经导管主动脉瓣置换术在高龄主动脉瓣狭窄患者中的应用

Application of transcatheter aortic valve replacement in very old patients with aortic stenosis

摘要:

目的 探讨经导管主动脉瓣置换术治疗高龄主动脉瓣狭窄患者的有效性和安全性。方法 回顾性分析2019年1月至2020年12月于中国医学科学院阜外心血管病医院行TAVR手术的主动脉瓣狭窄患者142例。其中年龄≥80岁患者22例为高龄老年组,65≤年龄＜80岁患者120例为老年组,比较2组围手术期结果。采用 SPSS 20.0 软件进行统计学分析。根据数据类型,组间比较分别采用χ²检验、t检验或者Fisher 精确检验。结果 高龄老年组和老年组中转外科手术发生率(0.0％和1.7%)、术中使用体外循环辅助率(0.0％和0.8%)、术中左室破裂发生率(0.0％和0.8%)、术后使用体外膜肺氧合辅助循环率(0.0％和1.7%)、术后外周血管并发症(0.0％和3.3%)、术后起搏器植入率(4.5%和8.3%)、术后致残性脑卒中(0.0％和0.8%)、围术期死亡发生率(0.0％和0.8%),差异均无统计学意义(均P>0.05)。非股动脉入路患者共6例(4.2%),其中老年组左侧锁骨下动脉入路1例(0.7%),升主动脉入路1例(0.7%),经颈动脉入路3例(2.5%)；高龄老年组经颈动脉入路1例(4.5%),差异均无统计学意义(均P>0.05)。结论 经导管主动脉瓣置换术是治疗高龄的主动脉狭窄患者的有效及安全的治疗方法。

Abstract:

Objective To investigate the efficacy and safety of transcatheter aortic valve replacement (TAVR) in the treatment of very old patients with aortic stenosis. Methods Clinical data of 142 aged patients with aortic stenosis undergoing TAVR in our hospital from January 2019 to December 2020 were collected and retrospectively analyzed. Among them, 22 patients (≥80 years old) were assigned into the very old group, and the other 120 ones (65-80 years old) into the elderly group. The perioperative outcomes were compared between the 2 groups. SPSS statistics 20.0 was used for statistical analysis. Inter-group comparison was performed using Chi-square test, student′s t test or Fisher exact test depending on different date types. Results During the perioperative period, there were no statistical differences in the ratios of being converted to surgery (0.0％ vs 1.7%), intraoperative extracorporeal circulation (0.0％ vs 0.8%), intraoperative left ventricular rupture (0.0％ vs 0.8%), post-operative ECMO assisted circulation (0.0％ vs 1.7%), incidence rate of postoperative peripheral vascular complications (0.0％ vs 3.3%), postoperative pacemaker implantation (4.5％ vs 8.3%), postoperative disabled stroke (0.0％ vs 0.8%), and perioperative mortality rate (0.0％ vs 0.8%) between the very old group and the elderly group (P>0.05). There were 6 patients (4.2%) undergoing TAVR with non-femoral artery approach, including 1 patient (0.7%) with left subclavian artery approach, 1 patient (0.7%) with ascending aorta approach, and 3 patients (2.5%) with transcarotid approach in the elderly group; and 1 case (4.5%) in the very old group via carotid artery approach, and no statistical difference was seen between the 2 groups (P>0.05). Conclusion TAVR is an effective and safe treatment for elderly patients with aortic stenosis.