超声心动图在经心尖途径经导管主动脉瓣置换术后早期疗效评价中的应用

doi:10.13481/j.1671-587X.20250128

Abstract

Abstract:

Objective To discuss the clinical application value of echocardiography in evaluating the early outcomes of transcatheter aortic valve replacement （TAVR） via the transapical approach， and to clarify the role of echocardiography in assessing the efficacy of the surgery. Methods The clinical data of 85 patients who received J-Valve prosthetic valves via the transapical TAVR were retrospectively analyzed. The patients were divided into AS group （simple aortic stenosis， n=20）， AR group （simple aortic regurgitation， n=37）， and AS&AR group （aortic stenosis with regurgitation， n=28）. Echocardiographic examination was performed on all the patients before operation， 1 week after operation， 3 months after operation， and 6 months after operation. The parameters including left ventricular end-diastolic volume （LVEDV）， left ventricular end-systolic volume （LVESV）， left ventricular ejection fraction （LVEF）， left ventricular fractional shortening （LVFS）， interventricular septal thickness （IVST）， left ventricular posterior wall thickness （LVPWT）， aortic valve peak flow velocity （AV V_max）， aortic valve mean transvalvular pressure gradient （AV PG_mean）， and paravalvular leak （PVL） width were measured to evaluate the cardiac function and the function of the prosthetic valve； the occurrence of postoperative complications of the patients in various groups was also analyzed. Results J-Valve prosthetic valves were successfully implanted in all 85 patients. There were no significant differences in age， gender， New York Heart Association （NYHA） heart function classification， history of hypertension， history of diabetes， history of hyperlipidemia， and history of coronary artery disease among various groups befor operation（P>0.05）， ensuring comparability. Compared with before operation， 1 week after operation， the AV V_max and AV PG_mean of the patients in AS group and AS&AR group were decreased （P<0.05）； there were no significant differences in various parameters of the patients in AR group （P>0.05）. Compared with before operation， 3 months after operation， the LVEF and LVFS of the patients in AS group were increased （P<0.05）， while the AV V_max and AV PG_mean were decreased （P<0.05）； the LVEDV and LVESV of the patients in AR group were decreased （P<0.05）， while the LVEF and LVFS were increased （P<0.05）； the LVEDV， LVESV， AV V_max， and AV PG_mean of the patients in AS&AR group were decreased （P<0.05）， while the LVEF and LVFS were increased （P<0.05）. Compared with before operation， LVEDV， LVESV， IVST， and LVPWT of the patients in all three groups 6 months after operation were decreased （P<0.05）， while LVEF and LVFS were increased （P<0.05）； the AV V_max and AV PG_mean of the patients in AS group and AS&AR group were decreased （P<0.05）； the AV PG_mean of the patients in AR group was decreased （P<0.05）. The postoperative complications included 3 cases of permanent pacemaker implantation （2 cases in AS group， 1 case in AR group）， 1 case of stroke （in AS group）， and 13 cases of PVL （4 cases in AS group， 5 cases in AR group， 4 cases in AS&AR group）. No deaths occurred during follow-up. Conclusion Echocardiography can accurately and quantitatively evaluate early changes in cardiac function and the functional state of prosthetic valves after transapical TAVR， providing objective evidence for evaluating surgical outcomes and postoperative complications.

Key words: Echocardiography, Transcatheter aortic valve replacement, Transapical approach, Aortic stenosis, Aortic regurgitation

CLC Number:

R542.5

Chaolong JIN,Xuegong SHI,Chengxin ZHANG,Youfeng LIANG,Jie XIAO,Zhe SHENG,Dingxin ZHANG. Application of echocardiography in early efficacy evaluation after transapical transcatheter aortic valve replacement via transapical approach[J].Journal of Jilin University(Medicine Edition), 2025, 51(1): 228-237.

Figures/Tables 7

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References 25

1	李喆，郭帅，叶蕴青，等. 中国中重度主动脉瓣疾病患者的临床特点及预后：来自China-VHD研究的分析［J］. 中国循环杂志， 2022， 37（4）： 322-328.
2	张泽，蒋伟，李思聪，等. 全胸腔镜微创心脏手术临床疗效分析［J］. 中国临床新医学， 2023， 16（4）： 375-378.
3	KHEIRI B， OSMAN M， BAKHIT A， et al. Meta-analysis of transcatheter aortic valve replacement in low-risk patients［J］. Am J Med， 2020， 133（2）： e38-e41.
4	罗一纯，刘路路，石峻，等. 应用J-Valve瓣膜经导管主动脉瓣置换术治疗高危单纯主动脉瓣反流多中心研究早期临床结果［J］. 中国胸心血管外科临床杂志， 2019， 26（8）： 737-743.
5	时应路，张成鑫，郭志祥，等. 经心尖途径经导管主动脉瓣置换术治疗主动脉瓣关闭不全的早期疗效分析［J］. 中国胸心血管外科临床杂志， 2023， 30（8）： 1116-1120.
6	张航，安景辉，刘苏，等. 经心尖经导管主动脉瓣置换术治疗主动脉瓣膜病变的临床研究［J］. 心脑血管病防治， 2023， 23（11）： 47-48， 52.
7	SHI J， WEI L， CHEN Y， et al. Transcatheter aortic valve implantation with J-valve： 2-year outcomes from a multicenter study［J］. Ann Thorac Surg， 2021， 111（5）： 1530-1536.
8	孙艳丹，李昱茜，白炜，等. 三维经食管超声心动图在心尖入路经导管主动脉瓣置换术中的应用价值［J］. 临床超声医学杂志， 2023， 25（1）： 58-61.
9	BENFARI G， SETTI M， NISTRI S， et al. Relevance of functional mitral regurgitation in aortic valve stenosis［J］. Am J Cardiol， 2020， 136： 115-121.
10	ILIUTA L， ANDRONESI A G， DIACONU C C， et al. Diastolic versus systolic left ventricular dysfunction as independent predictors for unfavorable postoperative evolution in patients with aortic regurgitation undergoing aortic valve replacement［J］. Medicina （Kaunas）， 2022， 58（11）： 1676.
11	宋羿，张大发. 主动脉瓣置换治疗主动脉瓣膜疾病的临床效果［J］. 右江民族医学院学报， 2020， 42（1）： 61-63.
12	PANÇ C， YILMAZ E， GÜRBAK İ， et al. Effect of prognostic nutritional index on short-term survival after transcatheter aortic valve implantation［J］. Turk Kardiyol Dern Ars， 2020， 48（6）： 585-593.
13	金朝龙，史学功，林先和，等. 实时三维经食道超声心动图在室间隔缺损微创封堵术中的应用［J］. 安徽医科大学学报， 2018， 53（5）： 812-815.
14	BLEAKLEY C， MONAGHAN M. 3D transesophageal echocardiography in TAVR［J］. Echocardiography， 2020， 37（10）： 1654-1664.
15	MEHTA A， SALE S， CAPDEVILLE M. The deployment of valve academic research consortium 3 （VARC-3）： new endpoints， broader definitions， and plenty of unanswered questions［J］. J Cardiothorac Vasc Anesth， 2021， 35（12）： 3463-3466.
16	冯晔子，张申伟，马倩倩，等. 主动脉瓣重度狭窄经导管主动脉瓣置换术后患者围术期效果观察［J］. 心肺血管病杂志， 2019， 38（11）： 1146-1149.
17	周广为，李宁，费翔，等. 二维超声心动图评价经导管主动脉瓣置入术后早期左心形态及收缩功能［J］. 第二军医大学学报， 2020， 41（8）： 864-870.
18	LIU L， PENG Y， SHI J，et al. Initial experience with repositionable J-Valve for severe aortic regurgitation： a single-center experience［J］.J Cardiovasc Surg（Torino），2022，63（4）：521-528.
19	SAMMOUR Y， KRISHNASWAMY A， KUMAR A， et al. Incidence， predictors， and implications of permanent pacemaker requirement after transcatheter aortic valve replacement［J］. JACC Cardiovasc Interv， 2021， 14（2）： 115-134.
20	AUFFRET V， PURI， URENA M， et al. Conduction disturbances after transcatheter aortic valve replacement： current status and future perspectives［J］. Circulation， 2017， 136（11）： 1049-1069.
21	SCHOECHLIN S， HEIN M， BRENNEMANN T， et al. 5-year outcomesafter transcatheter aortic valve implantation： focus on paravalvular leakage assessed by echocardiography and hemodynamic parameters［J］. Cathet Cardio Intervent， 2022， 99（5）： 1582-1589.
22	LAAKSO T， LAINE M， MORIYAMA N， et al. Impact of paravalvular regurgitation on the mid-term outcome after transcatheter and surgical aortic valve replacement［J］. Eur J Cardiothorac Surg， 2020，58（6）：1145-1152.
23	XUE Y， ZHOU Q， LI S， et al. Transapical transcatheter valve replacement using J-valve for aortic valve diseases［J］. Ann Thorac Surg， 2021， 112（4）：1243-1249.
24	中国医师协会心血管内科医师分会结构性心脏病专业委员会. 经导管主动脉瓣置换术中国专家共识（2020更新版）［J］. 中国介入心脏病学杂志， 2020， 28（6）： 301-309.
25	SCHEWEL D， FRERKER C， SCHEWEL J， et al. Clinical impact of paravalvular leaks on biomarkers and survival after transcatheter aortic valve implantation［J］. Catheter Cardiovasc Interv， 2015， 85（3）： 502-514.

Characteristic	AS Group（n=20）	AR Group（n=37）	AS&AR Group（n=28）	F/χ²	P
Age（x±s， year）	71.60±4.58	69.70±8.10	70.11±11.59	1.239	0.058
Gender [n（%）]				2.992	0.245
Male	9（45.0）	25（67.6）	15（53.6）
Female	11（55.0）	12（32.4）	13（46.4）
Height（x±s， cm）	160.90±8.30	161.78±6.68	160.54±10.60	1.457	0.830
Weight（x±s， kg）	63.18±11.39	62.92±9.81	63.43±10.76	0.019	0.981
History of smoking [n（%）]				2.033	0.391
Yes	8（40.0）	10（27.0）	6（21.4）
No	12（60.0）	27（73.0）	22（78.6）
Classification of cardiac function [n（%）]				-	0.612^*
Ⅱ	0（0.0）	2（5.4）	0（0.0）
Ⅲ	13（65.0）	27（73.0）	20（71.4）
Ⅳ	7（35.0）	8（21.6）	8（28.6）
Hypertension [n（%）]	10（50.0）	15（40.5）	13（46.4）	0.520	0.819
CHD [n（%）]	11（55.0）	15（40.5）	10（35.7）	1.865	0.409
Diabetes [n（%）]	1（5.0）	1（2.7）	0（0.0）	-	0.710^*
Hyperlipidemia [n（%）]	0（0.0）	0（0.0）	1（3.6）	-	0.565^*
Renal insufficiency [n（%）]	5（25.0）	7（18.9）	6（21.4）	-	0.942
Arrhythmology [n（%）]	10（50.0）	13（35.1）	10（35.7）	1.378	0.512

Clinical data	Group	n	Before operation	1 week after operation	3 months after operation	6 months after operation	F	P
LVEDV（mL）	AS	20	139±40	130±39	118±35	100±25^*	4.62	0.005
	AR	37	233±52	207±52	181±51^*	150±43^*	18.93	<0.001
	AS&AR	28	180±46	158±41	138±35^*	118±30^*	13.21	<0.001
LVESV（mL）	AS	20	71±33	63±30	54±25	37±11^*	6.23	0.001
	AR	37	129±42	119±39	90±35^*	64±24^*	22.45	<0.001
	AS&AR	28	98±33	82±29	66±24^*	48±17^*	18.64	<0.001
LVEF（%）	AS	20	50±8	53±7	56±6^*	63±3^*	14.24	<0.001
	AR	37	45±7	48±7	51±7^*	58±6^*	24.93	<0.001
	AS&AR	28	46±8	49±8	53±7^*	60±5^*	20.01	<0.001
LVFS（%）	AS	20	26±4	28±4	29±3^*	33±2^*	16.33	<0.001
	AR	37	23±4	25±4	26±4^*	31±4^*	23.80	<0.001
	AS&AR	28	24±5	25±4	28±5^*	32±4^*	13.92	<0.001
IVST（cm）	AS	20	1.43±0.21	1.42±0.19	1.35±0.18	1.19±0.13^*	7.91	<0.001
	AR	37	1.23±0.11	1.23±0.11	1.20±0.12	1.04±0.18^*	17.08	<0.001
	AS&AR	28	1.33±0.15	1.33±0.16	1.26±0.13	1.13±0.09^*	13.92	<0.001
LVPWT（cm）	AS	20	1.31±0.12	1.28±0.28	1.24±0.11	1.09±0.10^*	7.47	<0.001
	AR	37	1.18±0.11	1.18±0.10	1.15±0.11	0.98±0.09^*	30.65	<0.001
	AS&AR	28	1.24±0.10	1.25±0.10	1.21±0.09	1.03±0.09^*	32.98	<0.001
AV V_max（mmHg）	AS	20	482.14±87.73	248.05±29.11^*	237.15±27.74^*	196.85±33.40^*	128.04	<0.001
	AR	37	190.73±18.58	188.35±18.08	185.49±18.10	183.46±16.39	1.62	0.204
	AS&AR	28	458.01±78.22	265.29±34.54^*	254.04±38.97^*	207.93±29.56^*	142.27	<0.001
AV PG_mean（mmHg）	AS	20	56.88±20.35	18.35±4.83^*	14.90±5.58^*	9.80±3.65^*	82.52	<0.001
	AR	37	10.86±2.54	9.68±2.29	9.08±2.14	8.73±1.81^*	9.00	0.001
	AS&AR	28	50.94±16.80	17.89±4.24^*	14.75±4.76^*	8.96±3.05^*	116.95	<0.001

Group	n	Parameter	PVL			F/χ²	P
Group	n	Parameter	1 week after operation	3 months after operation	6 months after operation	F/χ²	P
AS	20	Width（l/cm）	0.06±0.12	0.04±0.09	0.02±0.05	1.100	0.340
		Case[n/（%）]	4（20.0）	4（20.0）	2（10.0）	1.035	0.749
AR	37	Width（l/cm）	0.05±0.12	0.03±0.08	0.01±0.32^*	1.905	0.044
		Case[n/（%）]	5（13.5）	4（10.8）	1（2.7）	3.211	0.305
AS&AR	28	Width（l/cm）	0.05±0.13	0.03±0.07	0.03±0.06	2.666	0.076
		Case[n/（%）]	4（14.3）	2（7.1）	2（7.1）	1.113	0.710

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[3]	ZHANG Yingying, YAN Yuanyuan, SHI Haihong. Application of speckle tracing echocardiography in examination of rat models of myocardial infarction and its significance [J]. Journal of Jilin University(Medicine Edition), 2019, 45(04): 882-886.
[4]	WANG Yin, LIU Yue, MO Zhongling, CHEN Liping. Application of three-dimensional speckle tracking echocardiography in evaluation on segmental motion and systolic function of left ventricular in patients with acute myocardial infarction after percutaneous coronary intervention and its values [J]. Journal of Jilin University Medicine Edition, 2017, 43(02): 429-434.
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[8]	YANG Xiao-chun,RAO Yan-wei,ZHANG Yong,LU Yu-xiong,SU Jing,SUN Lian-kun. Improvement effect of Sanshen Weixin Capsula on cardiac function in rats with heart failure induced by myocardial infarction [J]. Journal of Jilin University Medicine Edition, 2013, 39(4): 743-746.
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[10]	CONG Deng-Li, YU Xiao-Feng, QU Shao-Chun, CONG Zhi-Bin. Establishment and evaluation of acute pulmonary embolism model in rabbit monitored with echocardiography [J]. J4, 2010, 36(4): 683-686.
[11]	WANG Ling, WANG Jing, ZHENG Min, ZHANG Chun-Mei, LI Chan. Evaluation of left ventricular function in maintained hemodialysis patients using real-time three-dimensional echocardiography [J]. J4, 2010, 36(4): 779-782.
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Application of echocardiography in early efficacy evaluation after transapical transcatheter aortic valve replacement via transapical approach

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