关键词: 生物瓣膜衰败, 经导管瓣中瓣置换术, 主动脉瓣置换术, 超声心动图, 并发症

Abstract:

Objective Compare the efficacy and safety of Transcatheter Aortic Valve Replacement （ViV TAVR） versus Secondary Surgical Aortic Valve Replacement （redo SAVR） in patients with structural valve deterioration. Methods A retrospective analysis of clinical data was performed on 61 patients with valve failure who underwent ViV TAVR or redo SAVR treatment at the hospital between January 2020 and June 2022. Based on the differing treatment modalities， the patients were categorized into two groups： the ViV TAVR group （n = 31） and the redo SAVR group （n = 30）. The study compared perioperative-related indicators （surgical time， hospital stay duration， mechanical ventilation time， and intensive care unit observation period）， echocardiographic parameters at four time points： preoperatively （T₁）， 1 month postoperatively （T₂）， 3 months postoperatively （T₃）， and 6 months postoperatively （T₄）， as well as primary and secondary endpoint events. Results The ViV-TAVR group had shorter operation time and hospital stay， and less extracorporeal circulation assistance compared to the redo-SAVR group， with statistically significant differences （P < 0.05）. Intra-group comparisons showed that at 1 month （T2）， 3 months （T₃）， and 6 months （T₄） after surgery， the left ventricular ejection fraction （LVEF）， aortic valve peak flow velocity （AVmax）， peak transvalvular pressure gradient （PGmax）， and PGmean in both groups were lower than those at the preoperative （T₁） time point. At T₃ and T₄， the left ventricular end-diastolic diameter （LVEDD） in both groups was lower than that at T₁ and T₂， with statistically significant differences （P < 0.05）. The mortality rate within 30 days in the ViV-TAVR group was lower than that in the redo-SAVR group， with a statistically significant difference （P < 0.05）. However， there was no statistically significant difference in all-cause mortality within 24 months between the two groups （P > 0.05）. The incidence of acute renal failure in the ViV-TAVR group was lower than that in the redo-SAVR group， with a statistically significant difference （P < 0.05）. Conclusion Compared with redo SAVR， ViV TAVR not only significantly decreases the 30-day mortality risk and the incidence of acute renal failure in patients with bioprosthetic valve dysfunction but also demonstrates comparable long-term mortality rates to redo SAVR.

Key words: biological valve failure, transcatheter valve replacement surgery, aortic valve replacement surgery, echocardiography, complication