Division of Pediatric Cardiology, Nicklaus Children's Hospital, Miami, Florida.
Department of Pediatric Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio.
Catheter Cardiovasc Interv. 2020 Feb 15;95(3):389-397. doi: 10.1002/ccd.28628. Epub 2019 Nov 28.
Report long-term outcomes of percutaneous intervention in patients with pulmonary vein stenosis (PVS) after pulmonary vein isolation (PVI) from a single center over 16 years.
Outcome reports of percutaneous intervention for PVS resulting from PVI are limited.
Retrospective review of all patients with PVS after PVI who underwent percutaneous intervention at the Cleveland Clinic Foundation between January 2000 and December 2016.
A total of 205 patients underwent cardiac catheterization for PVS during the study period. Completely occluded veins which could not be recanalized occurred in six patients. Of the remaining 199 patients, 27 (14%) were lost to follow-up, leaving 172 patients with 276 veins for analysis. Balloon angioplasty was performed in 62 veins and stent implantation in 250 (primary in 214, to treat postdilation restenosis in 36). Re-intervention occurred in 45/62 (73%) balloon-dilated veins and 45/250 (18%) stented veins. Freedom from re-intervention at 1 and 5 years was 90 and 73% following stenting versus 40 and 23% following balloon dilation (p < .001, Hazard ratio (HR) = 5.7). Veins with stent diameter ≥7 mm (n = 231) had greater freedom from re-intervention (95% at 1 year, 79% at 5 years) than veins with stents <7 mm (43% at 1 year, 9% at 5 years), p < .001. There was clear symptomatic improvement after intervention and no procedural mortality.
Stent implantation at ≥7 mm for PVS after PVI is associated with low rates of re-intervention, in contrast to balloon dilation and stenting with small conventional stents.
报告克利夫兰诊所基金会 16 年来对肺静脉隔离（PVI）后肺静脉狭窄（PVS）患者进行经皮介入治疗的长期结果。
关于 PVI 后导致 PVS 的经皮介入治疗结果的报告有限。
回顾性分析 2000 年 1 月至 2016 年 12 月期间在克利夫兰诊所接受经皮介入治疗的所有 PVI 后 PVS 患者。
研究期间共有 205 例患者因 PVS 接受了心导管检查。6 例患者的静脉完全闭塞且无法再通。在其余 199 例患者中，27 例（14%）失访，172 例患者的 276 条静脉可用于分析。62 条静脉行球囊血管成形术，250 条静脉行支架植入术（原发性 214 例，治疗后扩张再狭窄 36 例）。45/62（73%）行球囊扩张的静脉和 45/250（18%）行支架植入的静脉再次介入治疗。支架植入后 1 年和 5 年免于再次介入的比例分别为 90%和 73%，而球囊扩张后分别为 40%和 23%（p < 0.001，风险比（HR）= 5.7）。支架直径≥7mm（n=231）的静脉再次介入治疗的比例明显低于支架直径<7mm（n=43）的静脉（1 年分别为 95%和 43%，5 年分别为 79%和 9%），p < 0.001。介入治疗后症状明显改善，无手术相关死亡。
与球囊扩张和小口径传统支架植入相比，PVI 后 PVS 行≥7mm 支架植入的再介入率较低。
