional status.     

Left ventricular morphological and functional adaptation in severe aortic stenosis after transcatheter aortic valve implantation

Background Transcatheter aortic valve implantation (TAVI) has been confirmed to improve the prognosis of high-risk patients with severe aortic stenosis (AS),sti...     

Left ventricular hypertrophy and remodeling after aortic valve replacement

Left ventricular geometric remodeling and regression of hypertrophy were assessed after aortic valve replacement with a mechanical prosthesis in 37 patients with aortic stenosis and 39 with aortic insufficiency, aged 54.2 +/- 14.3 and 52.6 +/- 16.6 years, respectively. The follow-up period was 2 years. In patients with aortic insufficiency, ejection fraction increased from 54.4 +/- 3.5 preoperatively to 59.6 +/- 3.4 after 6 months and 61.7 +/- 2.7 after 2 years. In patients with aortic stenosis, ejection fraction increased from 56.6 +/- 5.1 preoperatively to 63.9 +/- 4.4 after 6 months and 71.7 +/- 4.1 after 2 years. Geometric remodeling, regression of hypertrophy, and increased ejection fraction of the left ventricle were similar in both groups at 6 months after surgery, but after 2 years of follow-up, greater improvement was found in patients who had undergone valve replacement for aortic stenosis.     

Left ventricular remodeling early after aortic valve replacement: differential effects on diastolic function in aortic valve stenosis and aortic regurgitation

OBJECTIVES: The aim of this study was to evaluate the effect of aortic valve replacement (AVR) on left ventricular (LV) function and LV remodeling, comparing patients with aortic valve stenosis to patients with aortic regurgitation. BACKGROUND: Aortic valve disease is associated with eccentric or concentric LV hypertrophy and changes in LV function. The relationship between LV geometry and LV function and the effect of LV remodeling after AVR on diastolic filling, in patients with aortic valve stenosis compared with aortic regurgitation, are largely unknown.Nineteen patients with aortic valve disease (12 aortic valve stenosis, 7 aortic regurgitation) were studied using magnetic resonance imaging to assess LV geometry and LV function before and 9 +/- 3 months after AVR. Ten age-matched healthy males served as control subjects. RESULTS: Before AVR, the ratio between left ventricular mass index (LVMI) and left ventricular end-diastolic volume index (LVEDVI) was only increased in patients with aortic valve stenosis (1.37 +/- 0.16 g/ml) compared with control subjects (0.93 +/- 0.08 g/ml, p < 0.05). After AVR, LVMI/LVEDVI decreased significantly in aortic valve stenosis (to 1.15 +/- 0.14 g/ml, p < 0.0001), but increased significantly in aortic regurgitation (1.02 +/- 0.20 g/ml to 1.44 +/- 0.27 g/ml, p < 0.0001). Before AVR, diastolic filling was impaired in both aortic valve stenosis and aortic regurgitation. Early after AVR, diastolic filling improved in patients with aortic valve stenosis, whereas patients with aortic regurgitation showed a deterioration in diastolic filling. CONCLUSIONS: Early after AVR, patients with aortic valve stenosis show a decrease in both LVMI and LVMI/LVEDVI and an improvement in diastolic filling, whereas in patients with aortic regurgitation, LVMI decreases less rapidly than LVEDVI, causing concentric remodeling of the LV, most likely explaining the observed deterioration of diastolic filling in these patients.     

Left ventricular diastolic dysfunction late after aortic valve replacement in patients with aortic stenosis

Patients with severe aortic stenosis (AS) are known to have increased left ventricular (LV) mass and diastolic dysfunction. It has been suggested that LV mass and diastolic function normalize after aortic valve replacement (AVR). In the present study, change in LV mass index and diastolic function 10 years after AVR for AS was evaluated. Patients who underwent AVR from 1991 to 1993 (n = 57; mean age 67 +/- 8.6 years at AVR, 58% men) were investigated with Doppler echocardiography preoperatively and 2 and 10 years postoperatively. Diastolic function was evaluated by integrating mitral and pulmonary venous flow data. Expected values for each patient, taking age into consideration, were defined using a control group (n = 71; age range 18 to 83 years). Patients were classified into 4 types: normal diastolic function (type A), mild diastolic dysfunction (type B), moderate diastolic dysfunction (type C), and severe diastolic dysfunction (type D). There was a reduction in LV mass index between the preoperative (161 +/- 39 g/m2) and 2-year follow-up (114 +/- 28 g/m2) examinations (p <0.0001), but no further reduction was seen at 10 years (119 +/- 49 g/m2). The percentage of patients with increased LV mass index decreased from 83% preoperatively to 29% at 2-year follow-up (p <0.001). The percentage of patients with moderate to severe LV diastolic dysfunction (types C and D) was unchanged between the preoperative (7%) and 2-year follow-up (13%) examinations (p = 0.27). The percentage of patients increased at 10-year follow-up to 61% (p <0.0001). In conclusion, this reveals the development of moderate to severe diastolic dysfunction 10 years after AVR, despite a reduction in the LV mass index.     

Left ventricular remodeling with intensive exercise after aortic valve replacement

The influence of regular exercise on cardiac remodeling after aortic valve replacement (AVR) is virtually unknown. The case is reported of a 49-year-old male patient who had undergone biological valve replacement for severe aortic regurgitation with reduced left ventricular ejection fraction (LVEF; 45%) and massive left ventricular dilation (left ventricular end-diastolic diameter (LVEDD) 96 mm), which had been recognized for at least three years before surgery. Starting with the normal postoperative cardiac rehabilitation, the patient subsequently intensified his regular endurance training, reaching a total of 9,500 km of cycling within one year. The LVEF (51%) and LVEDD (60 mm) were almost normalized within this period. This was accompanied by an increase in peak VO2, from 27 to 52 ml/min/kg, and in peak exercise capacity (bicycle ergometer) from 75 to 283 W. These findings indicate that even intensive endurance training after AVR seems to be feasible and safe, and may have a beneficial effect on postoperative cardiac remodeling.