Implantation of the Edwards SAPIEN XT and SAPIEN 3 valves for pulmonary position in enlarged native right ventricular outflow tract
Implantation of the Edwards SAPIEN XT and SAPIEN 3 valves for pulmonary position in enlarged native right ventricular outflow tract
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DOI：
10.14744/anatoljcardiol.2020.46024
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发表时间：
2021-02-01
影响因子：
1.3
通讯作者：
Ergul, Yakup
中科院分区：
文献类型：
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作者：
Guzeltas, Alper;Tanidir, Ibrahim Cansaran;Ergul, Yakup
目的：经皮肺动脉瓣植入术（PPVI）进入右心室-肺动脉管道的情况越来越多，但对于自体右心室流出道（RVOT）扩张的患者，有几种选择可用，其中之一是标签外使用Edwards SAPIEN（R）瓣膜。本研究回顾了SAPIEN XT和SAPIEN 3（S3）瓣膜在自体RVOT扩张患者中在肺动脉位置进行瓣膜置换的结果。方法：2015年1月至2020年3月期间，对129例患者进行了PPVI手术。其中，103例（80%）自体RVOT扩张，其中86例符合PPVI预支架和瓣膜植入的条件。回顾性分析了84例使用SAPIEN XT或S3瓣膜成功植入PPVI并扩张自体RVOT的患者。结果：手术成功率为84/86（98%）。年龄中位数为18.7岁（8-46岁），体重中位数为57 kg（22-102 kg）。主要基础诊断为法洛四联症（n=77/84）。在50/84例（60%）病例中，支架植入术与瓣膜植入术同时进行，其中6例为混合手术，而在34/84例病例中，预支架植入术提前3 - 14周进行。瓣膜植入前，支架的右前斜径和侧径中位数分别为26 mm（20-32 mm）和28 mm（21-32 mm）。XT的瓣膜尺寸为26 mm（n=13）和29 mm（n=64），S3的瓣膜尺寸为29 mm（n=7）。在59例患者中，额外向瓣膜球囊中添加1-5 ml（中位数2 ml）体积以稳定。在所有混合手术中，支架和瓣膜均在同一手术中植入。在1至59个月（中位数14个月）的随访期间，无死亡病例报告，3例患者继发于手术发生三尖瓣返流，所有患者的瓣膜均继续发挥功能。结论：Edwards SAPIEN XT和S3瓣膜可替代PPVI治疗自体RVOT扩张患者。
Objective: Percutaneous pulmonary valve implantation (PPVI) into right ventricle-to-pulmonary artery conduits is increasingly being performed, but a few options are available for patients with a dilated native right ventricular outflow tract (RVOT), among which is the off-label use of Edwards SAPIEN (R) valves. This study reviews the results of the SAPIEN XT and SAPIEN 3 (S3) valve implantations in the pulmonary position in patients with a dilated native RVOT.Methods: Between January 2015 and March 2020, PPVI procedures were performed on 129 patients. Among them, 103 (80%) had dilated native RVOT, 86 of whom were eligible for PPVI prestenting and valve implantation. Retrospective analysis was performed on 84 patients who have undergone successful PPVI implantation using the SAPIEN XT or S3 valves with dilated native RVOT.Results: The procedural success rate was 84/86 (98%). The median age was 18.7 years (8-46 years), and the median weight was 57 kg (22-102 kg). The primary underlying diagnosis was tetralogy of Fallot (n=77/84). Stenting was performed simultaneously with valve implantation in 50/84 (60%) cases-six of which were hybrid procedures-whereas prestenting was performed 3 to 14 weeks earlier in 34/84 cases. Before valve implantation, the median right anterior oblique and lateral diameters of the stents were 26 mm (20-32 mm) and 28 mm (21-32 mm). Valve sizes were 26 mm (n=13) and 29 mm (n=64) for XT and 29 mm (n=7) for S3. In 59 patients, an additional 1-5 ml (median 2 ml) volume was added to the valves' balloons for stabilization. In all hybrid procedures, the stent and valve were implanted in the same session. During follow-ups of 1 to 59 months (median 14 months), no deaths were reported, 3 patients developed tricuspid regurgitation secondary to the procedure, and valves continued to function in all patients.Conclusion: The Edwards SAPIEN XT and S3 valves may be an alternative to PPVI in patients with dilated native RVOT.