摘要目的:探讨应用J-Valve瓣膜经心尖导管主动脉瓣置换术(TA-TAVI)治疗低冠状动脉开口的主动脉瓣狭窄患者的早期临床疗效安全性和有效性。方法:回顾性收集2020年1月至2022年4月在首都医科大学附属北京安贞医院瓣膜外科诊疗中心行TA-TAVI治疗的冠状动脉开口高度≤ 10 mm的主动脉瓣狭窄患者20例，所有患者均经术前影像学筛选。术前行冠状动脉保护5例：其中3例为冠状动脉开口高度低于5 mm；2例为冠状动脉支架置入术后，支架内狭窄<50%，且冠状动脉开口位置低于8 mm。分析TA-TAVI术后并发症、病死率及心功能预后情况。结果:20例中男5例，女15例。全组平均(73.00±6.20)岁。经胸超声心动图提示所有患者均为主动脉瓣重度狭窄，心功能(NYHA分级)Ⅲ－Ⅳ级占85%，其中主动脉瓣狭窄伴关闭不全患者比例达80%。主动脉根部CT三位成像测定患者平均冠状动脉开口高度：左冠状动脉开口高度(LCA)(9.07±3.70)mm，右冠状动脉开口高度(RCA)(11.39±3.00)mm；其中冠状动脉开口高度≤5 mm 3例(7.5%)，5~8 mm 5例(12.5%)，8~10 mm 16例(40.0%)。平均主动脉窦(valsalva)部直径：左(30.06±5.90)mm；右(28.50±5.68)mm；无(29.96±6.15)mm。所有患者手术均经心尖导管成功置入J-Valve瓣膜，以23号为多，同期行体外循环(CPB)辅助2例，术后置入永久起搏器2例，无中度及以上瓣周漏。全组患者术前与术后24 h肌钙蛋白I差异无统计学意义( P>0.05)，肌红蛋白差异有统计学意义( P<0.05)。5例冠状动脉保护患者术后监测冠状动脉血流3级，术后均未行冠状动脉支架置入术，无术中及术后冠状动脉阻塞患者，无30天内死亡。TA-TAVI术后30天疗效可，并发症发生率低，心功能预后良好。 结论:使用J-Valve经心尖导管主动脉瓣置换治疗低冠状动脉开口的主动脉瓣狭窄患者是安全有效的。

abstractsObjective:To investigate the safety and efficacy of J-valve transapical catheter aortic Valve replacement(TA-TAVI) in the early treatment of aortic stenosis with low coronary ostium.Methods:From January 2020 to April 2022, 20 patients with aortic stenosis with coronary opening height ≤10 mm who underwent TA-TAVI treatment in the Valve Surgery Center of Beijing Anzhen Hospital Affiliated to Capital Medical University were enrolled retrospectively. All patients underwent preoperative imaging screening, and 5 patients underwent preoperative coronary artery protection: The height of coronary artery opening was less than 5 mm in 3 cases. 2 cases had stent stenosis & LT after coronary artery stenting 50%, and the position of the coronary artery opening was less than 8mm. The postoperative complications, mortality and cardiac function prognosis of TA-TAVI were analyzed.Results:There were 5 males and 15 females. The average age of the whole group was(73.00±6.20) years. Transthoracic echocardiography showed that all patients had severe aortic valve stenosis, and 85% of the patients had NYHA grade Ⅲ-Ⅳ, and 80% of the patients had aortic valve stenosis with insufficiency. The mean height of left coronary artery opening was(9.07±3.70) mm. RCA(11.39±3.00) mm; The opening height of coronary artery was ≤5 mm in 3 cases(left 7.5%), 5-8 mm in 5 cases(12.5%), and 8-10mm in 16 cases(40.0%). Mean aortic sinus(valsalva) diameter: Left(30.06±5.90) mm; Right(28.50±5.68) mm; Non(29.96±6.15) mm. J-valve Valve was successfully implanted through apical catheter in all patients, most of whom were size 23. CPB was performed in 2 patients at the same time, permanent pacemaker was inserted in 2 patients, and moderate or above perivalvular leakage was found in 0 patients. All patients had TNI( P=0.12) and MYO( P=0.03) before and 24 hours after operation. None of the 5 patients underwent coronary artery stenting. None of the 5 patients died within 30 days after the operation. Ta-tavi is effective 30 days after operation, with low complication rate and good prognosis of cardiac function. Conclusion:J-valve transapical catheter aortic Valve replacement is safe and effective in the treatment of aortic stenosis with low coronary ostium.