St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
J Thorac Cardiovasc Surg. 2011 Mar;141(3):711-5. doi: 10.1016/j.jtcvs.2010.11.026. Epub 2011 Jan 26.
Mitral valve replacement with bioprosthetic valves is becoming more common. The incidence of structural valve deterioration and the need for reoperative mitral surgery are expected to increase. The operative mortality and morbidity associated with redo mitral surgery remains high. Transapical transcatheter mitral valve-in-valve implantation might offer an alternate and safer approach for high-risk patients.
From July 2007 to April 2010, 11 patients with symptomatic mitral prosthetic valve dysfunction underwent transapical transapical transcatheter mitral valve-in-valve implantation in our institution. Data were collected and entered into a database prospectively. The mean age was 81 ± 5 years, with 64% being female. The mean Society of Thoracic Surgeons risk score was 16.1% ± 5.8%.
All patients had successful transapical transcatheter mitral valve-in-valve implantation with no 30-day mortality. One patient died 45 days after surgical intervention from respiratory failure, and 1 patient died on day 135. All other patients were alive and in New York Heart Association class I/II at a median follow-up of 357 days. The median postprocedural transvalvular gradient was 7 mm Hg, and minimal transvalvular or paravalvular regurgitation was seen.
Transcatheter transapical valve-in-valve implantations into a failed mitral bioprosthesis is technically feasible with acceptable results. It might be a viable approach for selected high-risk patients.
使用生物瓣进行二尖瓣置换术越来越常见。预计结构性瓣膜退化的发生率和再次二尖瓣手术的需求将会增加。再次二尖瓣手术相关的手术死亡率和发病率仍然很高。经心尖经导管二尖瓣瓣中瓣植入术可能为高危患者提供一种替代且更安全的方法。
从 2007 年 7 月到 2010 年 4 月，我们机构对 11 例有症状的二尖瓣假体瓣膜功能障碍患者进行了经心尖经导管二尖瓣瓣中瓣植入术。前瞻性地收集和输入数据到数据库中。平均年龄为 81±5 岁，其中 64%为女性。平均胸外科医师协会风险评分 16.1%±5.8%。
所有患者均成功进行了经心尖经导管二尖瓣瓣中瓣植入术，30 天死亡率为零。1 例患者在手术后 45 天因呼吸衰竭死亡，1 例患者在第 135 天死亡。其余所有患者在中位随访 357 天时均存活且纽约心脏协会心功能分级为 I/II 级。术后跨瓣压差中位数为 7mmHg，可见最小程度的跨瓣或瓣周反流。
将经导管心尖瓣中瓣植入术应用于失败的二尖瓣生物瓣在技术上是可行的，且结果可以接受。对于选定的高危患者，它可能是一种可行的方法。
