LuX-Valve系统经导管三尖瓣置换26例近期疗效分析

Short-term clinical outcomes of 26 cases of transcatheter tricuspid valve replacement

目的探讨LuX-Valve系统行经导管三尖瓣置换(TTVR)的近期临床效果。方法回顾性分析2020年7月至2020年12月海军军医大学长海医院心血管外科收治的26例因重度三尖瓣关闭不全行TTVR患者的临床资料,男性10例,女性16例,年龄(65.5±7.9)岁。19例患者为左心瓣膜置换术后发生三尖瓣关闭不全。所有患者均在全身麻醉数字减影血管造影下经右胸小切口右心房入路,采用LuX-Valve系统行原位TTVR。结果术中人工瓣膜均成功释放,手术时间180 min,瓣膜释放时间(12.6±3.8)min。术后24 h胸腔引流量95 ml,ICU停留时间2 d,总住院时间(25.2±8.1)d。2例患者分别因右侧胸腔出血及瓣膜移位再次开胸。住院期间死亡1例,死因为呼吸功能衰竭。超声心动图随访提示1例患者术后发生三尖瓣瓣周漏,随访半年后瓣周漏逐渐缓解。1例患者术后3个月死于恶病质。结论经右胸小切口右心房入路采用LuX-Valve系统经导管释放人工瓣膜治疗三尖瓣关闭不全的近期临床效果较满意。

Objective To explore the short-term clinical outcomes of transcatheter tricuspid valve replacement(TTVR) using LuX-Valve system. Methods A total of 26 patients who underwent TTVR on account of severe tricuspid regurgitation in the Department of Cardiovascular Surgery, Changhai Hospital Affiliated to the Naval Medical University from July 2020 to December 2020 were enrolled in this study retrospectively. There were 10 males and 16 females, aging(65.5±7.9) years. The common indication for TTVR was tricuspid regurgitation after left heart valve surgery. The TTVR procedure was performed via a right atrial approach through a small right chest incision under general anesthesia and with the assistance of digital subtraction angiography. Results The LuX-Valve was successfully released during operation in all patients. The operation time was 180 minutes, the valve release time was(12.6±3.8) minutes. The volume of pleural drainage was 95 ml in 24 hours after the operation;the ICU stay time was 2 days and the total hospital stay was(25.2±8.1) days. Two cases received redio thoracotomy on account of hemothorax and valve migration, respectively.One case died perioperatively due to respiratory failure. One case with perivalvular leakage was identified after the operation. One case died of cachexia 3 months after discharge. Conclusion As a new transcatheter technology for the treatment of tricuspid regurgitation, the short-term clinical outcome of LuX-Valve is satisfactory.