Lopez Stéphane, Meyer Pierre, Teboul Jacques, Deharo Pierre, Mihoubi Alain, Elbeze Jean Pierre, Lena Diane, Camarasa Philippe, Laborde Jean Claude, Drogoul Laurent
Department of Cardiac Surgery, Heart Institute Arnault Tzanck, CHU de Nice, Saint Laurent du Var, France.
Department of Cardiology, Cardiac Catheterization Laboratory, Heart Institute Arnault Tzanck, CHU de Nice, Saint Laurent du Var, France.
Interact Cardiovasc Thorac Surg. 2018 Dec 1;27(6):850-855. doi: 10.1093/icvts/ivy192.
To assess the feasibility and results of 'valve-in-valve' implantation using the 23-mm CoreValve for the treatment of degenerated 19-mm and 21-mm Mitroflow bioprostheses.
We retrospectively analysed all consecutive patients who underwent transcatheter aortic valve implantation for 19-mm and 21-mm Mitroflow bioprostheses. The height of implantation with respect to the ring of the Mitroflow prosthesis was targeted at -6 mm for the first 3 cases. In the following cases, the target was higher to promote free supra-annular movement of the leaflets.
The procedure was successful in 17 of 18 patients (94%). For implantations above the limit of -6 mm, the mean gradient was 10.4 ± 2.6 mmHg compared with 28.1 ± 11.6 mmHg for implantations below the limit of -6 mm (P < 0.01). For patients with severe stenosis as main mechanism of failure of the bioprosthesis, the mean post-procedural gradient was 31.2 ± 11.8 mmHg compared with 12.7 ± 6 mmHg in the absence of severe stenosis (P < 0.01). Patient-prosthesis mismatch (indexed effective orifice area ≤ 0.85 cm2/m2) and severe mismatch (indexed effective orifice area ≤ 0.65 cm2/m2) were present in 83% (15 of 18) and 27% (5 of 18) of patients, respectively. We did not notice any complications following the procedures. Six months after the procedure, functional status was improved in all patients.
Our short series demonstrates the ability to perform transcatheter 'valve-in-valve' implantation in 19-mm and 21-mm Mitroflow prostheses with satisfactory results, but high post-procedural gradients and patient-prosthesis mismatch remain a relatively frequent problem mostly when severe stenosis is the main mechanism of failure. Implantation in a high position is critical to decrease the rate of high postimplantation gradients.
评估使用23毫米CoreValve进行“瓣中瓣”植入治疗退化的19毫米和21毫米Mitroflow生物瓣膜的可行性及结果。
我们回顾性分析了所有连续接受经导管主动脉瓣植入术治疗19毫米和21毫米Mitroflow生物瓣膜的患者。前3例患者，相对于Mitroflow人工瓣膜环的植入高度目标为-6毫米。在随后的病例中，目标高度更高，以促进瓣叶在瓣环上方的自由活动。
18例患者中有17例（94%）手术成功。对于植入高度高于-6毫米极限的患者，平均梯度为10.4±2.6毫米汞柱，而植入高度低于-6毫米极限的患者为28.1±11.6毫米汞柱（P<0.01）。对于以严重狭窄为生物瓣膜主要失效机制的患者，术后平均梯度为31.2±11.8毫米汞柱，而无严重狭窄的患者为12.7±6毫米汞柱（P<0.01）。患者-人工瓣膜不匹配（指数化有效瓣口面积≤0.85平方厘米/平方米）和严重不匹配（指数化有效瓣口面积≤0.65平方厘米/平方米）分别出现在83%（18例中的15例）和27%（18例中的5例）的患者中。术后我们未发现任何并发症。术后6个月，所有患者的功能状态均得到改善。
我们的短系列研究表明，对19毫米和21毫米Mitroflow人工瓣膜进行经导管“瓣中瓣”植入术是可行的，结果令人满意，但术后高梯度和患者-人工瓣膜不匹配仍然是一个相对常见的问题，尤其是当严重狭窄是主要失效机制时。高位植入对于降低术后高梯度发生率至关重要。
