二尖瓣生物瓣毁损行介入瓣中瓣的早期效果分析

The early outcomes of transcatheter valve-in-valve implantation treatment for mitral bioprosthetic valve dysfunction

目的:总结生物瓣毁损患者行介入二尖瓣瓣中瓣手术的经验和早期效果。方法:回顾性分析2019年1月—2022年3月在郑州大学第一附属医院行介入瓣中瓣手术治疗二尖瓣生物瓣毁损的19例患者的临床资料、手术效果及并发症情况。结果:19例患者中,既往置换Medtronic HancockⅡ瓣膜5例,Edwards Perimount瓣膜1例,佰仁思生物瓣膜1例,St Jude Medical Epic瓣膜12例。瓣膜型号25号10例,27号7例,29号2例。手术于杂交手术室完成,在X线透视及TEE检测下经心尖途径或经股静脉-房间隔途径,将压缩的介入瓣膜在导丝引导下植入二尖瓣生物瓣内。19例患者均成功经心尖入路或经房间隔入路完成介入二尖瓣瓣中瓣植入术。1例术后8 h内发生活动性出血,1例术后随访2年后死亡,其余17例患者无死亡及严重并发症发生。术后3个月完成全部随访,NYHA心功能分级较术前明显改善(P<0.05),二尖瓣均无反流,峰值流速[(1.81±0.36) m/s vs (2.61±0.49) m/s,P<0.05]及平均跨瓣压差[(6.1±2.3) mmHg vs(12.5±5.9) mmHg, 1 mmHg=0.133 kPa,P<0.05]明显下降。结论:对于外科手术高风险或禁忌患者,介入瓣中瓣技术治疗二尖瓣生物瓣毁损可获得良好的早期效果。

Objective: To summarize the experience and early outcomes of transcatheter mitral valve-in-valve implantation treatment in patients with bioprosthetic valve dysfunction. Methods: The clinical data, surgical results, and complications of 19 patients who received transcatheter mitral valve-in-valve implantation for mitral bioprosthetic valve dysfunction in the First Affiliated Hospital of Zhengzhou University from January 2019 to March 2022 were retrospectively analyzed. Results: In terms of the type of the mitral bioprosthetic valve, there were 5 cases of Medtronic Hancock Ⅱ valves, one case of Edwards Perimount valve, one case of BalMedic valve, and 12 cases of St Jude Medical Epic valves. The mitral bioprosthetic size included 25#for 10 cases, 27#for 7 cases, and 29#for 2 cases. The valve-in-valve procedure was completed in the hybrid operating room, and the compressed interventional valve was implanted into the mitral bioprosthetic valve under the guidance of the guide wire through the apical approach or the femoral vein to atrial septal approach under the detection of X-ray fluoroscopy and TEE. All 19 patients completed the interventional mitral valve-in-valve implantation through the apical approach or the atrial septal approach. One patient developed active bleeding within 8 hours after the operation, one patient died after 2 years of follow-up, and the remaining 17 patients had no death or serious complications. All follow-ups were completed 3 months after the operation, NYHA cardiac functional class was significantly improved(P<0.05), there was no mitral regurgitation after operation, and the mitral peak valve velocity[(1.81±0.36) m/s vs(2.61±0.49) m/s, P<0.05]and the mitral mean valve pressure gradient[(6.1±2.3) mmHg vs(12.5±5.9) mmHg, 1 mmHg=0.133 kPa, P<0.05]were significantly decreased. Conclusion: For patients with high surgical risk or contraindications, transcatheter mitral valve-in-valve implantation treatment for mitral bioprosthetic valve dysfunction can achieve good early results.