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经导管主动脉瓣置换治疗单纯性重度主动脉瓣反流合并不同程度肺动脉高压的短期结局

The short-term outcome of transcatheter aortic valve replacement for pure severe aortic regurgitation in patients with different degrees of pulmonary artery hypertension

    摘要
  • 摘要:
    目的 探讨经导管主动脉瓣置换术（transcatheter aortic valve replacement，TAVR）治疗单纯性重度主动脉瓣关闭不全（aortic regurgitation，AR）合并肺动脉高压（pulmonary artery hypertension, PAH）的短期预后。
    方法 回顾性分析2021年6月至2022年12月复旦大学附属中山医院收治的29例接受TAVR治疗的单纯性重度AR合并PAH患者的病例资料，根据患者超声心动图测得的肺动脉收缩压（systolic pulmonary artery pressure, SPAP），将患者分为轻中度PAH组（35≤SPAP＜50 mmHg，n＝18）和重度PAH组（SPAP≥50 mmHg，n＝11），收集2组患者基线信息、术中影像学资料及术后随访信息。
    结果 相比于轻中度PAH组，重度PAH组心功能Ⅲ、Ⅳ级占比较高（100% vs 61%, P＝0.018）、脑钠肽较高（2 820.35±1 762.82）vs（1 241.09±1 999.86）mg/mL, P＝0.040、左心室射血分数较低（45.64±10.24）% vs（54.61±11.36）%, P＝0.042、二尖瓣中重度反流及三尖瓣中重度反流占比更高（73% vs 33%，P＝0.039；82% vs 33%，P＝0.011）。TAVR术后，PAH患者的AR在术后1 d及术后1个月均显著改善（P＜0.001），SPAP均显著下降（P＜0.001），重度PAH组三尖瓣反流程度显著下降（P＝0.009）。在院期间及随访1个月结果发现，AR合并不同程度PAH的患者在术后1 d及术后1个月内无全因死亡及心源性死亡事件的发生。其中，有5.56%重度AR合并轻中度PAH患者与9.09%合并重度PAH的患者在术后1 d和1个月分别发生中重度瓣周漏，中重度AR的占比分别为5.56%和9.09%。2组术后不良事件差异无统计学意义。
    结论 TAVR治疗单纯性重度AR合并PAH是安全有效的，能够改善AR并且降低肺动脉压力。

     

    Abstract:
    Objective To explore the short-term prognosis of transcatheter aortic valve replacement (TAVR) for pure severe aortic regurgitation (AR) patients complicated with pulmonary artery hypertension (PAH).
    Methods From June 2021 to December 2022, 29 patients with pure severe AR and PAH who underwent TAVR in Zhongshan Hospital, Fudan University were enrolled. They were divided in mild to moderate PAH group (35≤SPAP < 50 mmHg, n＝18) and severe PAH group (SPAP≥50 mmHg, n＝11) according to their pulmonary artery pressure. The baseline information, imaging data and follow-up information of the patients were collected.
    Results Compared with mild to moderate PAH group, more patients in the severe PAH group were diagnosed with 3-4 NYHA cardiac function grade (100% vs 61%, P＝0.018), with a higher level of serum BNP (2 820.35±1 762.82 vs 1 241.09±1 999.86 mg/mL, P＝0.040), and lower LVEF (45.64±10.24% vs 54.61±11.36%, P＝0.042). Besides, Higher proportion of patients in severe PAH group were found with moderate to sever mitral regurgitation and tricuspid regurgitation, respectively (73% vs 33%, P＝0.039; 82% vs 33%, P＝0.011). After TAVR surgery, the degree of AR was significantly improved and SPAP markedly reduced at 1 day and 1 month after operation (P < 0.001), the systolic blood pressure of the pulmonary arteries significantly decreased (P < 0.001), the degree of tricuspid regurgitation was significantly decreased in the severe AR combined with severe PAH group (P＝0.009). During the hospital and 1-month follow-up, it was found that patients with AR combined with varying degrees of PAH did not experience any all-cause or cardiac death events within 1 day and 1 month after surgery. Among them, 5.56% of patients with severe AR combined with mild to moderate and 9.09% of patients with severe PAH experienced moderate to severe perivalve leakage 1 day and 1 month after surgery, respectively. The proportion of moderate to severe AR was 5.56% and 9.09%, respectively. There was no statistically significant difference in postoperative adverse events between the two groups.
    Conclusions TAVR is safe and effective in the treatment of simple severe AR complicated with PAH. It can improve AR and reduce pulmonary artery pressure simultaneously.

     

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