【摘要】 目的 探讨经心尖经导管主动脉瓣置换术（TA-TAVR）在75岁及以上主动脉根部扩张的主动脉瓣关闭不全（AI）患者中的治疗可行性及安全性。方法 回顾性分析2020年6月至2023年6月就诊于福建省立医院心血管外科的年龄75岁及以上的AI病变伴主动脉根部扩张患者26例,其中男性19例,占比73.1%,平均年龄（80.8±4.3）岁,包括单纯AI重度病变者24例、轻度主动脉瓣狭窄伴AI重度病变者1例和主动脉生物瓣置换术后衰败致AI重度病变者1例。26例患者均行择期TA-TAVR治疗,观察手术情况,术后1和3个月复查超声心动图。结果 26例患者手术成功率100%。术中植入29^#J-Valve^TM瓣膜25例,27^#J-Valve^TM瓣膜1例。无术中瓣膜移位,无紧急采取体外循环行外科主动脉瓣置换术,无二次植入瓣膜,无术后明显瓣周漏、冠状动脉开口阻塞和脑血管意外等并发症。术后即刻出现三度房室传导阻滞1例,采取临时心脏起搏治疗1周后给与永久起搏器治疗。术后1和3个月复查超声心动图显示,与术前比较,患者左心室舒张末内径[（5.55±1.10）cm和（5.56±1.02）cm比（6.39±1.20）cm,t=6.143和6.253]、左心室舒张末容积[（149.87±66.52） ml和（102.44±36.81）ml比（220.52±99.49）ml,t=7.181和8.386]、主动脉瓣流速[（194.53±56.07）cm/s和（195.18±63.35）cm/s比（229.94±87.46） cm/s,t=7.022和6.998]和主动脉跨瓣压差[（16.65±9.97）mmHg和（13.88±5.75）mmHg比（19.17±11.60） mmHg,t=6.188和6.457]均明显改善（均为P<0.05）;患者重度二尖瓣关闭不全比例降低（3.8%和0.0%比19.2%,χ²=3.845和14.866,均为P<0.05）,重度三尖瓣关闭不全比例降低（0.0%和0.0%比19.2%,χ²=14.866和14.866,均为P<0.05）。结论 TA-TAVR治疗75岁及以上主动脉根部扩张伴左心室扩大的AI患者具有一定的可行性与安全性。更多还原

【Abstract】 Objective To evaluate the feasibility and safety of transapical transcatheter aortic valve replacement（TA-TAVR） in patients aged 75 years and older with aortic insufficiency（AI） and aortic root dilation. Methods A retrospective analysis of 26 patients aged ≥75 years with AI and aortic root dilation who underwent TA-TAVR treatment at the Department of Cardiovascular Surgery of Fujian Provincial Hospital from June 2020 to June 2023 was conducted. The cohort included 19 males（73. 1%） with a mean age of 80. 8±4. 3 years. The patients included 24 cases of isolated severe AI, 1 case of mild aortic valve stenosis with severe AI, and 1 case of severe AI due to the degeneration of an aortic bioprosthetic valve after replacement. All 26 patients underwent elective TA-TAVR treatment. Operative outcomes were recorded, and echocardiography was performed at 1 and 3 months after the procedure. Results The surgical success rate of 26 patients was 100%. Twenty-five cases of 29^#J-Valve^TM valves and one case of 27^#J-Valve^TM valve were implanted. No intraoperative valve displacement, emergency cardiopulmonary bypass for surgical aortic valve replacement, secondary valve implantation, or major postoperative complications such as obvious perivalvular leakage, coronary artery orifice occlusion, or cerebrovascular events were observed. One case of third-degree atrioventricular block occurred immediately after the procedure; temporary pacing was applied, followed by permanent pacemaker implantation one week later. Compared to baseline, transthoracic echocardiography at 1 and 3 months showed significant improvements in left ventricular end-diastolic diameter [（5. 55±1. 10） cm and（5. 56±1. 02） cm vs.（6. 39± 1. 20） cm, t= 6. 143 and 6. 253], left ventricular end-diastolic volume [（149. 87±66. 52） ml and（102. 44±36. 81） ml vs.（220. 52±99. 49） ml, t= 7. 181 and 8. 386], aortic valve flow rate [（194. 53± 56. 07） cm/s and（195. 18± 63. 35） cm/s vs.（229. 94±87. 46） cm/s, t= 7. 022 and 6. 998] and aortic transvalvular pressure difference [（16. 65±9. 97） mm Hg and（13. 88±5. 75） mm Hg vs.（19. 17±11. 60） mm Hg, t= 6. 188 and 6. 457]（all P<0. 05）; The proportion of patients with severe mitral valve regurgitation decreased（3. 8% and 0. 0% vs. 19. 2%,χ²=3. 845 and 14. 866, both P<0. 05）, as did the proportion of those with severe tricuspid valve regurgitation（0. 0% and 0. 0% vs. 19. 2%,χ²= 14. 866 and 14. 866, both P< 0. 05）. Conclusions TA-TAVR appears to be a feasible and safe treatment option for patients aged 75 years and older with AI accompanied by aortic root dilation and left ventricular enlargement.更多还原