The Efficacy Of Surgical Treatment And TAVI Intervention For Bicuspid Aortic Valve Stenosis

Objective: To evaluate the clinical effects of TAVI interventional therapy and traditional median sternal aortic valve surgery.Methods: From January 2020 to December2022,a retrospective analysis was performed on 497 patients with aortic valve related surgery who were admitted to the Heart Center of the First Affiliated Hospital of Xinjiang Medical University and received basic and corresponding surgical treatment.Among them,213 patients were diagnosed with aortic valve related surgery.The criteria for inclusion were:(1)Based on clinical manifestations,physical examination,imaging(cardiac ultrasound),Diagnosis of aortic valve bilobar malformation;(2)Age ≤ 80 years old;(3)Perform cardiac surgery for the first time;(4)Patients over 50 years of age or with symptoms of angina should undergo coronary angiography to exclude coronary artery lesions.(5)The case data is complete,and the exclusion criteria are:(1)History of cardiac,chest wall,and lung surgery,chest wall abnormalities,scoliosis,and other diseases;(2)Pericardial disease,pericardial adhesions;(3)Patients with malignant tumors;(4)Patients with preoperative hematological diseases;(5)Severe chronic obstructive pulmonary disease(COPD),severe pulmonary hypertension;(6)Patients with failure of other important organs such as brain,lung,liver,etc.;(7)Patients in acute infection stage;(8)Patients with incomplete case data.SPSS20 was used for statistical processing,and 188 patients were eventually included.These patients underwent AVR,bentall surgery,wheat surgery,and TAVI surgery,respectively.AVR surgery,bentall surgery,and wheat surgery were set as the open chest group,and TAVI surgery was set as the non open chest group.General information,past medical history,surgical related information,preoperative and postoperative cardiac ultrasound testing data,and patient outcomes were collected.Results: There was no significant difference between the two groups in terms of age and gender complications,and there was no significant difference in cardiac function,cardiac ultrasound,postoperative implantation of CRRT,and postoperative implantation of IABP;The postoperative hospitalization days in the thoracotomy group were longer than those in the non thoracotomy group;Postoperative ICU hospitalization is longer and postoperative blood transfusion rate is higher.Compared with patients in the thoracotomy group,the incidence of postoperative atrioventricular block in the non thoracotomy group is higher;The incidence of perivalvular leakage is higher;The incidence of postoperative myocardial infarction is high,and the total cost of hospitalization is high.Conclusion: 1.Surgical thoracotomy and TAVI surgery are safe and effective in the treatment of aortic valve bilobar malformation.TAVI surgery has advantages in short surgical time,minimal trauma,short postoperative ICU hospitalization,short total postoperative hospitalization,and lower postoperative blood transfusion rate.It has the advantages of reducing trauma,accelerating recovery,and beauty.Surgical thoracotomy can simultaneously treat the ascending aorta or coronary artery lesions,which has advantages in terms of hospital costs and lower postoperative complications.Both surgical treatment and TAVI intervention should be performed in a comprehensive heart center.