CAJ | 학술논문

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。
목적：분향경도관주동맥판식입술（TAVI）치료중도주동맥판협착환자적경험。방법분석이완성TAVI환자적기선특정、술후혈류동역학변화정황급림상결과。결과2012년4월지2014년3월공36례환자우사천대학화서의원진행TAVI，평균년령（73.9±7.2）세，기중남24례（66.7%），평균구주심장수술풍험회귀평분위（20.6±9.9）%。25례（69.4%）환자주동맥판협형태정이협식기형。TAVI성공35례（97.2%），4례（11.1%）수식입제2매판막。술후주동맥판평균과판압차하강지（10.5±5.7）mmHg（1 mmHg=0.133 kPa），2례잔여판주루접근중도。술후30 d내사망1례（2.8%），뇌졸중2례（5.6%）。10례（27.8%）환자인출현Ⅲ도방실전도조체이식입료영구기박기。중위수방시간323 d，제2례환자분별우술후374 d화680 d사우악성종류외，기여환자균보지무증상생존。결론대우불괄합진행외과수술적이협식화삼협식주동맥판중도협착환자，TAVI시가행、안전화유효적。
Objective To discuss the preliminary experience of transcatheter aortic valve implatantion in patients with severe aortic valve stenosis. Methods The baseline characteristics, hemodynamic changes and clinical outcomes of the patients received TAVI in our institution were analyzed. Results A total of 36 patients underwent TAVI between April 2012 and March 2014. The mean age was (73.4±8.7) years and 24 (66.7%) of them were men. The mean logistic EuroSCORE was (20.6±9.9)%. 25(70%) patients had bicuspid aortic valves. TAVI was successful in 35 patients (97.2%) and valve-in-valve implantation was required in 4 (11.1%) of them. After the procedure, the mean aortic-valve gradient reduced to (10.5±5.7) mmHg. In 2 patients (5.6%), there was marginal moderate periprosthetic leak. At 30 days, the survival rate was 97.2%. Two patients (5.6%) developed who later showed fuel recovery, without significant sequela. Permanent pacemakers were implanted in 10 patients (27.8%) due to the onset of third-degree atrioventricular block after TAVI. To date, the median follow-up duration has exceeded 323 days. 2 patients died of cancer on 374 days and 680 days after TAVI, respectively. Conclusions TAVI is feasible, safe and effective in treating severe stenosis of bicuspid as well as tricuspid aortic valve in selected Chinese patients unsuitable for surgery.