Song G Y, Zhao Y W, Du G Y, Chen Y, Wang M Y, Teng S Y, Luo T, Zhou Z, Niu G N, Zhao Z Y, Lu Z N, Wu Y J
Coronary Artery Disease Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2022 Jun 24;50(6):563-569. doi: 10.3760/cma.j.cn112148-20210728-00626.
To summarize the single center experience of transcatheter aortic valve replacement (TAVR) with a simplified operative protocol. Consecutive patients who underwent transfemoral TAVR (TF-TAVR) from July 2020 to December 2020 in Fuwai Hospital were retrospectively analyzed. We compared the baseline characteristic, procedure information, 30-day follow-up outcomes of the patients who underwent TF-TAVR without the simplified operative protocol (routine group) or with the simplified operative protocol (simplified protocol group). 93 patients were collected, 42 patients belonging to routine group, 51 patients belonging to simplified protocol group. In simplified protocol group, there were 51 patients planned to use ultrasound-guided femoral access puncture, procedure was successful in all 51 patients (100%). There were 49 patients planned to use the radial artery as the secondary access, procedure was successful in 45 patients (92%). There were 48 patients planned to use the strategy of avoidance of urinary catheter, this strategy was achieved in 35 patients (73%). There were 12 patients planned to use the left ventricular guidewire to pace, procedure was successful in 11 patients (92%). There were no differences in baseline characteristics, major clinical endpoints and 30-day follow-up outcomes between the two groups. Meanwhile, the procedure time ((62.5±17.9)min vs. (78.3±16.7)min, 0.001), operation room time ((133.7±25.1)min vs. (159.2±42.6)min, 0.001), X-ray exposure time ((17.2±6.5)min vs. (20.2±7.7)min, 0.027) were significantly shorten in simplified protocol group compared with the routine group. Our study results indicate that the simplified operative protocol of TF-TAVR is as effective and safe as the routine operative protocol, meanwhile using the simplified operative protocol can significantly increase the operative efficiency of TF-TAVR.
总结采用简化手术方案进行经导管主动脉瓣置换术(TAVR)的单中心经验。对2020年7月至2020年12月在阜外医院接受经股动脉TAVR(TF-TAVR)的连续患者进行回顾性分析。我们比较了未采用简化手术方案的TF-TAVR患者(常规组)和采用简化手术方案的患者(简化方案组)的基线特征、手术信息、30天随访结果。共收集93例患者,其中42例属于常规组,51例属于简化方案组。在简化方案组中,51例计划采用超声引导下股动脉穿刺入路,全部51例手术成功(100%)。49例计划采用桡动脉作为备用入路,45例手术成功(92%)。48例计划采用避免留置尿管策略,35例实现该策略(73%)。12例计划采用左心室导丝起搏,11例手术成功(92%)。两组在基线特征、主要临床终点和30天随访结果方面无差异。同时,简化方案组的手术时间((62.5±17.9)分钟 vs.(78.3±16.7)分钟,P = 0.001)、手术室时间((133.7±25.1)分钟 vs.(159.2±42.6)分钟,P = 0.001)、X线暴露时间((17.2±6.5)分钟 vs.(20.2±7.7)分钟,P = 0.027)均较常规组显著缩短。我们的研究结果表明,TF-TAVR的简化手术方案与常规手术方案同样有效且安全,同时采用简化手术方案可显著提高TF-TAVR的手术效率。