【摘要】 目的分析经腋动脉入路行经皮主动脉瓣置入术(TAVR)治疗主动脉瓣重度狭窄的安全性和有效性。方法回顾性分析中国医学科学院阜外医院、南昌大学第一附属医院、大连医科大学附属第一医院、北京大学第三医院、广东省人民医院、哈尔滨医科大学附属第二医院、山东省立医院2019年1月至2021年5月行TAVR手术的主动脉瓣狭窄患者135例。根据入路分为经腋动脉入路组11例(11/135,8.1%)和经股动脉入路组124例(124/135,92%)。结果两组均未出现死亡病例。围手术期内共有1例(1/135,0.74%)患者术后需行ECMO(体外膜肺氧合)辅助循环,发生于经腋动脉入路组,两组间有显著的统计学差异(P<0.01)。术中左心室破裂1例(1/135,0.74%),中转外科手术1例(1/135,0.74%),术后致残性卒中1例(1/135,0.74%),均发生于经股动脉入路组,两组间相比未见统计学差异。术后外周血管并发症3例(3/135,2.2%),经腋动脉入路1例(1/11,9.1%),经股动脉入路2例(2/124,1.6%),两组比较未见统计学差异。术后起搏器植入10例(10/135,7.4%),均发生于经股动脉组,两组比较未见统计学差异。结论经腋动脉入路行经皮主动脉瓣置入术与经股动脉入路有相似的临床结果,是有效及安全的治疗方法。更多还原

【Abstract】 Objective To investigate the safety and efficacy of transcatheter aortic valve replacement via axillary artery approach for severe aortic stenosis. Methods The data of 135 patients with aortic valve stenosis who underwent TAVR from January 2019 to May 2021 in multiple centers were analyzed retrospectively. They patients were divided into 2 groups according to the access: 11 patients(11/135, 8.1%) in the transaxillary artery access group and 124 patients(124/135, 92%) in the transfemoral artery access group. Results There were no fatal cases in either group. A total of 1 patient(1/135, 0.74%) required postoperative ECMO(extracorporeal membrane pulmonary oxygenation) assisting circulation during the perioperative period, which occurred in the transaxillary artery access group, with a statistically significant difference between the two groups(P<0.01). One intraoperative left ventricular rupture(1/135, 0.74%) one intermediate surgical procedure(1/135, 0.74%), and one postoperative disabling stroke(1/135, 0.74%) occurred all in the transfemoral artery access group, and no statistically significant difference was seen between the two groups. Postoperative peripheral vascular complications occurred in 3 cases(3/135, 2.2%), 1 case(1/11, 9.1%) in the transaxillary artery access group and 2 cases(2/124, 1.6%) in the transfemoral artery access group, no statistical difference was seen between the two groups. Postoperative pacemaker implantation occurred in 10 cases(10/135, 7.4%), all in the transfemoral artery group, and no statistical difference was seen between the two groups. Conclusions Transcatheter aortic valve replacement via the axillary artery approach has similar clinical outcomes as the transfemoral approach and is an effective and safe treatment method.更多还原