Finch Will, Levi Daniel S, Salem Morris, Hageman Abbie, Aboulhosn Jamil
Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California.
Division of Cardiology, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California.
Catheter Cardiovasc Interv. 2015 Nov;86(5):E217-23. doi: 10.1002/ccd.25922. Epub 2015 Mar 30.
This study sought to elucidate the optimal bioprosthetic valve (BPV) size prior to Melody valve implantation.
BPVs provide an ideal "landing zone" for future Melody valve insertion. To guide surgical choice of BPV size, it is important to understand which BPV size can serve consistently as substrates for Melody valve placements.
A database of all patients who underwent Melody implantation at UCLA or Kaiser Permanente Los Angeles from 2010 to 2014 was analyzed retrospectively. Patients with an existing BPV were stratified into those with a valve diameter of ≥27 mm or <27 mm.
One hundred and sixty patients underwent catheterization with the intention to implant a Melody valve. Melody valve implantation was performed in the pulmonary position in 52 patients with prior BPVs. The immediate procedural success rate was 100%. Immediately post-Melody, the right ventricular to pulmonary artery gradient was significantly higher in the <27 mm group compared to the ≥27 mm group (14.3±3 vs. 8.6±6.8, P=0.006). There was a significantly shorter time from prior valve replacement to Melody implantation in the <27 mm group. There was one patient in whom transcatheter pulmonary valve implantation was aborted due to inadequate landing zone in the <27 mm group, and no patients in the ≥27 mm group (P=NS).
The results of this study indicate that 27 and 29 mm BPV provide a superior landing zone for Melody valve implantation with excellent immediate and intermediate term hemodynamic results when compared to smaller BPVs less than 27 mm.
本研究旨在阐明在植入美敦力瓣膜之前的最佳生物瓣膜（BPV）尺寸。
生物瓣膜为未来美敦力瓣膜的植入提供了理想的“着陆区”。为指导生物瓣膜尺寸的手术选择，了解哪种生物瓣膜尺寸能够持续作为美敦力瓣膜植入的基底很重要。
回顾性分析2010年至2014年在加州大学洛杉矶分校或洛杉矶凯撒医疗机构接受美敦力瓣膜植入的所有患者的数据库。将已有生物瓣膜的患者分为瓣膜直径≥27mm或<27mm两组。
160例患者接受了旨在植入美敦力瓣膜的导管插入术。52例有先前生物瓣膜的患者在肺动脉位置植入了美敦力瓣膜。即刻手术成功率为100%。美敦力瓣膜植入后即刻，<27mm组的右心室至肺动脉压差显著高于≥27mm组（14.3±3 vs. 8.6±6.8，P=0.006）。<27mm组从先前瓣膜置换到美敦力瓣膜植入的时间明显更短。<27mm组有1例患者因着陆区不足导致经导管肺动脉瓣膜植入术中止，≥27mm组无患者出现这种情况（P=无显著差异）。
本研究结果表明，与小于27mm的较小生物瓣膜相比，27mm和29mm的生物瓣膜为美敦力瓣膜植入提供了更好的着陆区，即刻和中期血流动力学结果优异。
