外科高危老年重度主动脉瓣狭窄不同治疗方式预后分析

发布时间：2018-08-14 09:46

【摘要】：目的：总结阜外医院住院治疗外科高危老年重度主动脉瓣狭窄(SAS)的数据,分析经导管主动脉瓣置入术(TAVI)、外科主动脉瓣置换术(SAVR)及药物等不同治疗方式对于预后的影响,提供TAVI技术在中国的早期经验,验证TAVI治疗的有效性。方法：回顾性分析阜外医院2012年9月至2015年6月住院治疗的外科手术高危的SAS患者。根据治疗方式不同,分为TAVI治疗组、SAVR治疗组及药物治疗组。术后1个月、6个月、1年进行随访。主要终点为术后1年内的全因死亡。结果：共有242例符合入选标准的患者,其中81例行TAVI治疗(包括57例经股动脉途径、12例经升主动脉途径以及12例经心尖途径),59例行SAVR,102例为药物治疗。TAVI组合并糖尿病(27.2% vs.11.9% P=0.027)、慢性阻塞性肺疾病(18.5% vs.6.8% P=0.045)的比例更高。而SAVR组合并慢性肾功能不全(13.6%vs.4.9% P=0.072)、合并复杂瓣膜病变(中重度主动脉瓣返流、二尖瓣反流)的比例较高。TAVI组平均STS评分为7.28,SAVR组为5.67(P=0.036)。围术期TAVI组血管并发症较多见(6.3% vs.0% P=0.057),发生传导阻滞需置入起搏器(11.3%vs.0% P=0.025)、轻度瓣周漏的概率也较高(29.6% vs.1.7% P0.001)；但术后1年新发房颤及再住院的的发生率较低(0% vs.2.3% P=0.674,3.0% vs.21.3% P=0.005)。1年脑卒中发生率在SAVR及TAVI组分别为6.8% vs.3.0% (P=0.628)。TAVI组与SAVR组1个月的全因死亡率分别为3.8%及5.2%(P=1.000)； 1年的全因死亡率分别为5.8%及9.8%(P=0.636)。药物治疗组1年死亡率54.9%。TAVI及SAVR组一年心功能均明显改善。结论：对于外科手术高危的老年SAS患者,TAVI及SAVR均优于药物治疗,其围术期并发症发生率有所差异,但改善1年生存率的作用是类似的。
[Abstract]:Objective: to summarize the data of hospitalized patients with high risk elderly patients with severe aortic valve stenosis (SAS) in Fuwei Hospital, and to analyze the influence of different treatment methods, such as (TAVI), aortic valve replacement, (SAVR) and drugs, on the prognosis. Provide early experience of TAVI technology in China to verify the effectiveness of TAVI therapy. Methods: the high risk SAS patients hospitalized in Fuwei Hospital from September 2012 to June 2015 were analyzed retrospectively. According to the different treatment methods, TAVI treatment group and drug treatment group were divided into two groups. One month, six months and one year were followed up. The main end point was all-cause death within 1 year after operation. Results: a total of 242 patients met the inclusion criteria. Among them, 81 cases were treated with TAVI (including 57 cases via ascending aorta and 12 cases via apical approach) and 59 cases with SAVRV were treated with drug therapy (27.2vs.11.9% Pf0.027), and the proportion of chronic obstructive pulmonary disease (18.5vs.6.8% P0.045) was higher. The proportion of patients with SAVR combined with chronic renal insufficiency (13.6vs.4.9%) and complicated valvular disease (moderate and severe aortic regurgitation, mitral regurgitation) was higher. The average STS score of TAVI group was 5.67 (P0.036). In perioperative TAVI group, vascular complications were more frequent (6.3% vs.0% P0. 057), pacemaker placement was required for conduction block (11. 3vs.0% P0. 025), and the probability of mild perivalvular leakage was also higher (29. 6% vs.1.7% P0. 001). However, the incidence of new atrial fibrillation and rehospitalization was lower in one year after operation (0% vs.2.3%, 0.674% vs 3.0% vs 21.3% P0. 005). The incidence of stroke in SAVR group and TAVI group was 6.8% vs 3.0% (P0.628). The total mortality rate of TAVI group and SAVR group was 3.8% and 5.2% respectively in one month (Pu 1.000). The total mortality in one year was 5.8% and 9.8% respectively (P0. 636). The 1-year mortality of 54.9%.TAVI and SAVR group were significantly improved. Conclusion: tavi and SAVR are superior to drug therapy in elderly SAS patients with high risk of surgery. The incidence of perioperative complications is different, but the effect of improving 1 year survival rate is similar.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.2

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