经心尖TAVI治疗重度主动脉瓣狭窄患者的 疗效及随访研究

Efficacy and Follow-Up Study of Transapical TAVI in the Treatment of Patients with Severe Aortic Stenosis

摘要: 目的：探讨经心尖经导管主动脉瓣植入术(TA-TAVI)治疗重度主动脉瓣狭窄(AS)患者的临床疗效、安全性及长期预后，为临床应用提供实践参考。方法：回顾性分析安徽医科大学第一附属医院2022年1月至2025年6月收治的166例接受经心尖TAVI治疗的重度AS患者的临床资料，收集患者基线特征、手术相关指标，术后进行定期随访，随访率91.6%，观察随访期间患者心功能改善、并发症发生及生存情况。采用SPSS 25.0统计软件进行数据处理，计量资料以均数 ± 标准差表示，计数资料以例数(百分比)表示。结果：166例患者中，手术成功率为100%，无中转开胸患者；术后随访(24.0 ± 12.0)个月，随访成功152例(91.6%)，失访14例。随访期间，患者纽约心脏病协会(NYHA)心功能分级I~II级占比从术前的30.0%提升至86.8%，差异具有统计学意义(P < 0.05)；左心室射血分数从术前(50.6% ± 9.8%)改善至术后(50.9% ± 8.4%)，主动脉瓣平均跨瓣压差维持在(14.2 ± 7.6) mmHg。随访期间，全因死亡19例(12.5%)，脑卒中18例(11.8%)，肾功能不全17例(11.2%)，永久起搏器植入4例(2.6%)。结论：经心尖TAVI治疗重度AS患者具有较好的临床疗效，能显著改善患者心功能状态，虽存在一定并发症发生率，但整体安全性可控，可作为高危重度AS患者的有效治疗选择。

Abstract: Objective: To explore the clinical efficacy, safety, and long-term prognosis of transapical transcatheter aortic valve implantation (TA-TAVI) in the treatment of patients with severe aortic stenosis (AS), and to provide practical references for clinical application. Methods: The clinical data of 166 patients with severe AS who underwent TA-TAVI treatment at the First Affiliated Hospital of Anhui Medical University from January 2022 to June 2025 were retrospectively analyzed. Baseline characteristics and surgical-related indicators of the patients were collected. Regular follow-ups were conducted after the operation, with a follow-up rate of 91.6%. The improvement of cardiac function, occurrence of complications, and survival status of the patients during the follow-up period were observed. Data were processed using SPSS 25.0 statistical software. Quantitative data were expressed as $\overline{x}\pm s$ and qualitative data were expressed as the number (percentage). Results: Among the 166 patients, the surgical success rate was 100%, and no patients were converted to open surgery. Postoperative follow-up (24.0 ± 12.0) months, 152 cases (91.6%) were successfully followed up, and 14 cases were lost to follow-up. During the follow-up period, the proportion of patients with New York Heart Association (NYHA) cardiac function classification from grade I to II increased from 30.0% before the operation to 86.8%. The difference was statistically significant (P < 0.05); the left ventricular ejection fraction improved from (50.6% ± 9.8%) before the operation to (50.9% ± 8.4%) after the operation, and the average transvalvular pressure difference of the aortic valve remained at (14.2 ± 7.6) mmHg. During the follow-up period, there were 19 cases of all-cause death (12.5%), 18 cases of stroke (11.8%), 17 cases of renal insufficiency (11.2%), and 4 cases of permanent pacemaker implantation (2.6%). Conclusion: TA-TAVI for treating patients with severe AS has good clinical efficacy, can significantly improve the cardiac function status of patients, although there is a certain incidence of complications, the overall safety is controllable, and it can be an effective treatment option for high-risk patients with severe AS.