A Comparative Study Of Transcatheter Intervention And Traditional Median Thoracotomy In The Treatment Of Aortic Valve Disease

ObjectiveThrough retrospective analysis,to compare the treatment of aortic valve disease by transcatheter intervention and traditional median thoracotomy,to explore the clinical efficacy and safety of transcatheter aortic valve replacement in the treatment of aortic valve disease,and to summarize the experience of transcatheter aortic valve replacement in the treatment of aortic valve disease.MethodsThe patients with aortic valve disease in our hospital from March 2017 to February 2020 were retrospectively analyzed.50 patients were selected in conformity with the inclusion criteria.24 patients(13’ males and 11 females)underwent transcatheter interventional aortic valve replacement in TAVR group and 26 patients(14 males and 12 females)underwent traditional median thoracotomy aortic valve replacement in SAVR group.The preoperative index,operation time,intraoperative blood loss,postoperative ventilator assist time,postoperative ICU monitoring time and perioperative complications of the two groups were contrasted and analyzed.1 month,3 months,6 months and 1 year after operation were paid a follow-up visit.ResultsThere was no death in both groups,and there was no significant difference in mortality between the two groups(P>0.05).There was no significant different part in preoperative data between the two groups,such as age,sex,body weight,body surface area,cardiothoracic ratio,factors and types of aortic valve disease,cardiac function grade,left ventricular ejection fraction and preoperative complications(P>0.05).The time of operation and the amount of intraoperative blood loss in the two groups were notably less than those in the SAVR group(P<0.05).During the perioperative period,there were differences in postoperative ventilator-assisted breathing time,postoperative ICU monitoring time,postoperative hospital stay,postoperative 24-hour drainage,postoperative blood transfusion rate and surgical incision length between TAVR group and SAVR group.There was notable difference between the two groups in postoperative mild perivalvular leakage(25%vs 3.8%P=0.03)and new atrioventricular block(16.7%vs 0 pause 0.03).There was no difference in the comparison of postoperative new atrial fibrillation(8.3%vs 19.2%P=0.27),new bundle branch block(12.5%vs 7.7%P=0.57),incision infection(0 vs 7.7%P=0.17),acute renal injury(12.5%vs 3.8%P=0.26)and stroke(4.2%vs 0 P=0.29).In TAVR group,there were notable differences in left ventricular ejection fraction,mean aortic valve transvalvular pressure difference and aortic valve maximum transvalvular pressure difference between before and after operation.In SAVR group,there were significant differences in left ventricular ejection fraction,mean aortic valve transvalvular pressure difference and aortic valve maximum transvalvular pressure difference between before and after operation.There was no significant difference in postoperative left ventricular ejection fraction(59.1±2.8%vs±1.8%,P=0.64),average aortic valve transvalvular pressure difference(8.4±2.3 vs 8.3±2.4 mmHg,P=0.89)and aortic valve maximum transvalvular pressure difference(17.4±5.8 vs 16.9±4.6 mmHg,P=0.34).There was no significant difference in bleeding,infective endocarditis,acute renal injury,stroke,artificial valve failure and cardiac function classification between the two groups(P>0.05).ConclusionTranscatheter aortic valve replacement is safe and effective for the treatment of elderly patients with aortic valve disease,and can achieve the same therapeutic effect as median thoracotomy aortic valve replacement,and the incision is beautiful,the trauma is less,and the hospital stay is relatively short.It is necessary to pay attention to the postoperative complications,closely monitor the changes of vital signs and various indexes,and detect and actively deal with the complications as soon as possible.