Prognosis of Transcatheter Closure Compared with Surgical Repair of Paravalvular Leak after Prosthetic Valve Replacement: A Retrospective Comparison
Prognosis of Transcatheter Closure Compared with Surgical Repair of Paravalvular Leak after Prosthetic Valve Replacement: A Retrospective Comparison
复制标题
人工瓣膜置换术后瓣周漏经导管封堵术与手术修复的预后比较：回顾性比较
DOI：
10.1055/s-0038-1639334
复制
发表时间：
2020-03-01
影响因子：
1.5
通讯作者：
Yang, Jian
中科院分区：
文献类型：
--
作者：
Yang, Chun;Liu, Yang;Yang, Jian
瓣膜置换术后的瓣周漏（PVL）仍然具有临床挑战性。经皮闭合是PVL患者的有效治疗方法，因为再手术的发病率和死亡率较高。本研究的目的是回顾性比较经导管封堵术和手术修复的临床结果与PVL.MethodsFrom 2000年1月至2016年5月，131例PVL患者在三个主要的医疗中心在中国。围手术期的特点和结果的procedure.ResultsSixty-eight（51.9%）PVLs患者进行了治疗，经皮经导管封堵术（I组）。67例（98%）手术成功，无院内死亡。63例（48.1%）PVL患者接受了再次手术（组II）。5例外科手术患者因残余返流进行了第三次心内直视手术，1例成功经皮闭合。6例患者术后在医院死亡。组II中的所有患者，但组I中只有11例需要围手术期输血。组I的手术时间和术后住院时间显著短于组II。1年随访时，I组55例（82%）患者和II组39例（68%）患者的心功能改善≥ 1个纽约心脏协会功能分级。在选定的患者中，与手术治疗相比，它与较低的住院死亡率、较短的手术时间和较少的输血相关。
ObjectiveParavalvular leak (PVL) after valve replacement remains clinically challenging. Percutaneous closure is an effective therapy for patients with PVLs because reoperation is associated with high rates of morbidity and mortality. The purpose of this study was to retrospectively compare the clinical outcome of transcatheter closure and surgical repair in patients with a PVL.MethodsFrom January 2000 to May 2016, 131 patients with PVL were treated at three major medical centers in China. Perioperative characteristics and outcomes of the procedure were reviewed.ResultsSixty-eight (51.9%) patients with PVLs were treated with percutaneous transcatheter closure (group I). The procedure was successful in 67 (98%) with no hospital deaths. Sixty-three (48.1%) patients with PVLs had a reoperation (group II). Five of the surgical patients had a third open-heart operation for residual regurgitation, and one underwent successful percutaneous closure. Six patients died in the hospital postoperatively. All patients in group II but only 11 in group I needed perioperative blood transfusions. The procedural time and hospital stay after the procedure were significantly shorter in group I than in group II. At the 1-year follow-up, cardiac function improved by ≥ 1 New York Heart Association functional class in 55 (82%) patients in group I and in 39 (68%) patients in group II.ConclusionsTranscatheter closure was shown to be a safe, effective therapeutic option in patients with PVL. It was associated with a lower hospital mortality rate, shorter procedural time, and fewer blood transfusions than surgical treatment in selected patients.