St. Paul's Hospital, University of British Columbia, Vancouver, Canada.
Catheter Cardiovasc Interv. 2010 Feb 1;75(2):286-94. doi: 10.1002/ccd.22250.
Conduits placed in the right ventricular outflow tract (RVOT) have limited longevity which often requires increasingly complex reoperations. Transcatheter pulmonary valve implantation improves conduit hemodynamics through a minimally invasive approach. We present data for 7 patients treated with the Edwards SAPIEN transcatheter heart valve (THV).
Patients' ranged in age from 16 to 52 years, one was female, and all had NYHA class II-III symptoms. Patients had pulmonary homografts that had been placed 2-25 years earlier during the Ross procedure (n = 4), repaired double outlet right ventricle with situs inversus (n = 1), or Rastelli repair for D-TGA, pulmonary atresia, and ventricular septal defect (n = 2). Patients had either severe pulmonary stenosis and/or moderate to severe pulmonary regurgitation.
All patients had successful percutaneous implantation of the 23 mm SAPIEN THV under general anesthesia. Fluoroscopy times ranged from 16 to 49 mins and procedure times ranged from 110 to 237 mins. The RV:systemic pressure ratio decreased from 78 +/- 18 to 39 +/- 8%, the RVOT gradient improved from 60.7 +/- 24.3 to 14.9 +/- 6.9 mm Hg, no patients had pulmonary insufficiency, and all patients had symptom improvement. At a maximum follow-up of 3.5 years (median 22.5 months), Doppler peak gradients ranged from 7-36 mm Hg, and there is no evidence of late stent fracture or structural valve failure.
The SAPIEN THV can be used successfully in the treatment of patients with right ventricle to pulmonary artery homograft failure. The valve is durable to at least 3.5 years without stent fracture or regurgitation. Clinical trials are underway to assess the long-term safety and efficacy of this valve.
放置在右心室流出道（RVOT）的管道寿命有限，这通常需要进行越来越复杂的再次手术。经导管肺动脉瓣植入术通过微创途径改善了管道的血液动力学。我们报告了 7 例接受 Edwards SAPIEN 经导管心脏瓣膜（THV）治疗的患者的数据。
患者年龄从 16 岁到 52 岁不等，1 例为女性，所有患者均有 NYHA Ⅱ-Ⅲ级症状。患者均有肺动脉同种移植物，这些移植物在 Ross 手术（n=4）中 2-25 年前放置，修复了伴有内脏逆位的双出口右心室（n=1），或 Rastelli 修复 D-TGA、肺动脉瓣闭锁和室间隔缺损（n=2）。患者要么患有严重的肺动脉瓣狭窄，要么患有中度至重度的肺动脉瓣反流。
所有患者均在全身麻醉下成功地进行了经皮 23 毫米 SAPIEN THV 植入。透视时间从 16 分钟到 49 分钟不等，手术时间从 110 分钟到 237 分钟不等。RV:体循环压力比从 78±18%降至 39±8%，RVOT 梯度从 60.7±24.3mmHg 改善至 14.9±6.9mmHg，无患者出现肺动脉瓣关闭不全，所有患者的症状均有所改善。在最长 3.5 年（中位数 22.5 个月）的随访中，多普勒峰值梯度范围为 7-36mmHg，无支架断裂或结构性瓣膜失效的证据。
SAPIEN THV 可成功用于治疗右心室至肺动脉同种移植物衰竭的患者。该瓣膜至少在 3.5 年内耐用，无支架断裂或反流。正在进行临床试验以评估该瓣膜的长期安全性和疗效。
