Transapical transcatheter aortic valve implantation for predominant aortic regurgitation with a self-expandable valve
Transapical transcatheter aortic valve implantation for predominant aortic regurgitation with a self-expandable valve
复制标题
经心尖经导管主动脉瓣植入治疗主动脉瓣反流为主的自扩张瓣膜
DOI：
10.21037/jtd.2020.01.04
复制
发表时间：
2020-03-01
影响因子：
2.5
通讯作者：
Wang, Chunsheng
中科院分区：
文献类型：
--
作者：
Liu, Huan;Liu, Shun;Wang, Chunsheng
经导管主动脉瓣植入术（TAVI）已成为治疗高危重度主动脉瓣狭窄的金标准。然而，使用该技术治疗主动脉瓣返流（AR）的经验仍然有限。之前，我们已经证明了使用J-ValveTM（JieCheng Medical Technology Co.，有限公司、中国苏州）治疗主要AR，而从未报告长达4年的中期结局。方法2014年5月至2018年10月在中山医院采用J-ValveTM经心尖TAVI治疗主动脉瓣返流患者47例。使用瓣膜学术研究联盟-2标准（VARC-2）分析了随访4年的手术和临床结局。结果所有患者年龄73.7±7.9岁，经多学科心脏小组评估后，均被认为是外科主动脉瓣置换术（SAVR）的禁止或高风险（logistic欧洲心脏手术风险评估系统，21.1%~ 44.4%;平均24.3%±5.1%）。所有患者经心尖穿刺均获得成功。整个队列在最近一次随访（371 - 1,968天，中位数574天）中的临床结局包括全因死亡率（6.4%）、致残性卒中（2.3%）、新的永久性起搏器（6.8%）和瓣膜相关再介入（0）。末次随访时，44例患者中有37例发生瓣周漏（PVL），为无或微量，44例患者中有7例为轻度。瓣膜植入后随访期间的平均跨瓣压差为9.3±2.5 mmHg。结论J-ValveTM经心尖TAVI治疗AR具有良好的中期疗效，前期研究1年时的优势可持续4年。
Background Transcatheter aortic valve implantation (TAVI) has become the gold standard for high-risk severe aortic stenosis. However, the experience of treating aortic regurgitation (AR) with this technology is still limited. Previously, we have demonstrated excellent 1-year outcomes of transapical TAVI with J-ValveTM (JieCheng Medical Technology Co., Ltd., Suzhou, China) in treating predominant AR, while the mid-term outcomes up to 4 years have never been reported. Methods Transapical TAVI with J-ValveTM to treat predominant AR was performed in 47 patients in Zhongshan Hospital from May 2014 through October 2018. Procedural and clinical outcomes with follow-up up to 4 years were analyzed using Valve Academic Research Consortium-2 criteria (VARC-2). Results All patients (age 73.7±7.9 years) were considered to be prohibitive or high-risk for surgical aortic valve replacement (SAVR) (logistic European System for Cardiac Operative Risk Evaluation, 21.1% to 44.4%; mean, 24.3%±5.1%) after evaluated by a multidisciplinary heart team. Transapical implantations were successful in all patients. The clinical outcomes of the entire cohort in the latest follow-up (371 to 1,968 days, median 574 days) included all-cause mortality (6.4%), disabling stroke (2.3%), new permanent pacemaker (6.8%) and valve-related re-intervention (0). Paravalvular leak (PVL) was rate as none or trace in 37 of 44 and mild in 7 of 44 patients at the latest follow-up. Mean transvalvular gradient was favorable after valve implantation during follow-up at 9.3±2.5 mmHg. Conclusions This study revealed that, transapical TAVI with J-ValveTM for treating AR has encouraging mid-term outcomes, and the advantages at one year demonstrated in previous study can be maintained through 4 years.