主动脉瓣球囊成形术治疗严重主动脉瓣狭窄的直接益处:冠状动脉重症监护病房的血流动力学超声评估

M. Calcaianu, U. Crimizade, N. Messas, D. Bresson, J. Wiedemann, O. Roth, M. Kindo, O. Morel, J. Lévy, L. Jacquemin, P. Ohlmann
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引用次数: 0

摘要

背景:球囊主动脉瓣成形术(BAV)可以通过降低主动脉瓣梯度和增加主动脉瓣面积(AVA),作为外科主动脉瓣置换术(AVR)或经导管主动脉瓣置换术(TAVI)的桥梁治疗,在严重晚期主动脉瓣狭窄(AS)中可能是一种挽救生命的方法。很少有人知道BAV对心输出量的好处。我们的研究建议通过经胸超声心动图(TTE)评估BAV后的血流动力学变化。方法:前瞻性纳入2014年7月至2015年7月连续30例接受BAV治疗的AS患者。bav前后分别行TTE血流动力学评估。低心输出量(CO)定义为心脏指数(CI) < 2.5 L/min/ m2。结果:平均年龄82±8岁;56.7%为女性;logistic EuroSCORE I平均值为31±19%。20例(67%)低有限公司TTE表明患者低公司改善艾娃(从0.57±0.2,1.05±0.5,p = 0.043), CI(从1.9±0.4,2.8±1.0 L / min /米2,p < 0.0001), LVEF(±16日31日至38±13%,p = 0.006),倾向于降低收缩期肺动脉压力(sPAP)(于52±19日至43±11毫米汞柱,p = 0.06),增加平均动脉压(MAP)(79±10至83±12毫米汞柱,p = 0.046)。正常CO (CI≥2.5 L/min/ m2)患者的血流动力学差异无统计学意义。结论:通过增加AVA、BAV,可立即显著改善心输出量,特别是基线时低CO的患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Immediate benefit of balloon aortic valvuloplasty in severe aortic stenosis: hemodynamic echographic assessment in Intensive Coronary Care Unit
Background : Balloon aortic valvuloplasty (BAV) might be a life saving procedure in critically advanced aortic stenosis (AS) as a bridge therapy to surgical aortic valve replacement (AVR) or to trans-catheter aortic heart valve (TAVI), by reducing trans-aortic gradient and increasing aortic valve area (AVA). Few is known on the benefit of BAV on cardiac output. Our study proposed to evaluate the hemodynamic changes after BAV by transthoracic echocardiography (TTE). Methods: 30 consecutive patients with AS undergoing BAV were prospectively included between July 2014 and July 2015. Hemodynamic assessment was performed pre- and post-BAV by TTE. Low cardiac output (CO) was defined by a cardiac index (CI) < 2.5 L/min/m 2 . Results: Mean age was 82 ± 8 years; 56.7% were female; mean logistic EuroSCORE I was 31 ± 19 %. 20 patients (67%) had low CO. TTE showed that the patients with low CO improved AVA (from 0.57 ± 0.2 to 1.05 ± 0.5, p=0.043), CI (from 1.9 ± 0.4 to 2.8 ± 1.0 L/min/m 2 , p<0.0001), LVEF (from 31 ± 16 to 38 ± 13%, p=0.006), tend to decrease systolic pulmonary artery pressure (sPAP) (from 52 ± 19 to 43 ± 11 mmHg, p=0.06) and to increase mean arterial pressure (MAP) (from 79 ± 10 to 83 ± 12 mmHg, p=0.046). There was no statistically significant difference in terms of hemodynamic in patients with a normal CO (CI ≥ 2.5 L/min/m 2 ). Conclusion: By increasing AVA, BAV significantly and immediately improve cardiac output especially in patients with low CO at baseline.
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