Experience of aortic valve implantation through apical approach
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摘要:
目的探讨经心尖途径行主动脉瓣植入术治疗高危主动脉瓣病变患者的围手术期效果。 方法回顾性总结2018年9~11月在我院行经心尖主动脉瓣植入术3例患者的围手术期经验。 结果所有患者术前均经过心脏团队充分评估患者的手术风险及获益，分析可能存在风险，术前经主动脉瓣根部CTA评估植入角度、瓣膜型号及手术入路，术中在DSA及经食道超声引导下释放J-valve瓣膜。手术过程顺利，术后1例患者出现高位房室传导阻滞，后经心内科植入永久心脏起搏器，其余2例患者恢复良好，未见明显瓣周漏及心律失常，术后1月复查心功能明显提高，近期临床效果良好。 结论经心尖主动脉瓣植入术是高危主动脉瓣患者的有效治疗方法，明显降低围手术期风险，术后早期效果满意。 Abstract:ObjectiveTo evaluate the perioperative outcome of patients with high-risk aortic valve disease performed with transapical aortic valve implantation. MethodsA retrospective analysis of the perioperative experience of 3 patients with transapical aortic valve implantation in our department from September to November 2018. ResultsAll patients underwent a full evaluation of the patient's surgical risk and benefit by the cardiac team before surgery. The risk was analyzed carefully. The implantation angle, valve type and surgical approach were evaluated by the aortic valve root CTA before surgery. The J-valve valve was released under continuous transesophageal ultrasound guidance. The operations were successful. One patient had high atrioventricular block after operation, and a permanent cardiac pacemaker was implanted by the cardiologist before discharge. The other two patients recovered well. No paravavular leak and arrhythmia were observed. The review of cardiac function was significantly improved, and the recent clinical effect was good. ConclusionTransapical aortic valve implantation is an effective treatment for patients with high-risk aortic valve, which significantly reduces the risk of perioperative period. It is satisfactory in early postoperative results. -
Key words:
- aortic valve disease /
- transcatheter /
- minimally invasive /
- transapical
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图 2 TAVI手术过程
A: 经颈内静脉植入右心室心尖部临时起搏导线; B: 经心尖穿刺建立轨道后, 准备植入J-valve输送系统; C: 在DSA监测下释放人工支架瓣膜; D: 支架瓣膜释放完毕, 撤出输送系统及导丝.
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