Transcatheter mitral valve replacement(TMVR)has become an alternative to surgical mitral valve replacement for the treatment of patients with severe mitral insufficiency(MI)who are at very high or prohibitive surgical...Transcatheter mitral valve replacement(TMVR)has become an alternative to surgical mitral valve replacement for the treatment of patients with severe mitral insufficiency(MI)who are at very high or prohibitive surgical risk.[1]Because of impaired left ventricular dysfunction and previous cardiac surgery,some aged patients with degenerated bioprosthetic mitral valve and mitral regurgitation were refused to redo surgery.[2]Increasing demand are required for minimally invasive treatment of these patients.Hundreds of patients worldwide have been treated with a transcatheter mitral valve-in-ring or valve-in-valve procedure using transcatheter aortic valve.[3]However,rare case of transcatheter mitral valve-in-valve/ring replacement using transcatheter mitral valve system was reported.Here,we reported a successfully case of transcatheter mitral“valve-in-valve”replacement for the treatment of bioprosthetic mitral valve degeneration and severe regurgitation with domestic Mithos^TM valve.展开更多
Objectives Transcatheter valve-in-valve （VIV） implantation for failed bioprostheses has become an alternative to open surgery in those deemed high risk. The purpose of this study was to evaluate the effectiveness an...Objectives Transcatheter valve-in-valve （VIV） implantation for failed bioprostheses has become an alternative to open surgery in those deemed high risk. The purpose of this study was to evaluate the effectiveness and outcomes of this emerging procedure. Methods Fourty VIV procedures were performed in 38 consecutive patients （mean age 70 ± 14 years and mean Logistic EuroScore 23.6 ± 15.5%） with severe aortic （n = 19） or mitral （n = 21） bioprosthetic valve dysfunction between 2014 and 2017. Bioprosthetic failure was secondary to stenosis in 11 （27.5%）, regurgitation in 19 （47.5%）, and combined in 10 （25.0%） bioprostheses. Clinical, echocardiographic, and procedural profiles were characterized, and the short-term results of the study patients were reported. Results Successful transfemoral （n = 15）, trans-subclavian （n = 1）, or transapical （n = 3） aortic VIV using either balloon-expandable valves （Edwards Sapien XT, n = 7） or self-expandable valves （Medtronic CoreValve, n = 12）; and transapical （n = 21） mitral VIV using either Edwards Sapien XT （n = 15） or me-chanically expandable valves （Boston Scientific Lotus, n = 6） were accomplished in all 40 VIV procedures. Implantation was successful with immediate restoration of satisfactory valve function in all patients. Five patients （13.2%） died at a median follow up of 9.3 months. Most of the 33 patients alive were in good functional status with good prosthetic valve performance. Conclusions Transcatheter VIV implantation is a feasible and safe option for the management of bioprosthetic valve failure. It may offer a less invasive alternative for those high-risk patients needing repeat valve replacement.展开更多
Background This preclinical study in sheep sought to demonstrate the initial safety and feasibility of a novel transcatheter mitral valve system(Mi-thos valve)composed of a self-expanding frame and a bovine pericardia...Background This preclinical study in sheep sought to demonstrate the initial safety and feasibility of a novel transcatheter mitral valve system(Mi-thos valve)composed of a self-expanding frame and a bovine pericardial tissue bioprosthesis.Methods The valve was implanted in 26 sheep using a transapical approach for short-and long-term evaluation.The technical feasibility,safety,durability,and valve function were evaluated during and 6 months after the procedure using intracardiac and transthoracic echocardiography,multisliced computed tomography,histological analysis,and electron microscopy.Results The success rate of valve implantation was 100%,and the immediate survival rate after surgery was 84%.Five animals died within 90 min after the development of the prosthetic valve due to an acute left ventricular outflow tract obstruction(n=2)and sudden intraoperative ventricular fibrillation(n=3).Twelve animals died within 1 month due to acute left heart dysfunction.Mild(n=5)and moderate(n=2)paravalvular leakage occurred in seven animals,and two moderate PVL animals died of chronic heart failure within three months.Multimodality imaging studies of the remaining seven animals showed excellent function and alignment of the valves,with no coronary artery obstruction,no left ventricular outflow tract obstruction,no severe transvalvular gradients and no paravalvular leakage.Macroscopic evaluation demonstrated stable,secure positioning of the valve,with full endothelialization of the valve leaflets without injury to the ventricular or atrial walls.Histological and electron microscopic examinations at six months showed no obvious macro-or microcalcification in the leaflets.Conclusions Preclinical studies indicate that transcatheter implantation of the Mi-thos valve is technically safe and feasible.The durability,functionality,and lack of leaflet calcification were all verified in animal experiments.The information from these preclinical studies will be applied to patient selection criteria and the first-in-human studies.展开更多
基金supported by the National Natural Science Foundation of China(81600240)the Science Foundation for Distinguished Young Scholars of Shaanxi Natural Science Basic Research Program(2018JC-015).
文摘Transcatheter mitral valve replacement(TMVR)has become an alternative to surgical mitral valve replacement for the treatment of patients with severe mitral insufficiency(MI)who are at very high or prohibitive surgical risk.[1]Because of impaired left ventricular dysfunction and previous cardiac surgery,some aged patients with degenerated bioprosthetic mitral valve and mitral regurgitation were refused to redo surgery.[2]Increasing demand are required for minimally invasive treatment of these patients.Hundreds of patients worldwide have been treated with a transcatheter mitral valve-in-ring or valve-in-valve procedure using transcatheter aortic valve.[3]However,rare case of transcatheter mitral valve-in-valve/ring replacement using transcatheter mitral valve system was reported.Here,we reported a successfully case of transcatheter mitral“valve-in-valve”replacement for the treatment of bioprosthetic mitral valve degeneration and severe regurgitation with domestic Mithos^TM valve.
文摘Objectives Transcatheter valve-in-valve （VIV） implantation for failed bioprostheses has become an alternative to open surgery in those deemed high risk. The purpose of this study was to evaluate the effectiveness and outcomes of this emerging procedure. Methods Fourty VIV procedures were performed in 38 consecutive patients （mean age 70 ± 14 years and mean Logistic EuroScore 23.6 ± 15.5%） with severe aortic （n = 19） or mitral （n = 21） bioprosthetic valve dysfunction between 2014 and 2017. Bioprosthetic failure was secondary to stenosis in 11 （27.5%）, regurgitation in 19 （47.5%）, and combined in 10 （25.0%） bioprostheses. Clinical, echocardiographic, and procedural profiles were characterized, and the short-term results of the study patients were reported. Results Successful transfemoral （n = 15）, trans-subclavian （n = 1）, or transapical （n = 3） aortic VIV using either balloon-expandable valves （Edwards Sapien XT, n = 7） or self-expandable valves （Medtronic CoreValve, n = 12）; and transapical （n = 21） mitral VIV using either Edwards Sapien XT （n = 15） or me-chanically expandable valves （Boston Scientific Lotus, n = 6） were accomplished in all 40 VIV procedures. Implantation was successful with immediate restoration of satisfactory valve function in all patients. Five patients （13.2%） died at a median follow up of 9.3 months. Most of the 33 patients alive were in good functional status with good prosthetic valve performance. Conclusions Transcatheter VIV implantation is a feasible and safe option for the management of bioprosthetic valve failure. It may offer a less invasive alternative for those high-risk patients needing repeat valve replacement.
基金This paper was supported by the National Key Research and Development Plan(2016YFC1101000)National Natural Science Foundation of China(81600240 and 81470500)The Distinguished Young Scholar Cultivation Project of Xijing Hospital(XJZT14J03,XJZT15ZL01,and 13QNP129)。
文摘Background This preclinical study in sheep sought to demonstrate the initial safety and feasibility of a novel transcatheter mitral valve system(Mi-thos valve)composed of a self-expanding frame and a bovine pericardial tissue bioprosthesis.Methods The valve was implanted in 26 sheep using a transapical approach for short-and long-term evaluation.The technical feasibility,safety,durability,and valve function were evaluated during and 6 months after the procedure using intracardiac and transthoracic echocardiography,multisliced computed tomography,histological analysis,and electron microscopy.Results The success rate of valve implantation was 100%,and the immediate survival rate after surgery was 84%.Five animals died within 90 min after the development of the prosthetic valve due to an acute left ventricular outflow tract obstruction(n=2)and sudden intraoperative ventricular fibrillation(n=3).Twelve animals died within 1 month due to acute left heart dysfunction.Mild(n=5)and moderate(n=2)paravalvular leakage occurred in seven animals,and two moderate PVL animals died of chronic heart failure within three months.Multimodality imaging studies of the remaining seven animals showed excellent function and alignment of the valves,with no coronary artery obstruction,no left ventricular outflow tract obstruction,no severe transvalvular gradients and no paravalvular leakage.Macroscopic evaluation demonstrated stable,secure positioning of the valve,with full endothelialization of the valve leaflets without injury to the ventricular or atrial walls.Histological and electron microscopic examinations at six months showed no obvious macro-or microcalcification in the leaflets.Conclusions Preclinical studies indicate that transcatheter implantation of the Mi-thos valve is technically safe and feasible.The durability,functionality,and lack of leaflet calcification were all verified in animal experiments.The information from these preclinical studies will be applied to patient selection criteria and the first-in-human studies.
