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土耳其年轻心脏病专家进行球囊扩张式经导管主动脉瓣植入术的初步经验:11例患者的病例系列

Initial experiences of young cardiologists with balloon-expandable transcatheter aortic valve implantation in Turkey: a case series of eleven patients.

作者信息

Gokdeniz Tayyar, Aykan Ahmet Cagri, Agac Mustafa Tarik, Parlar Ali Ihsan, Dogan Orhan Veli, Celik Sukru

机构信息

Department of Cardiology, Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey.

出版信息

Eurasian J Med. 2013 Jun;45(2):99-107. doi: 10.5152/eajm.2013.21.

Abstract

OBJECTIVE

Surgical aortic valve replacement is the gold standard of treatment for symptomatic severe aortic stenosis in all age groups. Transcatheter aortic valve implantation (TAVI), which is performed by senior interventional cardiologists in experienced centers, is an alternative therapy for patients considered to be at high risk for surgery. The aim of this study is to describe the procedural success and short-term results of TAVI performed by young interventional cardiologists in Trabzon, Turkey.

MATERIALS AND METHODS

Eleven patients, 10 women and 1 man, who were treated by balloon-expandable TAVI through transfemoral access between January 2012 and April 2012, were included in the study. The clinical and echocardiographic parameters of the patients were compared before and three months after the procedure.

RESULTS

The median calculated logistic EuroSCORE and Society of Thoracic Surgeons (STS) score of patients were 28% (24%-34%) and 14% (12%-18%), respectively. The median age of the patients was 83 years and ranged from 80-85 years. The mean aortic valve pressure gradient and the aortic valve area were significantly improved after TAVI. The mean aortic valve pressure gradient was 48 (46-53) mmHg before treatment and 20 (16-23) mmHg after treatment (p=0.003). The aortic valve area was 0.65 (0.55-0.70) cm(2) before treatment and 1.7 (1.6-1.8) cm(2) after treatment. The functional status of the patients improved from NYHA class 3-4 to NYHA class 1-2. Intraprocedural mortality was not observed, and the overall 3 month mortality was 9%.

CONCLUSION

TAVI can be performed successfully by young cardiologists. In centers with high patient loads, we encourage young cardiologists to perform TAVI if they have received the appropriate training and to form specialized, cooperating teams with a focus on TAVI.

摘要

目的

外科主动脉瓣置换术是各年龄组有症状重度主动脉瓣狭窄的治疗金标准。经导管主动脉瓣植入术(TAVI)由经验丰富中心的资深介入心脏病专家实施,是被认为手术风险高的患者的替代治疗方法。本研究的目的是描述土耳其特拉布宗年轻介入心脏病专家实施TAVI的手术成功率和短期结果。

材料与方法

纳入2012年1月至2012年4月间经股动脉途径接受球囊扩张式TAVI治疗的11例患者,其中10例女性,1例男性。比较患者术前及术后3个月的临床和超声心动图参数。

结果

患者的计算逻辑欧洲心脏手术风险评估系统(EuroSCORE)和胸外科医师协会(STS)评分中位数分别为28%(24%-34%)和14%(12%-18%)。患者年龄中位数为83岁,范围在80-85岁。TAVI术后主动脉瓣平均压力阶差和主动脉瓣面积显著改善。治疗前主动脉瓣平均压力阶差为48(46-53)mmHg,治疗后为20(16-23)mmHg(p=0.003)。治疗前主动脉瓣面积为0.65(0.55-0.70)cm²,治疗后为1.7(1.6-1.8)cm²。患者功能状态从纽约心脏协会(NYHA)3-4级改善至NYHA 1-2级。术中未观察到死亡,3个月总死亡率为9%。

结论

年轻心脏病专家可成功实施TAVI。在患者量大的中心,我们鼓励年轻心脏病专家在接受适当培训后实施TAVI,并组建专注于TAVI的专业协作团队。

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