5-Year Experience With Transcatheter Transapical Mitral Valve-in-Valve Implantation for Bioprosthetic Valve Dysfunction
5-Year Experience With Transcatheter Transapical Mitral Valve-in-Valve Implantation for Bioprosthetic Valve Dysfunction
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DOI：
10.1016/j.jacc.2013.01.058
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发表时间：
2013-04-30
影响因子：
24
通讯作者：
Ye, Jian
中科院分区：
文献类型：
--
作者：
Cheung, Anson;Webb, John G.;Ye, Jian
目的总结经导管二尖瓣置入术(TVIV)的临床经验。对于二尖瓣退行性变的高危患者，经导管二尖瓣置入术可能是一种风险较低的替代治疗方法。方法2007年7月至2012年9月，连续23例二尖瓣生物瓣功能不全患者接受经心尖TVIV治疗。生物假体失败继发于狭窄6例(26.1%)，反流9例(39.1%)，合并8例(34.8%)。结果所有患者均为老年人(平均年龄81+/-6岁)和传统再手术的高危人群(胸外科学会评分12.1+/-6.8%)。所有患者均使用可扩张球囊瓣膜(爱德华兹生命科学公司，加利福尼亚州欧文)成功地完成了经心尖二尖瓣TVIV，术中未出现重大并发症。住院期间发生大卒中1例(4.4%)，大出血6例(26.1%)。术后二尖瓣跨瓣压差从11.1+/-4.6 mm Hg降至6.9+/-2.2 mm Hg(p<；0.01)。TVIV术后二尖瓣间返流全部消失(47.8%)或轻度(52.2%)。未见跨瓣返流病例。所有患者在30天的随访期内均存活。中位随访时间为753天(四分位数范围为376至1119天)，存活率为90.4%。1例患者在2个月后因经导管瓣膜的心房移位而成功接受二尖瓣TVIV再介入治疗。所有存活的患者均为纽约心脏协会功能I/II级，瓣膜性能良好。结论经导管二尖瓣根尖置入术治疗生物二尖瓣置换术具有手术并发症少、死亡率低、中期临床和血流动力学结果良好等优点。(J Am Coll心脏ol 2013；61：1759-66)(C)2013，美国心脏病学会基金会
Objectives The study sought to describe the authors' experience with mitral transapical transcatheter valve-in-valve implantation (TVIV).Background Increasing numbers of mitral biological prostheses are being implanted in clinical practice. Transcatheter valve-in-valve implantation may be a lower risk alternative treatment for high-risk patients with mitral valve degeneration.Methods Twenty-three consecutive patients with severe mitral bioprosthetic valve dysfunction underwent transapical mitral TVIV between July 2007 and September 2012. Bioprosthetic failure was secondary to stenosis in 6 (26.1%), regurgitation in 9 (39.1%), and combined in 8 (34.8%) patients.Results All patients were elderly (mean age 81 +/- 6 years) and at high-risk for conventional redo surgery (Society of Thoracic Surgeons score 12.1 +/- 6.8%). Successful transapical mitral TVIV was accomplished in all patients using balloon expandable valves (Edwards Lifesciences, Irvine, California) with no intraoperative major complications. One (4.4%) major stroke and 6 (26.1%) major bleeds were reported during hospitalization. Mitral transvalvular gradient significantly decreased from 11.1 +/- 4.6 mm Hg to 6.9 +/- 2.2 mm Hg following the procedure (p < 0.01). Intervalvular mitral regurgitation was absent (47.8%) or mild (52.2%) in all cases after mitral TVIV. No cases of transvalvular regurgitation were seen. All patients were alive on 30-day follow-up. At a median follow-up of 753 days (interquartile range: 376 to 1,119 days) survival was 90.4%. One patient underwent successful mitral TVIV reintervention at 2 months due to atrial migration of the transcatheter valve. All patients alive were in New York Heart Association functional class I/II with good prosthetic valve performance.Conclusions Transcatheter transapical mitral valve-in-valve implantation for dysfunctional biological mitral prosthesis can be performed with minimal operative morbidity and mortality and favorable midterm clinical and hemodynamic outcomes. (J Am Coll Cardiol 2013;61:1759-66) (C) 2013 by the American College of Cardiology Foundation