超声心动图评价经心尖经导管主动脉瓣置换术治疗主动脉瓣单纯关闭不全的近中期疗效

Objectives: To investigate the improvement of clinical symptoms and the structure and function of left ventricle after apical approach transcatheter aortic valve replacement (TAVR) in the treatment of patients with isolated aortic insufficiency. Methods: A total of 53 patients with isolated aortic insufficiency treated by TAVR via apical approach from January 2018 to June 2019 in Xijing Hospital, Air Force Military Medical University were included in this study. The patients were followed up for 1 year, and the postoperative left ventricular dimensions, intra-aortic biological valve regurgitation, perivalvular leakage and mitral regurgitation were observed by echocardiography. The changes of aortic valve maximum velocity (AV-Vmax), aortic valve maximum pressure gradient (AV-PGmax), aortic valve mean pressure gradient (AV-PGmean), left atrial end-systolic diameter (LAESD), left ventricular end-diastolic posterior wall thickness (LVPWT), left ventricular end-diastolic diameter (LVEDD), left ventricular end-diastolic length (LVEDL), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), mitral valve maximum velocity (MV-Vmax), mitral valve maximum pressure gradient (MV-PGmax) before and after operation were compared. Results: At 12 months after operation, patients with the NYHA classification below grade Ⅱ increased from 8 cases (15.1%) to 42 cases (79.2%, P<0.05). Among the 11 patients with postoperative NYHA classification grade Ⅲ and Ⅳ, 2 patients had severe mitral regurgitation. There was no significant difference in LVEDD([73.2±5.0]mm vs.[68.3±6.8] mm) and LVEF([33.7±7.6]% vs. [35.7±9.8]%) between before and at 12 months after operation in the remaining 9 patients (both P>0.05). Compared with preoperative level, data from the 42 patients with NYHA classification below grade Ⅱ showed that LVEDD([64.4±8.2]mm vs. [57.4±9.7]mm) and LVEDV([190.0±60.2]ml vs.[149.1±63.8]ml) were significantly decreased at hospital discharge (within 1 week, P<0.05); LVESV([105.6±47.9]ml vs. [77.1±56.6]ml), LVEF([41.6±9.7] % vs. [49.7±10.9 ]%), LVPWT([9.8±1.7]mm vs. [11.6±1.5]mm), were significantly different at 6 months post TAVR (all P<0.05). 53 patients AV-Vmax([172.7±41.1]cm/s vs.[191.9±39.4 ]cm/s), AV-PGmax([12.6±6.3] mmHg [1 mmHg=0.133 kPa] vs. [15.4±6.5]mmHg), AV-PGmean([5.8±2.9] mmHg vs. [7.8±3.3]mmHg) were significantly different at 6 months post TAVR (all P<0.05). There were 16 patients with secondary mitral regurgitation before operation, and which as reduced to 7 patients at the time of postoperative discharge. Conclusions: After TAVR, the overall left ventricular dimensions are significantly reduced, the degree of mitral valve insufficiency is also gradually reduced, the clinical symptoms are significantly improved, and LVEF is significantly increased, thus our results indicate that TAVR induces left ventricular reverse remodeling in patients with isolated AR.