经心尖经导管主动脉瓣置换术治疗高龄高危主动脉瓣关闭不全

Transapicai transcatheter aortic valve replacement for high risk elderly patients with predominant aortic incompetence

目的探讨使用J-Valve^TM系统行经心尖经导管主动脉瓣置换术治疗高龄高危主动脉瓣关闭不全患者的可行性。方法回顾性分析2014年4月至2015年7月在复旦大学附属中山医院心外科接受经心尖经导管主动脉瓣置换术的16例主动脉瓣关闭不全患者的临床资料。男性11例，女性5例；年龄61-84岁，平均年龄（76±6）岁。患者术前左心功能不全症状均超过3个月，欧洲心脏手术危险评估系统评分22.2%-44.4%，平均27%±6%。使用J-Valve^TM系统为患者行经心尖经导管主动脉瓣置换术。分别于出院前，以及术后1、3和12个月对患者进行临床评估和超声心动图检查；出院前复查多层螺旋CT。结果所有病例成功植入J-Valve^TM系统。住院期间因瓣周漏并发多器官功能衰竭死亡1例。其余15例患者平均术后住院时间为（6.1±1.3）d。随访174-410 d，中位随访时间188 d。随访期间2例患者存在支架瓣膜内的轻微反流；13例患者存在瓣周漏，均为轻中度以下；无重大并发症或死亡。结论使用J-Valve^TM系统行经心尖经导管主动脉瓣置换术治疗高危高龄主动脉瓣关闭不全患者是可行的，术后早期结果满意。

ObjectivesTo introduce the application of the J-Valve^TM system in elderly patients with predominant aortic incompetence without significant valve calcification, and to evaluate its feasibility.MethodsFrom April 2014 to July 2015, 33 cases of transapical implantation of J-Valve^TM were performed in Department of Cardiac Surgery, Zhongshan Hospital, Fudan University. Sixteen of these patients were diagnosed as predominant aortic incompetence without significant valve calcification. There were 11 male and 5 female patients aged from 61 to 84 years, with a mean age of （76±6） years. All patients had symptoms of left ventricular dysfunction for at least 3 months. They were considered to be prohibitive for surgical valve replacement （logistic European system for cardiac operative risk evaluation： 22.2% to 44.4%, mean 27%±6% after evaluation by an interdisciplinary heart team. The J-Valve^TM system was applied in transapical transcatheter aortic valve replacement for patients. The multi-slice CT was performed before discharge. Clinical evaluation including patients＇ history, symptoms and New York Heart Association classification and echocardiogram evaluation were performed before discharge, 1st month, 3th month and 12th month after the operation respectively.ResultsImplantations were successful in all patients. One patient died from moderate paravalvular leak which led to multi-organ failure during the hospital stay. The mean time of postoperative hospital stay of the other 15 patients was （6.1±1.3） days. The 15 patients were followed by 174 to 410 days, with a median time of 188 days. Only two patients had trivial prosthetic valve incompetence, the other 13 patients had no prosthetic valve incompetence; two patients had no paravavular leak and the other 13 patients had paravavular leak of no more than moderate grade. There were no major complication or mortality during the follow-up.ConclusionsThe transapical implantation of the J-Valve^TM system in high risk elderly patients with predominant aortic incompetence is feasible.The early postoperative outcome is satisfactory.