经导管主动脉瓣置换术治疗二叶式主动脉瓣重度狭窄患者的短期疗效分析

Short-Term Efficacy of Transcatheter Aortic Valve Replacement in Patients with Severe Bicuspid Aortic Stenosis

摘要: 目的：评估二叶式主动脉瓣(BAV)重度狭窄患者行经导管主动脉瓣置换术(TAVR)治疗前后心脏结构、心功能变化及手术相关不良事件发生情况，探讨其短期疗效。方法：本研究分析了2017年9月至2022年9月于青岛大学附属烟台毓璜顶医院行TAVR手术的主动脉瓣重度狭窄患者。按瓣叶形态分为BAV组与三叶式主动脉瓣(TAV)组，比较2组患者临床资料、术前超声心动图资料。术后随访1个月，分别在术后1周和1月时，比较2组患者手术前与术后超声心动图参数，并进一步对2组间超声心动图参数的变化值进行比较。同时比较2组间患者术后6月内不良事件发生情况。结果：共71例主动脉瓣重度狭窄患者接受TAVR，其中BAV组17例，TAV组54例。BAV组患者年龄偏小，高血压、心房颤动患病率低于TAV组(P均 < 0.05)。2组间余临床资料比较差异无统计学意义(P均 > 0.05)。左室舒张末期内径(LVEDD)、主动脉瓣跨瓣峰值压差(AVPG)、主动脉瓣峰值血流速度(V_max)、左室射血分数(LVEF)、中度及以上瓣膜反流比率等在2组间差异无统计学意义(P均 > 0.05)。术后随访1个周时，2组患者AVPG和V_max均低于治疗前，LVEF均高于治疗前(P均 < 0.05)。２组间AVPG和V_max较术前下降值、LVEF较术前上升值比较差异均无统计学意义(P均 > 0.05)。术后随访1个月时，2组患者LVEDD、AVPG和V_max均低于治疗前，LVEF均高于治疗前(P均 < 0.05)。２组间LVEDD、AVPG和V_max较术前下降值、LVEF较术前上升值比较差异均无统计学意义(P均 > 0.05)。在围术期，BAV组死亡1例，TAV组死亡2例。随访6个月，2组随访期间均无死亡病例，2组间血管并发症、III度房室传导阻滞、切口愈合不良等不良事件发生率比较差异无统计学意义(P均 > 0.05)。结论：TAVR可明显改善BAV组患者的心脏结构及左室功能，短期临床疗效与TAV组相似，且术后发生不良事件的风险无明显增加。

Abstract: Objective: To evaluate the changes of cardiac structure, cardiac function and the incidence of surgical related adverse events before and after transcatheter aortic valve replacement (TAVR) in patients with severe bicuspid aortic stenosis (AS), and to investigate its short-term efficacy. Methods: This study analyzed the patients with severe AS who underwent TAVR in the Affiliated Yantai Yuhuangding Hospital of Qingdao University from September 2017 to September 2022. The patients were divided into bicuspid aortic valve (BAV) group and tricuspid aortic valve (TAV) group according to the shape of valve leaves. The clinical data and preoperative echocardiography data of the two groups were compared. The patients were followed up for 1 month. At 1 week and 1 month after TAVR, the preoperative and postoperative echocardiographic parameters of the two groups were compared, and the changes of the echocardiographic parameters between the two groups were further compared. At the same time, the adverse events within 6 months after TAVR were compared between the two groups. Results: A total of 71 patients with severe AS underwent TAVR, including 17 patients in BAV group and 54 patients in TAV group. The prevalence of hypertension and atrial fibrillation in BAV group was lower than that in TAV group (P < 0.05). There was no significant difference in other clinical data between the two groups (P > 0.05). There was no significant difference between the two groups in left ventricular end-diastolic dimension (LVEDD), aortic valve peak gradient (AVPG), peak aortic velocity (V_max), left ventricular ejection fraction (LVEF), and the percentages of moderate or above valve regurgitation (P > 0.05). In 1 week after operation, AVPG and V_max of patients in both groups were lower than those before TAVR, and LVEF was higher than those before TAVR (P < 0.05). There was no significant difference between the two groups in the decrease value of AVPG and V_max and the increase valve of LVEF (P > 0.05). In 1 month after operation, LVEDD, AVPG and V_max of patients in both groups were lower than those before TAVR, and LVEF was higher than those before TAVR (P < 0.05). There was no significant difference between the two groups in the decrease value of LVEDD, AVPG and V_max and the increase value of LVEF (P > 0.05). Two patients died in TAV group and one patient died in BAV group in perioperative period. No death was found in both groups within 6 months of follow-up. There was no significant difference between the two groups in the incidence of vascular complications, third degree atrioventricular block, poor wound healing and other adverse events (P > 0.05). Conclusions: TAVR can significantly improve the cardiac structure and left ventricular function of patients with severe bicuspid AS. The short-term clinical efficacy is similar to that of patients with severe tricuspid AS, and the risk of adverse events after TAVR is not significantly increased.