2023 年第 11 期 第 18 卷

重度主动脉瓣关闭不全患者经导管主动脉瓣置换术围手术期二尖瓣关闭不全转归的临床研究

Clinical study of perioperative mitral regurgitation outcomes of transcatheter aortic valve implantation in patients with severe aortic regurgitation

作者：朱可心1刘金凤1谢萌1吴山1李晓明1于惠梅1张纯1王云龙2

英文作者：Zhu Kexin1 Liu Jinfeng1 Xie Meng1 Wu Shan1 Li Xiaoming1 Yu Huimei1 Zhang Chun1 Wang Yunlong2

单位：1首都医科大学附属北京安贞医院介入超声科，北京100029；2首都医科大学附属北京安贞医院心内科3A病房，北京100029

英文单位：1Department of Interventional Ultrasound Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 23A Ward Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：经导管主动脉瓣置换术；主动脉瓣关闭不全；持续性二尖瓣关闭不全

英文关键词：Transcatheteraorticvalveimplantation;Aorticregurgitation;Persistentmitralregurgitation

• 摘要：

• 目的  探讨重度主动脉瓣关闭不全（AR）合并中重度功能性二尖瓣关闭不全（FMR）患者经导管主动脉瓣置换术（TAVI）术后二尖瓣关闭不全（MR）的转归情况，并分析持续性MR的影响因素。方法  回顾性分析2021年1月至2023年6月在首都医科大学附属北京安贞医院接受TAVI的重度AR合并中重度FMR患者的临床资料，对比分析手术前后MR情况，并通过Logistic回归方法分析持续性MR的危险因素。结果  51例行TAVI患者术后1个月左心房内径（LAD）、左心室舒张末期内径、二尖瓣反流面积均小于术前，肺动脉收缩压优于术前（均P＜0.05）。术后1个月超声心动图提示，18例患者存在持续性MR。持续性MR患者的LAD大于非持续性MR患者，且合并陈旧性心肌梗死比例更高（均P＜0.05）。Logistic回归分析结果显示，术前LAD增加是重度AR合并中重度FMR患者TAVI后发生持续性MR的独立危险因素（比值比=1.138，95%置信区间：1.020～1.270，P=0.021）。结论  TAVI可有效改善重度AR合并中重度FMR患者情况及二尖瓣反流程度。LAD增大为持续性MR的独立危险因素。

• Objective  To investigate the outcome of mitral regurgitation (MR) after transcatheter aortic valve implantation (TAVI) in patients with severe aortic regurgitation (AR) combined with moderate to severe functional mitral regurgitation (FMR), and to analyze the influencing factors of persistent MR. Methods  The clinical data of patients with severe AR combined with moderate to severe FMR who received TAVI in Beijing Anzhen Hospital, Capital Medical University from January 2021 to June 2023 were retrospectively analyzed, and the preoperative and postoperative MR were compared and analyzed, and the risk factors for persistent MR were analyzed by Logistic regression method. Results  At 1 month after TAVI, left atrial diameter (LAD), left ventricular end-diastolic diameter, and mitral regurgitation area of 51 patients were significantly lower than those before TAVI, and pulmonary artery systolic pressure was better than that before TAVI (all P＜0.05). Echocardiography at 1 month after surgery showed that 18 patients had persistent MR. The LAD of patients with persistent MR was greater than that of patients with non-persistent MR, and the proportion of old myocardial infarction was higher (all P＜0.05). Logistic regression analysis showed that the increase of preoperative LAD was an independent risk factor for persistent MR after TAVI in patients with severe AR and moderate to severe FMR(odds ratio=1.138, 95% confidence interval: 1.020-1.270, P=0.021). Conclusion  TAVI can effectively improve the condition and the degree of mitral regurgitation in patients with severe AR and moderate to severe FMR. The increase of LAD is an independent risk factor for persistent MR.