Objectives: To explore the efficacy and safety of emergency transcatheter aortic valve replacement (TAVR). Methods: Data of patients who underwent emergency TAVR in eight centers, namely Fuwai Hospital, Wuhan Asia Heart Hospital, Xijing Hospital, Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Guangdong Provincial People's Hospital, Zhongshan Hospital Affiliated to Fudan University, the First Affiliated Hospital of Zhengzhou University, the Second Xiangya Hospital of Central South University, between May 2017 and December 2020 were retrospectively analyzed. The use of mechanical circulatory support system (MCS) and the results of laboratory tests (N-terminal B-type natriuretic peptide (NT-proBNP)) and echocardiography (mean aortic valve cross valve pressure difference and left ventricular ejection fraction) before and after operation were collected. The primary endpoint was all-cause death, and the secondary endpoints were stroke, major bleeding, major vascular complications, myocardial infarction, permanent pacemaker implantation, and acute renal injury. Device success was caculated, which refered to absence of procedural mortality and correct positioning of a single prosthetic heart valve into the proper anatomical location and intended performance of the prosthetic heart valve (mean aortic valve gradient<20 mmHg(1 mmHg=0.133 kPa) or peak velocity<3 m/s, with no moderate or severe prosthetic valve regurgitation). Kaplan-Meier survival curve was used to estimate the survival rate of patients during follow-up. Results: This study included 48 patients. The age was (72.5±8.1) years, and 34 patients were males (70.8%). Device success rate was 91.7% (44/48). The mean aortic valve transvalvular pressure was significantly decreased after operation ((12.3±6.4)mmHg vs. (60.2±23.8)mmHg, P<0.000 1). Left ventricular ejection fraction was significantly increased ((41.5±11.7)% vs. (31.0±11.3)%, P<0.000 1). NT-proBNP significantly decreased (3 492.0 (1 638.8, 7 165.5) ng/L vs. 12 418.5 (6 693.8, 35 000.0) ng/L, P<0.000 1). In-hospital all-cause mortality was 8.3% (4/48). During hospitalization, the rate of stroke was 2.1% (1/48), major bleeding was 6.3% (3/48), major vascular complications was 10.4% (5/48), myocardial infarction was 4.2% (2/48), permanent pacemaker implantation was 6.3% (3/48), and the rate of acute renal injury was 12.5% (6/48). MCS was used in 20 patients (41.7%). The median follow-up time was 196 days. During the follow-up, one patient died (due to systemic metastasis of pancreatic cancer), two cases suffered new myocardial infarction and one case received permanent pacemaker implantation. The survival rate of 30 days, 1 year and 2 years after the operation were 91.7% (44/48), 89.6% (43/48), 89.6% (43/48), respectively. Conclusion: Emergency TAVR may be a safe and effective treatment for patients with severe decompensated aortic valve stenosis.
目的： 初步探讨急诊经导管主动脉瓣置换术（TAVR）的有效性及安全性。 方法： 该研究为回顾性研究。入选2017年5月至2020年12月于中国医学科学院阜外医院、广东省人民医院、华中科技大学同济医学院附属协和医院、第四军医大学西京医院、上海复旦大学附属中山医院、武汉亚洲心脏病医院、郑州大学第一附属医院、中南大学湘雅二医院8家中心行急诊TAVR的患者。收集机械循环辅助装置（MCS）使用情况及手术前后实验室检验［N末端B型利钠肽原（NT-proBNP）］及超声心动图检查结果（平均主动脉瓣跨瓣压差、左心室射血分数）。主要终点事件为全因死亡，次要终点事件为卒中、大出血、主要血管并发症、心肌梗死、永久起搏器置入、急性肾损伤。计算器械置入成功率，器械置入成功指患者存活，单个人工主动脉瓣置入位置合适且术后平均主动脉瓣跨瓣压差<20 mmHg（1 mmHg=0.133 kPa）或主动脉瓣峰值流速<3 m/s，同时无中度及以上人工主动脉瓣膜反流。采用Kaplan-Meier生存曲线法估计患者随访期间生存率。 结果： 共纳入48例患者，年龄（72.5±8.1）岁，其中男性34例（70.8%）。器械置入成功率为91.7%（44/48）。全部患者的术后平均主动脉瓣跨瓣压差较术前降低［（12.3±6.4）mmHg比（60.2±23.8）mmHg，P<0.000 1］，左心室射血分数升高［（41.5±11.7）%比（31.0±11.3）%，P<0.000 1］，NT-proBNP下降［3 492.0（1 638.8，7 165.5）ng/L比12 418.5（6 693.8，35 000.0）ng/L，P<0.000 1］。入选患者的院内全因死亡率为8.3%（4/48），住院期间卒中发生率为2.1%（1/48），大出血发生率为6.3%（3/48），主要血管并发症发生率为10.4%（5/48），心肌梗死发生率为4.2%（2/48），永久起搏器置入率为6.3%（3/48），急性肾损伤发生率为12.5%（6/48）。20例患者应用了MCS，使用率达41.7%。中位随访时间196 d，随访期间全因死亡1例（因胰腺癌全身转移），新增心肌梗死2例，置入永久起搏器1例。术后30 d、1年及2年的生存率分别为91.7%（44/48）、89.6%（43/48）、89.6%（43/48）。 结论： 对于急危重症状态的失代偿性主动脉瓣重度狭窄患者，急诊TAVR可能是一种安全有效的治疗手段。.