Transcatheter Valve-in-Valve Implantation for Failed Bioprosthetic Heart Valves
Transcatheter Valve-in-Valve Implantation for Failed Bioprosthetic Heart Valves
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DOI：
10.1161/circulationaha.109.924613
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发表时间：
2010-04-27
期刊：
影响因子：
37.8
通讯作者：
Cheung, Anson
中科院分区：
文献类型：
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作者：
Webb, John G.;Wood, David A.;Cheung, Anson
背景-目前植入的大多数人工心脏瓣膜都是组织瓣膜，预计它们会随着时间的推移而退化并最终失效。重复心脏手术来更换这些瓣膜与显着的发病率和死亡率相关。在失败的生物假体内进行经导管心脏瓣膜植入，即“瓣中瓣”手术，可能提供一种侵入性较小的替代方案。方法和结果——对 24 名高危患者进行了瓣中瓣植入。失败的瓣膜是主动脉瓣 (n=10)、二尖瓣 (n=7)、肺瓣 (n=6) 或三尖瓣 (n=1) 生物瓣膜。除 1 名患者外，所有患者均成功植入并立即恢复满意的瓣膜功能。植入后没有患者出现轻度反流。手术过程中没有患者死亡。 30 天死亡率为 4.2%。死亡率主要与这种高风险经历早期的学习曲线问题有关。基线时，88% 的患者处于纽约心脏协会功能分级 III 或 IV 级；在最后一次随访时，88%的患者属于I级或II级。中位随访时间为 135 天（四分位距为 46 至 254 天），最长随访时间为 1045 天，91.7% 的患者仍存活并具有满意的瓣膜功能。 结论——经导管瓣中瓣植入是治疗生物瓣膜衰竭的一种可重复的选择。主动脉瓣、肺动脉瓣、二尖瓣和三尖瓣组织瓣膜均适合这种方法。这一发现可能对高危患者的瓣膜置换术具有重要意义。 （流通。2010 年；121：1848-1857。）
Background-The majority of prosthetic heart valves currently implanted are tissue valves that can be expected to degenerate with time and eventually fail. Repeat cardiac surgery to replace these valves is associated with significant morbidity and mortality. Transcatheter heart valve implantation within a failed bioprosthesis, a "valve-in-valve" procedure, may offer a less invasive alternative.Methods and Results-Valve-in-valve implantations were performed in 24 high-risk patients. Failed valves were aortic (n=10), mitral (n=7), pulmonary (n=6), or tricuspid (n=1) bioprostheses. Implantation was successful with immediate restoration of satisfactory valve function in all but 1 patient. No patient had more than mild regurgitation after implantation. No patients died during the procedure. Thirty-day mortality was 4.2%. Mortality was related primarily to learning-curve issues early in this high-risk experience. At baseline, 88% of patients were in New York Heart Association functional class III or IV; at the last follow-up, 88% of patients were in class I or II. At a median follow-up of 135 days (interquartile range, 46 to 254 days) and a maximum follow-up of 1045 days, 91.7% of patients remained alive with satisfactory valve function.Conclusions-Transcatheter valve-in-valve implantation is a reproducible option for the management of bioprosthetic valve failure. Aortic, pulmonary, mitral, and tricuspid tissue valves were amenable to this approach. This finding may have important implications with regard to valve replacement in high-risk patients. (Circulation. 2010; 121: 1848-1857.)