杨宗达,廖旭嘉,赵铎

• 1:佛山市第一人民医院心血管外科

摘要(Abstract)：

目的:总结单中心应用J-Valve瓣膜行经心尖途径治疗高危主动脉瓣疾病及二尖瓣生物瓣衰败的临床经验，评估其安全性、有效性及中期随访结果。方法:回顾性纳入2022年1月—2025年12月于佛山市第一人民医院接受经心尖J-Valve瓣膜置入术的患者共40例，包括主动脉瓣置换组35例(主动脉瓣关闭不全23例，主动脉瓣狭窄12例)和二尖瓣瓣中瓣组5例。收集患者基线资料、围术期指标、并发症及随访结果，对比手术前后心功能、左心室重构指标及生活质量的变化。结果:全组手术成功率为92.5%(37/40)。主动脉瓣置换组中，1例瓣环30 mm患者术后1个月发生瓣膜移位行Bentall手术，1例二叶畸形患者术中瓣膜移位中转开胸，围术期死亡1例(2.5%),因术前全身状态不佳术后多器官功能衰竭。术后永久起搏器植入2例(5.0%)。中位随访18个月，主动脉瓣置换组患者左心室射血分数由术前的(52.4±9.8)%提升至(58.6±7.2)%(P<0.01),左心室舒张末期内径由(62.5±8.4) mm降至(53.2±7.1) mm(P<0.01),6 min步行距离由(265±78) m增至(412±65) m(P<0.01),N末端脑钠肽前体显著下降。二尖瓣瓣中瓣组5例中3例术后6个月～1年内因瓣膜重度狭窄死亡，1例术后介入瓣瓣膜狭窄进行开胸手术生物瓣置换，1例二尖瓣瓣中瓣存活，原因与原位瓣环小、介入瓣展开不良导致亚临床血栓形成相关。1例主动脉瓣术后患者停用华法林后出现瓣膜血栓致重度狭窄，重启抗凝后血栓消失。结论:J-Valve经心尖途径治疗高危主动脉瓣疾病安全有效，术后心功能及左心室重构显著改善。但二尖瓣瓣中瓣术后早期衰败率高，需谨慎选择病例并优化抗凝策略。术后抗凝方案应个体化，心房颤动患者需长期抗凝，无心房颤动患者建议至少半年华法林抗凝后终身服用阿司匹林，以预防亚临床血栓形成。

关键词(KeyWords)： 经导管主动脉瓣置换术;经心尖途径;J-Valve瓣膜;主动脉瓣关闭不全;瓣中瓣;抗凝治疗

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 杨宗达,廖旭嘉,赵铎

DOI: 10.13201/j.issn.1001-1439.2026.10.009

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