Percutaneous Mitral Valve Replacement Using a Transvenous, Transseptal Approach Transvenous Mitral Valve Replacement
Percutaneous Mitral Valve Replacement Using a Transvenous, Transseptal Approach Transvenous Mitral Valve Replacement
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DOI：
10.1016/j.jcin.2015.01.028
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发表时间：
2015-05-01
影响因子：
11.3
通讯作者：
Rihal, Charanjit S.
中科院分区：
文献类型：
--
作者：
Coylewright, Megan;Cabalka, Allison K.;Rihal, Charanjit S.
结论：本文的目的是描述一种新的经导管二尖瓣置换术方法的可行性，仅使用静脉access.Background失败的二尖瓣假体需要再次手术可以代表一个高风险的临床情况。虽然重复心脏手术仍然是大多数二尖瓣手术失败的标准治疗，但对于手术风险高或极高的患者，正在开发新的经导管选择。大多数情况下，这是通过经心尖的方法在手术室进行，与并发症的相关风险以及延长住院时间。方法我们描述了一个病例系列的4个连续患者在高风险的再手术与退行性二尖瓣假体（生物瓣膜或瓣膜环）成功接受经静脉，结果2014年4月至5月，4例患者接受了经静脉，经导管心脏瓣膜经中隔二尖瓣置换术。平均年龄为72 +/- 9.9岁，胸外科医师协会的平均风险评分为12.5 +/-7.2%。所有患者都有严重的、限制生命的呼吸困难。4例手术均获得成功，无术中或术后并发症;超声心动图显示二尖瓣瓣中瓣或瓣中环就位良好且功能正常。患者在瓣膜置换术后2天内出院，呼吸困难明显改善。结论我们描述了一种经导管二尖瓣置换术的创新技术。该病例系列证明了仅使用股静脉入路进行经导管二尖瓣置换术的可行性，与经心尖入路或再次手术相比，并发症和住院时间显著减少。(C)2015年美国心脏病学院基金会。
OBJECTIVES The aim of this paper is to describe the feasibility of a novel transcatheter approach for mitral valve replacement using only venous access.BACKGROUND Failure of mitral valve prostheses necessitating reoperation can represent a high-risk clinical scenario. Although repeat cardiac surgery remains the standard of care for most failed mitral valve operations, nascent transcatheter options are under development for patients at high or extremely risk of surgery. Most often, this is performed via a transapical approach in the operating room, with associated risk of complications as well as extended length of hospital stay.METHODS We describe a case series of 4 consecutive patients at high risk of reoperation with degenerative mitral prostheses (bioprosthetic valves or rings) who successfully underwent transvenous, transseptal mitral valve replacement with a commercially available transcatheter heart valve.RESULTS From April to May 2014, 4 consecutive patients underwent transvenous, transseptal mitral valve replacement with a transcatheter heart valve. The mean age was 72 +/- 9.9 years, and the average Society of Thoracic Surgeons risk score was 12.5 +/- 7.2%. All patients had severe, life-limiting dyspnea. The 4 procedures were successful without intra-or post-procedural complications; echocardiography indicated a well-seated and functioning mitral valve-in-valve or valve-in-ring. Patients were discharged within 2 days after valve replacement with marked improvement in dyspnea.CONCLUSIONS We describe an innovative technique of transcatheter mitral valve replacement. This case series demonstrates the feasibility of transcatheter mitral valve replacement using only femoral venous access, with a marked reduction in complications and length of hospital stay compared with transapical access or redo surgery. (C) 2015 by the American College of Cardiology Foundation.