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  • 周广为,潘佳君,乔帆,李莉,陆方林,徐志云*.经导管主动脉瓣置换术围手术期心电图表现及临床意义[J].第二军医大学学报,2019,40(9):1032-1035    [点击复制]
  • ZHOU Guang-wei,PAN Jia-jun,QIAO Fan,LI Li,LU Fang-lin,XU Zhi-yun*.Electrocardiogram during perioperative period of transcatheter aortic valve replacement: characteristics and clinical implications[J].Acad J Sec Mil Med Univ,2019,40(9):1032-1035   [点击复制]
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经导管主动脉瓣置换术围手术期心电图表现及临床意义
周广为,潘佳君,乔帆,李莉,陆方林,徐志云*
0
(海军军医大学(第二军医大学)长海医院心血管外科, 上海 200433
*通信作者)
摘要:
目的 总结经导管主动脉瓣置换术(TAVR)围手术期心电图表现及临床意义。方法 纳入2017年12月至2018年12月我院心血管外科行TAVR治疗的20例重度主动脉瓣狭窄或重度主动脉瓣关闭不全患者。其中经心尖途径8例(采用J-Valve自膨胀瓣膜),经股动脉途径12例(采用Venus-A自膨胀瓣膜),根据术前、术后心电图表现分析患者围手术期心律失常的发生情况。结果 20例患者均合并严重心力衰竭(纽约心脏协会心功能分级为Ⅲ、Ⅳ级),平均年龄为(77.8±4.9)岁。20例TAVR全部成功,随访时间为(8.0±3.1)个月。其中应用Venus-A瓣膜患者围手术期新发Ⅲ度房室传导阻滞者2例(均于术后7~12 d自行恢复正常传导功能),新发左束支传导阻滞者6例,新发右束支传导阻滞者2例;应用J-Valve瓣膜患者围手术期无新发Ⅲ度房室传导阻滞,新发左束支传导阻滞者4例,新发右束支传导阻滞者2例,新发多源室性心动过速及室性早搏者3例。结论 左束支传导阻滞是TAVR围手术期发生较多的心律失常类型。
关键词:  经导管主动脉瓣置换术  围手术期  心电描记术  心律失常
DOI:10.16781/j.0258-879x.2019.09.1032
投稿时间:2019-02-04修订日期:2019-06-06
基金项目:国家重点研发计划(2016YFC1100900).
Electrocardiogram during perioperative period of transcatheter aortic valve replacement: characteristics and clinical implications
ZHOU Guang-wei,PAN Jia-jun,QIAO Fan,LI Li,LU Fang-lin,XU Zhi-yun*
(Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China
*Corresponding author)
Abstract:
Objective To summarize the characteristics and clinical implications of electrocardiogram (ECG) during the perioperative period of transcatheter aortic valve replacement (TAVR). Methods From Dec. 2017 to Dec. 2018, 20 patients with severe aortic valve stenosis or severe aortic valve insufficiency who underwent TAVR were admitted to Department of Cardiovascular Surgery of our hospital. Eight cases had transapical aortic valve implantation with J-Valve self-expandable valves and 12 cases had transfemoral aortic valve implantation with Venus-A self-expandable valves. Arrhythmia incidence was analyzed based on the ECG results during perioperative period. Results All the 20 cases were complicated with severe heart failure (New York Heart Association classification of cardiac function Ⅲ-Ⅳ). The mean age of patients was (77.8±4.9) years. TAVR was successfully performed in all the 20 patients. The mean follow-up period was (8.0±3.1) months. In the Venus-A self-expandable valve group, there were 2 cases of new onset grade Ⅲ atrioventricular block (resolved 7-12 d postoperatively), 6 cases of new onset left bundle branch block (LBBB), and 2 cases of new onset right bundle branch block (RBBB). In J-Valve self-expandable valve group, there were 4 cases of new onset LBBB, 2 cases of new onset RBBB and 3 cases of multifocal ventrical tachycardia plus ventricular premature beat. Conclusion New onset LBBB arrhythmia has a high incidence during the perioperative period of TAVR.
Key words:  transcatheter aortic valve implantation  perioperative period  electrocardiography  arrhythmia