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在不同类型管道中使用爱德华兹SAPIEN经导管心脏瓣膜进行经皮肺动脉瓣植入术:单中心经验的初步结果

Percutaneous pulmonary valve implantation using Edwards SAPIEN transcatheter heart valve in different types of conduits: initial results of a single center experience.

作者信息

Odemis Ender, Guzeltas Alper, Saygi Murat, Ozyilmaz Isa, Momenah Tarek, Bakir Ihsan

机构信息

Department of Pediatric Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul, Turkey.

出版信息

Congenit Heart Dis. 2013 Sep-Oct;8(5):411-7. doi: 10.1111/chd.12047. Epub 2013 Mar 1.

Abstract

BACKGROUND

Percutaneous pulmonary valve implantation is frequently used as a less invasive method in patients with conduit dysfunction. The common valve type cannot be used in conduits with a diameter larger than 22 mm. There has been limited experience concerning the used of the SAPIEN Transcatheter Heart Valve, produced for use in conduits with a large diameter. This study presents hemodynamic and early follow-up results from a single center in Turkey concerning the use of the SAPIEN Transcatheter Heart Valve in different types of conduits and different lesions.

PATIENTS AND METHOD

Between October 2010 and July 2012, seven SAPIEN Transcatheter Heart Valve implantations were performed. There was mixed type 2 pure insufficiency with stenosis and insufficiency in five patients. Three different conduits were used, and one native pulmonary artery process was performed. Patients were followed for hemodynamic findings, functional capacities, valve competence, reshrinking, and breakage in the stent, and the results were evaluated.

RESULTS

Implantations were successfully performed in all patients. Right ventricular pressures and gradients were significantly reduced, and there was no pulmonary regurgitation in any patient. Functional capacities evidently improved in all patients except for one with pulmonary hypertension. No major complication was observed. During the mean time of follow-up (7.2 ± 4.7 months), no valve insufficiency or stent breakage was observed.

CONCLUSION

Procedural results and short-term outcomes of the SAPIEN Transcatheter Heart Valve were very promising in the patients included in the study. The SAPIEN Transcatheter Heart Valve can be a good alternative to surgical conduit replacement, particularly in patients with larger and different types of conduits.

摘要

背景

经皮肺动脉瓣植入术常被用作治疗管道功能障碍患者的一种侵入性较小的方法。常用的瓣膜类型不适用于直径大于22毫米的管道。关于用于大直径管道的爱德华SAPIEN经导管心脏瓣膜的使用经验有限。本研究展示了土耳其一家单中心关于爱德华SAPIEN经导管心脏瓣膜在不同类型管道和不同病变中的血流动力学及早期随访结果。

患者与方法

2010年10月至2012年7月期间,进行了7例爱德华SAPIEN经导管心脏瓣膜植入术。5例患者为2型混合型单纯反流伴狭窄和反流。使用了三种不同的管道,并进行了一例天然肺动脉手术。对患者进行血流动力学检查、功能能力、瓣膜功能、再狭窄和支架断裂情况的随访,并对结果进行评估。

结果

所有患者的植入手术均成功完成。右心室压力和压力阶差显著降低,所有患者均无肺动脉反流。除一名肺动脉高压患者外,所有患者的功能能力均明显改善。未观察到重大并发症。在平均随访时间(7.2±4.7个月)内,未观察到瓣膜反流或支架断裂。

结论

在本研究纳入的患者中,爱德华SAPIEN经导管心脏瓣膜的手术结果和短期预后非常乐观。爱德华SAPIEN经导管心脏瓣膜可能是外科管道置换的一个良好替代方案,特别是对于较大及不同类型管道的患者。

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