【摘要】 目的:探讨重度主动脉瓣狭窄(AS)患者经导管主动脉瓣置换术(TAVR)的安全性及有效性。方法:回顾性连续收集2017年12月—2023年12月中山市人民医院进行TAVR的89例重度AS患者基线特征、影像学评估、围手术期及术后随访的结果，并进行经验性总结。结果:平均年龄74.0(69.5,80.0)岁，美国胸外科协会(STS)评分4.45%(3.19%,6.49%);二叶式主动脉瓣为46例(51.69%)。所有患者接受全身麻醉，以股动脉作为血管入路，自膨式瓣膜与球扩式瓣膜分别为82例(92.13%)、7例(7.87%)。技术成功率为97.75%,器械成功率为94.38%。术后纽约心脏病协会(NYHA)心功能分级Ⅲ及Ⅳ级者比例下降(68.54%vs 3.37%,P<0.001),N末端脑钠肽前体明显下降，左心室舒张末期内径改善，主动脉瓣峰值跨瓣压差下降，主动脉瓣峰值跨瓣流速下降。围手术期并发症以瓣周漏最为常见为48例(53.93%),轻、中、重度瓣周漏所占比例分别为34.83%、15.73%、3.37%。新发房室传导阻滞13例(14.44%),新发完全性左束支传导阻滞19例(21.35%),需植入永久起搏器者8例(8.99%);发生心包填塞者6例(6.74%);手术入路主要血管并发症3例(3.37%);造影剂诱发急性肾损伤9例(10.11%);急性缺血性脑卒中1例(1.12%)。术后平均随访时间为(23.55±18.08)个月，全因死亡为10例(11.24%)。其余患者生活质量均得到明显改善。结论:TAVR改善重度AS患者的生存率及生活质量，具有良好的安全性及有效性。更多还原

【Abstract】 Objective: To investigate the safety and efficacy of transcatheter aortic valve replacement(TAVR) in patients with severe aortic stenosis(AS). Methods: The baseline characteristics, imaging evaluation, perioperative and postoperative follow-up results of 89 patients with severe AS who underwent TAVR in Zhongshan People’s Hospital from December 2017 to December 2023 were retrospectively collected, and summarized. Results: The mean age was 74.0(69.5, 80.0) years, and the American Society for Thoracic Surgery(STS) score was 4.45%(3.19%, 6.49%). Bicuspid aortic valve disease was found in 46 cases(51.69%). All patients received general anesthesia and femoral artery was used as the vascular approach. The 82 patients(92.13%) had self-dilatation valve and 7 patients(7.87%) had spherical dilatation valve. The technical success rate was 97.75%, and the instrument success rate was 94.38%. The proportion of patients with New York Heart Association(NYHA) grade Ⅲ and Ⅳ decreased after surgery(68.54% vs 3.37%, P<0.001), the N-terminal brain natriuretic peptide prebody decreased significantly, the left ventricular end-diastolic diameter improved, the peak trans-valve pressure decreased, and the peak trans-valve flow rate decreased. Perivalvular leakage was the most common complication in 48 cases(53.93%), and the proportion of mild, moderate and severe perivalvular leakage were 34.83%, 15.73% and 3.37%, respectively. There were 13 cases(14.44%) of new atrioventricular block, 19 cases(21.35%) of new complete left bundle branch block, and 8 cases(8.99%) of patients needed permanent pacemaker implantation. Pericardial tamponade occurred in 6 cases(6.74%). There were 3 cases(3.37%) of major vascular complications of surgical approach. Contrast media-induced acute kidney injury was in 9 cases(10.11%); Acute ischemic stroke occurred in 1 case(1.12%). The mean follow-up time was(23.55±18.08) months, and 10 cases(11.24%) died of all causes. The quality of life of other patients was significantly improved. Conclusion: TAVR is safe and effective in improving the survival rate and quality of life in patients with severe aortic stenosis.更多还原