The Research About Safety And Efficacy Of Transcatheter Aortic Valve Replacement For High-risk Patients With Aortic Regurgitation

Background:Aortic regurgitation(AR)is the heart valve disease with the highest incidence rate in China.Surgical aortic valve replacement(SAVR)is the most common method for treating moderate-to-severe patients with AR,However,this method has disadvantages such as severe trauma,long time with surgery,excessive intraoperative bleeding,long time with hemostasis,perioperative infection,sternal malunion,long time with postoperative recovery,and elderly patients with cardiac insufficiency and complications often cannot tolerate this operation.Transcatheter aortic valve replacement(TAVR)is mainly used to treat patients with Aortic stenosis(AS),and its safety and effectiveness have been recognized by interventional experts.The indications for TAVR have expanded in recent years,Expert consensus suggests that TAVR should be considered for patients with AR who are contraindicated with SAVR or expected to benefit after TAVR treatment.however,there is no comprehensive and systematic study on the safety and effectiveness of TAVR in the treatment of high-risk patients with AR at home and abroad.Purpose:Discuss the safety and efficacy of TAVR for high-risk patients with AR,To find safe and effective treatment for high-risk patients with AR,and to further expand the indications of TAVR.Method:we collected the date of high-risk patients with AR who hospitalized in Central China Fu Wai hospital from September 2020 to March 2022.There are 33 patients treated with TAVR and 60 patients treated with SAVR.By analyzing the baseline data,perioperative data,perioperative adverse events,ultrasonic indicators,and end point events of TAVR and SAVR groups,the safety and efficacy of TAVR in the treatment of highrisk AR patients were further discussed.Results:1.The TAVR is better than SAVR in the amount of bleeding,the timespan of operation,the timespan in ICU,the timespan of postoperation,the total timespan in hospital with statistical significant(P<0.05).2.One year after operation,the indexes of regurgitant valve orifice area,pulmonary artery systolic pressure,left ventricular end diastolic diameter and left ventricular end systolic diameter in TAVR and SAVR groups showed the decreasing trend,while the indexes of Left Ventricular ejection fraction and Left ventricular posterior wall thickness showed the increasing trend.the indexes of Left Ventricular ejection fraction in TAVR group improved better than SAVR group.3.In the TAVR group,the success rate of artificial valve implantation was 81.82%(27/33),among which 3 cases received Valve in Valve due to severe Perivalvular Leakage and 3 cases received Valve in Valve due to poor valve placement,and no conversion to surgery for thoracotomy.It is no significant differences in the incidence of all-cause death,stroke,perioperative infection,electrical defibrillation,angiopathy complications,hemodynamic disturbance,gastrointestinal bleeding and myocardial infarction between TAVR and SAVR groups(P > 0.05).The incidence of perivalvular leakage,valve in valve and cardiac conduction block in TAVR group was higher than that in SAVR group,and the difference was statistically significant(P < 0.05).Conclusion:1.Compared with SAVR,TAVR has less trauma,less blood loss,shorter operation time,short special care time and faster recovery.2.TAVR can promote reverse left ventricular remodeling and improve cardiac function in high-risk patients with AR,especially in improving left heart function.3.TAVR can safely and effectively treat high-risk patients with AR,but attention should be paid to postoperative complications such as perivalvular leakage,valve in valve and cardiac conduction block disease.