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用于肺动脉瓣反流伴右心室流出道扩张患者的自膨式经皮瓣膜:一年结果。

A self-expanding percutaneous valve for patients with pulmonary regurgitation and an enlarged native right ventricular outflow tract: one-year results.

机构信息

Zhongshan Hospital of Fudan University, Shanghai, China.

出版信息

EuroIntervention. 2019 Jan 20;14(13):1371-1377. doi: 10.4244/EIJ-D-18-00715.

Abstract

AIMS

The aim of the study was to evaluate the midterm safety and efficacy of a self-expanding valve (Venus P-valve) in the treatment of patients with pulmonary regurgitation and a native right ventricular outflow tract (RVOT) in China.

METHODS AND RESULTS

Patients who had moderate or severe pulmonary regurgitation after surgical repair of the RVOT with a transannular or RVOT patch were included in the study. Fifty-five patients (67% female; average age 28.7±12.4 years) from six different hospitals in China were enrolled. The procedure success rate was 98.2%. In the one failure, the patient experienced valve dislodgement two days after the procedure. During the 12-month follow-up, two patients died, one due to infective endocarditis. Three other patients developed infective endocarditis. Two patients developed atrial flutter, and one patient had a pulmonary embolism. Echocardiography examinations at 12 months showed that two patients had mild pulmonary regurgitation, and 19 patients had trace pulmonary regurgitation. No paravalvular regurgitation occurred. The mean peak pulmonary gradient was 16.3±7.4 (range 4-38) mmHg. Compared with the baseline data, the right ventricular end-diastolic volume index (RVEDVI) was reduced from 137.6±15.8 mL/m2 to 83.9±16.0 mL/m2 (p<0.001), and the New York Heart Association (NYHA) class was significantly improved (p<0.01).

CONCLUSIONS

The one-year results of the China Venus P-valve study show considerable promise for a hitherto unmet need in patients with pulmonary regurgitation and an enlarged native RVOT.

摘要

目的

本研究旨在评估在中国,一种自膨式瓣膜(Venus P-valve)在治疗右心室流出道(RVOT)成形术后出现中重度肺动脉瓣反流且存在固有 RVOT 扩张患者中的中期安全性和疗效。

方法和结果

本研究纳入了因 RVOT 环部或 RVOT 补片成形术后出现中重度肺动脉瓣反流的患者。来自中国 6 家不同医院的 55 例患者(67%为女性;平均年龄 28.7±12.4 岁)入组。手术成功率为 98.2%。1 例手术失败,患者在术后 2 天发生瓣膜移位。在 12 个月的随访中,2 例患者死亡,1 例因感染性心内膜炎死亡,另外 3 例患者发生感染性心内膜炎。2 例患者发生房性心动过速,1 例患者发生肺栓塞。12 个月时的超声心动图检查显示,2 例患者出现轻度肺动脉瓣反流,19 例患者出现微量肺动脉瓣反流,无瓣周漏。平均肺动脉瓣峰值压差为 16.3±7.4(4-38)mmHg。与基线数据相比,右心室舒张末期容积指数(RVEDVI)从 137.6±15.8 mL/m2 降低至 83.9±16.0 mL/m2(p<0.001),纽约心脏协会(NYHA)心功能分级显著改善(p<0.01)。

结论

中国 Venus P-valve 研究的 1 年结果表明,对于肺动脉瓣反流且固有 RVOT 扩张的患者存在的未满足的需求,该治疗方法具有很大的应用前景。

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