重庆首例经导管主动脉瓣置换术及文献回顾
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摘要
目的:提高临床医生对经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)的认识。方法:通过对1例TAVR手术患者的诊治过程及术中影像资料的介绍,结合文献阐述该手术的适应证、人工瓣膜、手术并发症及前景。结果:本例患者因心衰入院,超声心动图提示为重度主动脉瓣狭窄,内科保守治疗效果不佳,外科手术风险较高,予以TAVR治疗。术后患者心衰症状消失,超声心动图显示主动脉瓣跨瓣压差明显降低,术后3个月左室内径明显减小。结论:TAVR对患者创伤小,恢复快,已成为严重主动脉瓣狭窄外科手术风险中高危患者的一种选择。
Objective:To improve the understanding of clinicians on transcatheter aortic valve replacement(TAVR). Methods:The diagnosis and treatment course and intraoperative image data of a patient with TAVR surgery were reported. The indications,artificial valves,surgical complications and prospects were discussed through literature review. Results:The patient was hospitalized for heart failure. The echocardiography indicated severe aortic stenosis;conservative treatment was not effective,and the risk of surgical operation was high,so TAVR was choose. After TAVR,the heart failure symptoms disappeared,and echocardiography showed significant decrease in aortic valve differential pressure. The left ventricular diameter decreased significantly 3 months after surgery. Conclusion:TAVR surgery is less traumatic and patients recover quickly. TAVR surgery has become a choice for severe aortic stenosis patients with middle-high risk of surgery.
Objective:To improve the understanding of clinicians on transcatheter aortic valve replacement(TAVR). Methods:The diagnosis and treatment course and intraoperative image data of a patient with TAVR surgery were reported. The indications,artificial valves,surgical complications and prospects were discussed through literature review. Results:The patient was hospitalized for heart failure. The echocardiography indicated severe aortic stenosis;conservative treatment was not effective,and the risk of surgical operation was high,so TAVR was choose. After TAVR,the heart failure symptoms disappeared,and echocardiography showed significant decrease in aortic valve differential pressure. The left ventricular diameter decreased significantly 3 months after surgery. Conclusion:TAVR surgery is less traumatic and patients recover quickly. TAVR surgery has become a choice for severe aortic stenosis patients with middle-high risk of surgery.
引文
[1] Leon MB,Smith CR,Mack M,et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery[J].N Engl J Med,2010,363(17):1597-1607.
[2] Di Eusanio M,Fortuna D,De Palma R,et al. Aortic valve replacement:results and predictors of mortality from a contemporary series of2256 patients[J]. J Thorac Cardiovasc Surg,2011,141(4):940-947.
[3] Barbanti M,Webb JG,Gilard M,et al. Transcatheter aortic valve implantation in 2017:state of the art[J]. EuroIntervention,2017,13(AA):AA11-21.
[4] Baumgartner H,Falk V,Bax JJ,et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease[J]. Eur Heart J,2017,38(36):2739-2791.
[5] Nishimura RA,Otto CM,Bonow RO,et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease:a report of the American college of cardiology/American Heart Association task force on clinical practice guidelines[J]. J Am Coll Cardiol,2017,70(2):252-289.
[6] Sedrakyan A,Dhruva SS,Shuhaiber J. Transcatheter aortic valve replacement in younger individuals[J]. JAMA Intern Med,2017,177(2):159-160.
[7] TerréJA,George I,Smith CR. Pros and cons of transcatheter aortic valve implantation(TAVI)[J]. Ann Cardiothorac Surg,2017,6(5):444-452.
[8] D’Onofrio A,Facchin M,Besola L,et al. Intermediate clinical and hemodynamic outcomes after transcatheter aortic valve implantation[J].Ann Thorac Surg,2016,101(3):881-888.
[9] Thyregod HG,Steinbrüchel DA,Ihlemann N,et al. Transcatheter versus surgical aortic valve replacement in patients with severe aortic valve stenosis:1-year results from the all-comers notion randomized clinical trial[J]. J Am Coll Cardiol.2015 May 26,65(20):2184-2194.
[10] Baron SJ,Arnold SV,Wang K,et al. Health status benefits of transcatheter vs surgical aortic valve replacement in patients with severe aortic stenosis at intermediate surgical risk:results from the partner 2randomized clinical trial[J]. JAMA Cardiol,2017,2(8):837-845.
[11] Abdel-Wahab M,Neumann FJ,Mehilli J,et al. 1-year outcomes after transcatheter aortic valve replacement with balloon-expandable versus self-expandable valves:results from the CHOICE randomized clinical trial[J]. J Am Coll Cardiol,2015,66(7):791-800.
[12] Collas VM,Dubois C,Legrand V,et al. Midterm clinical outcome following Edwards SAPIEN or Medtronic Corevalve transcatheter aortic valve implantation(TAVI):results of the Belgian TAVI registry[J].Catheter Cardiovasc Interv,2015,86(3):528-535.
[13] Kodali SK,Williams MR,Smith CR,et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement[J]. N Engl J Med,2012,366(18):1686-1695.
[14] Ghanem A,Müller A,N?hle CP,et al. Risk and fate of cerebral embolism after transfemoral aortic valve implantation:a prospective pilot study with diffusion-weighted magnetic resonance imaging[J]. J Am Coll Cardiol,2010,55(14):1427-1432.
[15] Bosmans J,Bleiziffer S,Gerckens U,et al. The incidence and predictors of early-and mid-term clinically relevant neurological events after transcatheter aortic valve replacement in real-world patients[J]. J Am Coll Cardiol,2015,66(3):209-217.
[16] Harjai KJ,Grines CL,Leon MB. Transcatheter aortic valve replacement:2015 in review[J]. J Interv Cardiol,2016,29(1):27-46.
[17] Erkapic D,De Rosa S,Kelava A,et al. Risk for permanent pacemaker after transcatheter aortic valve implantation:a comprehensive analysis of the literature[J]. J Cardiovasc Electrophysiol,2012,23(4):391-397.
[18] Jochheim D,Zadrozny M,Theiss H,et al. Aortic regurgitation with second versus third-generation balloon-expandable prostheses in patients undergoing transcatheter aortic valve implantation[J]. EuroIntervention,2015,11(2):214-220.
[2] Di Eusanio M,Fortuna D,De Palma R,et al. Aortic valve replacement:results and predictors of mortality from a contemporary series of2256 patients[J]. J Thorac Cardiovasc Surg,2011,141(4):940-947.
[3] Barbanti M,Webb JG,Gilard M,et al. Transcatheter aortic valve implantation in 2017:state of the art[J]. EuroIntervention,2017,13(AA):AA11-21.
[4] Baumgartner H,Falk V,Bax JJ,et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease[J]. Eur Heart J,2017,38(36):2739-2791.
[5] Nishimura RA,Otto CM,Bonow RO,et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease:a report of the American college of cardiology/American Heart Association task force on clinical practice guidelines[J]. J Am Coll Cardiol,2017,70(2):252-289.
[6] Sedrakyan A,Dhruva SS,Shuhaiber J. Transcatheter aortic valve replacement in younger individuals[J]. JAMA Intern Med,2017,177(2):159-160.
[7] TerréJA,George I,Smith CR. Pros and cons of transcatheter aortic valve implantation(TAVI)[J]. Ann Cardiothorac Surg,2017,6(5):444-452.
[8] D’Onofrio A,Facchin M,Besola L,et al. Intermediate clinical and hemodynamic outcomes after transcatheter aortic valve implantation[J].Ann Thorac Surg,2016,101(3):881-888.
[9] Thyregod HG,Steinbrüchel DA,Ihlemann N,et al. Transcatheter versus surgical aortic valve replacement in patients with severe aortic valve stenosis:1-year results from the all-comers notion randomized clinical trial[J]. J Am Coll Cardiol.2015 May 26,65(20):2184-2194.
[10] Baron SJ,Arnold SV,Wang K,et al. Health status benefits of transcatheter vs surgical aortic valve replacement in patients with severe aortic stenosis at intermediate surgical risk:results from the partner 2randomized clinical trial[J]. JAMA Cardiol,2017,2(8):837-845.
[11] Abdel-Wahab M,Neumann FJ,Mehilli J,et al. 1-year outcomes after transcatheter aortic valve replacement with balloon-expandable versus self-expandable valves:results from the CHOICE randomized clinical trial[J]. J Am Coll Cardiol,2015,66(7):791-800.
[12] Collas VM,Dubois C,Legrand V,et al. Midterm clinical outcome following Edwards SAPIEN or Medtronic Corevalve transcatheter aortic valve implantation(TAVI):results of the Belgian TAVI registry[J].Catheter Cardiovasc Interv,2015,86(3):528-535.
[13] Kodali SK,Williams MR,Smith CR,et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement[J]. N Engl J Med,2012,366(18):1686-1695.
[14] Ghanem A,Müller A,N?hle CP,et al. Risk and fate of cerebral embolism after transfemoral aortic valve implantation:a prospective pilot study with diffusion-weighted magnetic resonance imaging[J]. J Am Coll Cardiol,2010,55(14):1427-1432.
[15] Bosmans J,Bleiziffer S,Gerckens U,et al. The incidence and predictors of early-and mid-term clinically relevant neurological events after transcatheter aortic valve replacement in real-world patients[J]. J Am Coll Cardiol,2015,66(3):209-217.
[16] Harjai KJ,Grines CL,Leon MB. Transcatheter aortic valve replacement:2015 in review[J]. J Interv Cardiol,2016,29(1):27-46.
[17] Erkapic D,De Rosa S,Kelava A,et al. Risk for permanent pacemaker after transcatheter aortic valve implantation:a comprehensive analysis of the literature[J]. J Cardiovasc Electrophysiol,2012,23(4):391-397.
[18] Jochheim D,Zadrozny M,Theiss H,et al. Aortic regurgitation with second versus third-generation balloon-expandable prostheses in patients undergoing transcatheter aortic valve implantation[J]. EuroIntervention,2015,11(2):214-220.
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