Effect Of Transcatheter Aortic Valve Replacement On Left Heart Function In Patients With Severe Aortic Regurgitation

Objective: In the last few years,since the number of domestic aortic valve came on the market,our country is developing in full swing,transcatheter aortic valve replacement TAVR.The First Affiliated Hospital of Wannan Medical College(Yijishan)successfully carried out the first TAVR in 2020 after the strict construction of the cardiac structure center in the early stage.In 2022,there were more than 60 cases of TAVR surgery,including aortic stenosis(AS)and/or aortic regurgitation(AR).This paper aims to explore the changes of left heart function in patients with simple severe AR after TAVR by comparing the left heart function before and after TAVR in patients with simple severe AR,so as to evaluate the effect of surgery.This paper aims to explore the changes of left heart function in patients with simple severe AR after TAVR by comparing the left heart function before and after TAVR in patients with simple severe AR,so as to evaluate the effect of surgery.Methods: A retrospective study of 41 patients diagnosed as severe AR in Yijishan Hospital Affiliated to Wannan College from October 2020 to June 2022 was conducted.Clinical symptoms of patients in the perioperative period(before surgery,1 week after surgery),postoperative follow-up time point(1 month after surgery,6 months after surgery),the New York Heart Association,NYHA)cardiac function classification,Nterminal Pro-B-type natriuretic peptide,NT-Pro BNP),left ventricular ejection shortening(LVEF),left ventricular end-diastolic dimension(left ventricular end-diastolic dimension,LVEDD)and postoperative complications were analyzed and evaluated statistically.Results: The clinical symptoms of patients with simple severe AR were significantly relieved 1 week after surgery,and there were 40 cases(97.56%)of patients with NYHA grade Ⅲ-Ⅳ cardiac function before surgery,which were reduced to 12 cases(43.90%)after the re-evaluation 1 week after surgery.The comparison of NT-Pro BNP,LVEF% and LVEDD 1 week after surgery was significantly improved.There was significant statistical difference(P<0.01).The improvement of cardiac function was more obvious 1 month after surgery,NYHA cardiac function grade Ⅰ increased from 1 case(2.44%)1 week after surgery to 8 cases(20.51%),grade Ⅳ 0 cases,NT-Pro BNP,LVEF% and LVEDD 1 month after surgery were still statistically significant compared with the preoperative level(P<0.01).Six months after surgery,the improvement of all indexes was more obvious than that before surgery.There was 1 case(2.44%)of NYHA patients with grade I-ⅱcardiac function before surgery,and the follow-up at 6 months after surgery increased to35 cases(89.74%).NT-Pro BNP [(4149±3105.397)pg/ml vs(1021±926.408)pg/ml](p<0.01)];LVEF% [(48±9.094)vs(57±9.16)](p<0.01);LVEDD [(57±7.756)mm vs(53±6.639)mm](p<0.01).The NT-Pro BNP,LVEF% and LVEDD of 6 months after surgery were significantly different from those before surgery.Results: The clinical symptoms of patients with simple severe AR were significantly relieved 1 week after surgery,and there were 40 cases(97.56%)of patients with NYHA grade Ⅲ-Ⅳ cardiac function before surgery,which were reduced to 12 cases(43.90%)after the re-evaluation 1 week after surgery.The comparison of NT-Pro BNP,LVEF% and LVEDD 1 week after surgery was significantly improved.There was significant statistical difference(P<0.01).The improvement of cardiac function was more obvious 1 month after surgery,NYHA cardiac function grade Ⅰ increased from 1 case(2.44%)1 week after surgery to 8 cases(20.51%),grade Ⅳ 0 cases,NT-Pro BNP,LVEF% and LVEDD 1 month after surgery were still statistically significant compared with the preoperative level(P<0.01).Six months after surgery,the improvement of all indexes was more obvious than that before surgery.There was 1 case(2.44%)of NYHA patients with grade I-ⅱcardiac function before surgery,and the follow-up at 6 months after surgery increased to35 cases(89.74%).NT-Pro BNP [(4149±3105.397)pg/ml vs(1021±926.408)pg/ml](p<0.01)];LVEF% [(48±9.094)vs(57±9.16)](p<0.01);LVEDD [(57±7.756)mm vs(53±6.639)mm](p<0.01).The NT-Pro BNP,LVEF% and LVEDD of 6 months after surgery were significantly different from those before surgery.Conclusion: TAVR treatment is a feasible method for simple AR patients.Rapid postoperative hemodynamic recovery can significantly relieve clinical symptoms,increase LVEF value,reduce NTPro BNP and improve long-term prognosis.However,this improvement in cardiac function is gradual and can improve coronary perfusion through postoperative increase in diastolic blood pressure,and may also be associated with improved left ventricular remodeling.