Analysis Of Multicenter Clinical Outcomes Of TAVR In The Treatment Of Severe Aortic Valve Disease

Objective:The multicenter clinical results of transcatheter aortic valve replacement(TAVR)in the treatment of aortic valve disease were summarized and analyzed to provide a basis for better TAVR surgery.Methods:A total of 70 cases of TAVR treatment of high-risk aortic valve disease were included in this study,including 31 cases of TAVR surgery in the Department of Cardiac Surgery and Cardiovascular Medicine of the Affiliated Hospital of Guizhou Medical University from January 2018 to January 2022,17 cases of TAVR surgery in Southern Hospital of Southern Medical University from January 2020 to December2021,and 22 cases of TAVR surgery in the Department of Cardiac Surgery and Cardiovascular Medicine of the Affiliated Hospital of Southwest Medical University from January 2019 to January 2022.Among them,11 cases of simple aortic regurgitation(AR)were set to the AR-TAVR group,and 59 cases with aortic stenosis(AS)were set as AS-TAVR group.Among the above 70 cases,25 cases underwent TAVR surgery through the apex path,which was set to the TA-TAVR group,and 45 cases underwent TAVR surgery through the femoral artery path,which was set to the TF-TAVR group.In addition,59 cases of severe aortic stenosis were treated by surgical aortic valve replacement(SAVR),which were set up as SAVR groups,including 23 cases of SAVR surgery in the Affiliated Hospital of Guizhou Medical University from January 2018 to January 2022,15 cases of SAVR surgery in southern hospital of Southern Medical University from January 2020 to December 2021,and21 cases of SAVR surgery in the Affiliated Hospital of Southwest Medical University from January 2019 to January 2022.The clinical data of all the above cases were collected within 3 months of preoperative and postoperative follow-up,1.Comparing the clinical results of TAVR surgery and SAVR surgery in patients with severe aortic stenosis;2.Observing the safety and efficacy of TAVR in the treatment of patients in the AR-TAVR group;3.Comparing the incidence of postoperative adverse events in the TA-TAVR group and the TF-TAVR group,summarizing and analyzing the preliminary clinical efficacy of transcatheter valve replacement in the treatment of aortic valve disease.Results:The mean age and Euro SCORE score of AS-TAVR patients were higher than those in the SAVR group,and the difference was statistically significant(P<0.05).The NYHA cardiac function grade of the two groups was significantly improved 1 month after surgery compared with before surgery,and there was no significant statistical significance between the two groups.The mean transaortic valve pressure in the two groups decreased from preoperatively in January and after surgery,and there was no significant statistical significance between the two groups.The left heart ejection fraction of the two groups was significantly higher than before surgery,and there was no statistically significant difference between the two groups.There were 3 deaths in the AS-TAVR group,with a mortality rate of about 5%,and there were no deaths in the SAVR group.One case of stroke occurred in the TAVR group at 1 month after surgery,and 2 cases in the SAVR group in 3 months after surgery,and the difference was not statistically significant.There were 8 cases in the TAVR group with indications for permanent pacemaker implantation within 1 month after surgery,but none in the SAVR group,and the difference was statistically significant(P<0.05).2.Eleven patients with simple aortic regurgitation underwent TAVR surgery.Echocardiography within one month after surgery suggested that the left ventricular ejection fraction was improved compared with preoperative,and the difference was statistically significant(P<0.05),and the left ventricular end-diastolic end-aperture and left ventricular end-systolic volume were significantly reduced after surgery,and the difference was statistically significant(P<0.05).One patient had indications for permanent pacemaker implantation surgery.A small amount of perivalvular leakage occurred in one patient.One patient developed postoperative renal impairment.There were no serious bleeding events,vascular damage,coronary artery obstruction,stroke and other complications.3.No serious vascular damage occurred after surgery in the two different surgical routes,and there were 2 deaths in the TF-TAVR group,the mortality rate was about 4.4%,and the surgical completion rate was about 98%.There was one death case in the TA-TAVR group,the mortality rate was about 4%,and the surgical completion rate was 100%,and the difference between the two groups was not statistically significant.There were no serious bleeding events in the TF-TAVR group and one case of postoperative cardiac tamponade in the TA-TAVR group.There were 8 people with permanent pacemaker implantation indications,all of whom were in the TF-TAVR group,and the difference was statistically significant(P<0.05).Postoperative acute kidney injury,two cases in each group,the difference was not statistically significant.There were 10 cases in the TF-TAVR group and 1 case in the TA-TAVR group and 1 case in the moderate peripular leakage TF-TAVR group,and the difference was statistically significant(P<0.05).Conclusions:1.Compared with traditional surgical methods,TAVR surgery is equally safe and effective for the treatment of patients with aortic stenosis.2.Patients with simple aortic regurgitation undergo TAVR surgery safely and reliably.3.There was no statistical difference in mortality rate between the two different surgical pathways,and the incidence of permanent pacemaker implantation and peripular leakage in TAVR surgery on the apex path was lower.