Transvenous, Antegrade Melody Valve-in-Valve Implantation for Bioprosthetic Mitral and Tricuspid Valve Dysfunction A Case Series in Children and Adults
Transvenous, Antegrade Melody Valve-in-Valve Implantation for Bioprosthetic Mitral and Tricuspid Valve Dysfunction A Case Series in Children and Adults
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DOI：
10.1016/j.jcin.2013.02.010
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发表时间：
2013-06-01
影响因子：
11.3
通讯作者：
Rihal, Charanjit S.
中科院分区：
文献类型：
--
作者：
Cullen, Michael W.;Cabalka, Allison K.;Rihal, Charanjit S.
目的 本研究的目的是报告使用 Melody 瓣膜（美敦力公司，明尼阿波利斯，明尼苏达州）对退化二尖瓣和三尖瓣生物瓣膜患者进行经皮瓣中瓣膜治疗的结果。 背景 更换退化生物瓣膜的开放手术与发病率和死亡率相关。 方法 19 名患有退化生物瓣膜的患者（中位年龄 65 岁，范围 10 至 88 岁；7 名男性）二尖瓣 (n = 9) 或三尖瓣 (n = 10) 生物瓣膜接受经静脉瓣中瓣植入 Melody 瓣膜。 结果 在二尖瓣患者中，胸外科医生协会死亡率平均评分为 13.3 +/- 5.6%。所有患者的人工瓣膜平均舒张压流入梯度 >= 5 mm Hg。 9 名二尖瓣患者中的 7 名和 10 名三尖瓣患者中的 7 名存在中度或更严重的反流。 Melody 瓣膜植入全部成功。在二尖瓣患者中，平均舒张压梯度从 12.3 +/- 4.6 mm Hg 降至 5.2 +/- 2 mm Hg (p < 0.01)。 6 名患者的残余反流程度为轻微至轻度，2 名患者的残余反流程度为轻度至中度，1 名患者的残余反流程度为中度。在三尖瓣患者中，平均舒张压压差从 10.0 +/- 4.3 mm Hg 降至 5.6 +/- 2.5 mm Hg (p < 0.01)。 9 名患者的残余反流程度为轻微至轻度，1 名患者的残余反流程度为轻度至中度。 19 名患者中有 17 名纽约心脏协会功能分级有所改善 (p < 0.01)。没有发生围手术期死亡、心肌梗塞、中风或瓣膜栓塞。 4 例患者出现血管通路部位并发症。 结论 在二尖瓣或三尖瓣位置经皮瓣中瓣植入 Melody 瓣膜治疗生物瓣膜功能障碍是可行的，并且可以使精心挑选的高危患者的症状得到显着改善。 (c) 2013 年，美国心脏病学会基金会
Objectives The purpose of this study was to report the results of percutaneous valve-in-valve therapy using the Melody valve (Medtronic, Minneapolis, Minnesota) for patients with degenerated mitral and tricuspid bioprosthetic valves.Background Open surgery for replacement of degenerated bioprosthetic valves is associated with morbidity and mortality.Methods Nineteen patients (median age 65 years, range 10 to 88 years; 7 males) with degenerated mitral (n = 9) or tricuspid (n = 10) bioprosthetic valves underwent transvenous valve-in-valve implantation of the Melody valve.Results In the mitral patients, the mean Society of Thoracic Surgeons mortality score was 13.3 +/- 5.6%. All patients had a prosthetic valve mean diastolic inflow gradient >= 5 mm Hg. Moderate or worse regurgitation was present in 7 of 9 mitral and 7 of 10 tricuspid patients. Implantation of a Melody valve was successful in all. Among the mitral patients, mean diastolic gradient decreased from 12.3 +/- 4.6 mm Hg to 5.2 +/- 2 mm Hg (p < 0.01). Residual regurgitation was trivial to mild in 6, mild to moderate in 2, and moderate in 1 patient. Among the tricuspid patients, mean diastolic gradient decreased from 10.0 +/- 4.3 mm Hg to 5.6 +/- 2.5 mm Hg (p < 0.01). Residual regurgitation was trivial to mild in 9 and mild to moderate in 1 patient. New York Heart Association functional class improved in 17 of 19 patients (p < 0.01). No periprocedural deaths, myocardial infarctions, strokes, or valve embolizations occurred. Vascular access site complications occurred in 4 patients.Conclusions Percutaneous valve-in-valve implantation of the Melody valve in the mitral or tricuspid position for treatment of bioprosthetic valve dysfunction is feasible and can lead to significant symptomatic improvement in carefully selected high-risk patients. (c) 2013 by the American College of Cardiology Foundation