Davidavicius Giedrius, Rucinskas Kestutis, Drasutiene Agne, Samalavicius Robertas, Bilkis Valdas, Zakarkaite Diana, Aidietis Audrius
Centre of Cardiology and Angiology, Vilnius University, Vilnius, Lithuania.
Centre of Cardiac Surgery, Vilnius University, Vilnius, Lithuania.
J Thorac Cardiovasc Surg. 2014 Nov;148(5):1965-9. doi: 10.1016/j.jtcvs.2014.05.001. Epub 2014 May 9.
To report "hybrid" procedure feasibility and the clinical success of transcatheter paravalvular leak closure through apical access.
Seven patients (73.6±6.1 years; 4 men) with severe mitral prosthesis paravalvular leak were selected. All patients were at high risk for open surgery because of severe comorbidities and heart failure (New York Heart Association class III-IV).
The defect size was 25±7.8 mm in the long axis and 9.3±2 mm in the short axis. Two defects were detected in 2 patients. The transapical procedure was performed in a "hybrid" surgery room using minithoracotomy and general anesthesia. Three-dimensional transesophageal echocardiography and fluoroscopy were used for imaging. A total of 19 Amplatzer Vascular Plug III devices (St Jude Medical) were implanted in 7 patients, 2.7/patient and 1 to 3/fistula. The procedure time was 150.7±66.8 minutes. In 6 of 7 patients (85.7%), the paravalvular leak was successfully closed, resulting in no or mild residual regurgitation. One patient had moderate regurgitation despite deployment of 3 Amplatzer Vascular Plug III devices. Two patients required blood transfusion related to procedural blood loss. The patients were discharged at 15.3±6.5 days and followed up at 215.7±138.6 days. All but 1 patient reported symptomatic improvement by ≥1 New York Heart Association class at follow-up. One patient died 216 days postoperatively.
A "hybrid approach" for transcatheter paravalvular leak closure of mitral prosthesis from the apical route is effective in reducing the regurgitation grade and improving functional capacity in high-risk patients. Complete closure of the defect was maintained at follow-up in most patients.
报告经心尖途径经导管关闭人工瓣膜瓣周漏的“杂交”手术可行性及临床成功率。
选取7例严重二尖瓣人工瓣膜瓣周漏患者（年龄73.6±6.1岁；4例男性）。所有患者因严重合并症和心力衰竭（纽约心脏协会心功能Ⅲ - Ⅳ级）而接受开放手术的风险极高。
缺损长轴大小为25±7.8 mm，短轴为9.3±2 mm。2例患者检测到2处缺损。经心尖手术在“杂交”手术室采用小切口开胸及全身麻醉进行。使用三维经食管超声心动图和荧光透视成像。7例患者共植入19枚Amplatzer血管封堵器Ⅲ型（圣犹达医疗公司），平均每位患者植入2.7枚，每个瘘口植入1至3枚。手术时间为150.7±66.8分钟。7例患者中有6例（85.7%）瓣周漏成功关闭，术后无或仅有轻度残余反流。1例患者尽管植入了3枚Amplatzer血管封堵器Ⅲ型仍有中度反流。2例患者因手术失血需要输血。患者术后15.3±6.5天出院，随访215.7±138.6天。除1例患者外，所有患者在随访时纽约心脏协会心功能分级改善≥1级。1例患者术后216天死亡。
经心尖途径对二尖瓣人工瓣膜瓣周漏进行经导管关闭的“杂交方法”可有效降低反流程度并改善高危患者的心功能。大多数患者在随访时缺损保持完全闭合。
