通过单向左向右心房分流进行左心房减压治疗左心衰竭：V-Wave装置的首例人体经验
Left atrial decompression through unidirectional left-to-right interatrial shunt for the treatment of left heart failure: first-in-man experience with the V-Wave device.
作者信息
Amat-Santos Ignacio J, Bergeron Sebastien, Bernier Mathieu, Allende Ricardo, Barbosa Ribeiro Henrique, Urena Marina, Pibarot Philippe, Verheye Stefan, Keren Gad, Yaacoby Menashe, Nitzan Yaacov, Abraham William T, Rodés-Cabau Josep
机构信息
Department of Cardiology, Quebec Heart & Lung Institute, Quebec City, Quebec, Canada.
出版信息
EuroIntervention. 2015 Jan;10(9):1127-31. doi: 10.4244/EIJY14M05_07.
AIMS
Elevated filling pressures of the left atrium (LA) are associated with poorer outcomes in patients with chronic heart failure. The V-Wave is a new percutaneously implanted device intended to decrease the LA pressure by the shunting of blood from the LA to the right atrium. This report describes the first-in-man experience with the V-Wave device.
METHODS AND RESULTS
A 70-year-old man with a history of heart failure of ischaemic origin, left ventricular dysfunction (LVEF: 35%, pulmonary wedge: 19 mmHg), no right heart dysfunction, NYHA Class III and orthopnoea despite optimal treatment, was accepted for V-Wave device implantation. The device consists of an ePTFE encapsulated nitinol frame that is implanted at the level of the interatrial septum and contains a trileaflet pericardium tissue valve sutured inside which allows a unidirectional LA to right atrium shunt. The procedure was performed through a transfemoral venous approach under fluoroscopic and TEE guidance. The device was successfully implanted and the patient was discharged 24 hours after the procedure with no complications. At three-month follow-up a left-to-right shunt through the device was confirmed by TEE. The patient was in NYHA Class II, without orthopnoea, the Kansas City Cardiomyopathy index was 77.6 (from 39.1 at baseline) and NT-proBNP was 322 ng/mL (from 502 ng/mL at baseline). The QP/QS was 1.17 and the pulmonary wedge was 8 mmHg, with no changes in pulmonary pressure or right ventricular function.
CONCLUSIONS
Left atrial decompression through a unidirectional left-to-right interatrial shunt represents a new concept for the treatment of patients with left ventricular failure. The present report shows the feasibility of applying this new therapy with the successful and uneventful implantation of the V-Wave device, which was associated with significant improvement in functional, quality of life and haemodynamic parameters at 90 days.
目的
左心房（LA）充盈压升高与慢性心力衰竭患者的预后较差相关。V-Wave是一种新的经皮植入装置，旨在通过将血液从左心房分流至右心房来降低左心房压力。本报告描述了V-Wave装置的首例人体应用经验。
方法与结果
一名70岁男性，有缺血性心力衰竭病史，左心室功能障碍（左心室射血分数：35%，肺楔压：19 mmHg），无右心功能障碍，纽约心脏协会（NYHA）心功能分级为III级，尽管接受了最佳治疗仍有端坐呼吸，接受了V-Wave装置植入。该装置由一个ePTFE包裹的镍钛诺框架组成，植入房间隔水平，内部缝合有三叶心包组织瓣膜，允许左心房向右心房单向分流。该手术在透视和经食管超声心动图（TEE）引导下经股静脉途径进行。装置成功植入，患者术后24小时出院，无并发症。在3个月的随访中，TEE证实通过该装置存在左向右分流。患者NYHA心功能分级为II级，无端坐呼吸，堪萨斯城心肌病指数为77.6（基线时为39.1），N末端脑钠肽前体（NT-proBNP）为322 ng/mL（基线时为502 ng/mL）。肺循环血流量与体循环血流量比值（QP/QS）为1.17，肺楔压为8 mmHg，肺压力或右心室功能无变化。
结论
通过单向左向右房间分流进行左心房减压是治疗左心室衰竭患者的一个新概念。本报告显示了应用这种新疗法的可行性，V-Wave装置成功且顺利植入，在90天时功能、生活质量和血流动力学参数有显著改善。
Zotero 插件