经导管主动脉瓣置换术(TAVR)治疗主动脉瓣狭窄与主动脉瓣关闭不全的临床疗效对比分析

Comparative Analysis of Clinical Efficacy of Transcatheter Aortic Valve Replacement (TAVR) in the Treatment of Aortic Stenosis and Aortic Regurgitation

摘要: 目的：对比经导管主动脉瓣置换术治疗主动脉瓣狭窄与主动脉瓣关闭不全的临床疗效，分析主动脉瓣关闭不全患者行TAVR手术效果如何，探索TAVR用于治疗主动脉瓣关闭不全的可能性。方法：回顾性分析青岛大学附属医院2017年9月~2022年7月因主动脉瓣疾病于心血管外科住院拟行经导管主动脉瓣置换术的152患者，收集符合纳入标准的患者的病史及人口学、手术前后实验室检验资料、影像辅助检查等全部临床资料，对手术过程、并发症以及手术前后超声心动图结果等使用独立或配对样本t检验、2检验或Fisher确切概率法检验、Wilcoxon秩和检验等统计学方法进行分析。结果：共入选149例患者，平均年龄(73.89 ± 6.27)岁，男96例，女53例。术后30天内死亡、新发脑卒中、行开胸手术、术中CRP、体外循环辅助、ECMO辅助、外周血管并发症、瓣中瓣应用情况两组差异无明显统计学意义。永久起搏器置入情况主动脉瓣关闭不全组较狭窄组发生率高(27.03% vs 8.93%, P = 0.012)，主动脉瓣关闭不全组瓣周漏的发生率则低于狭窄组(27.03% vs 50.00%, P = 0.015)。主动脉瓣狭窄组患者术后1月较术前左室射血分数改善[59.0 (55, 60) vs 56.0 (45, 60) P < 0.001]，主动脉瓣关闭不全组患者术后1月较术前左室射血分数无明显变化(P > 0.05)。主动脉瓣狭窄组患者术后1月较术前左心室舒张末期内径减小[4.60 (4.3, 5.1) vs 4.85 (4.4, 5.5) P < 0.001]；主动脉瓣关闭不全组患者术后1月较术前左心室舒张末期内径减小[5.2 (4.6, 5.5) vs 5.5 (5.4, 6.1) P < 0.001]。结论：主动脉瓣关闭不全患者行TAVR手术，效果与主动脉瓣狭窄组患者大致相似，是一个可行的治疗方法，可适当扩大手术指征。

Abstract: Objective: To compare the clinical efficacy of transcatheter aortic valve replacement (TAVR) in the treatment of aortic stenosis and aortic insufficiency, analyze the efficacy of TAVR in patients with aortic insufficiency, and explore the possibility of TAVR in the treatment of aortic insufficiency. Methods: A retrospective analysis was performed on 152 patients admitted to the Department of Cardiovascular Surgery for aortic valve disease in the Affiliated Hospital of Qingdao University from September 2017 to July 2022 for transcatheter aortic valve replacement (TAVR), and all clinical data meeting the inclusion criteria, including medical history and demography, laboratory test data before and after surgery, and imaging auxiliary examination, were collected. Statistical methods such as independent or paired sample t-test, Chi-square test or Fisher’s exact probability test and Wilcoxon rank sum test were used to analyze the surgical process, complications and echocardio-graphic results before and after surgery. Results: A total of 149 patients were enrolled, with an av-erage age of (73.89 ± 6.27) years, including 96 males and 53 females. Death within 30 days after surgery, cerebral infarction, thoracotomy, CRP, extracorporeal circulation assistance, ECMO assis-tance, peripheral vascular complications, and application of the valve in-valve had no significant difference between the two groups. The incidence of permanent pacemaker implantation was high-er in the aortic insufficiency group than in the stenosis group (27.03% vs 8.93%, p = 0.012), and the incidence of perisvalular leakage was lower in the group with aortic insufficiency than in the steno-sis group (27.03% vs 50.00%, P = 0.015). The left ventricular ejection fraction of patients in the aortic stenosis group was improved 1 month after surgery compared with that before surgery [59.0 (55, 60) vs 56.0 (45, 60) P < 0.001], and the left ventricular ejection fraction of patients in the aortic insufficiency group was not significantly changed 1 month after surgery compared with that before surgery (P > 0.05). In the aortic stenosis group, the left ventricular end-diastolic diameter de-creased 1 month after surgery compared with that before surgery [4.60 (4.3, 5.1) vs 4.85 (4.4, 5.5) P < 0.001]. The left ventricular end-diastolic diameter of aortic valve insufficiency group decreased 1 month after surgery compared with that before surgery [5.2 (4.6, 5.5) vs 5.5 (5.4, 6.1) P < 0.001]. Conclusions: The effect of TAVR surgery in patients with aortic insufficiency is roughly similar to that in patients with aortic stenosis, which is a feasible treatment method and can appropriately expand surgical indications.