经皮肺动脉瓣植入术前使用 AndraStent XXL 对右心室流出道进行预扩张。
Right ventricular outflow tract prestenting with AndraStent XXL before percutaneous pulmonary valve implantation.
机构信息
CHU Toulouse, Pediatric and Congenital Cardiology, Children's Hospital, Université de Toulouse, 31300 Toulouse, France; Institut des Maladies Métaboliques et Cardiovasculaires, Université de Toulouse, INSERM U1048, I2MC, 1, Avenue Jean-Poulhès, BP 84225, Toulouse, France.
Centre de Référence Malformations Cardiaques Congénitales, Complexes-M3C, Necker Hospital for Sick Children, George-Pompidou European Hospital, Assistance Publique des Hopitaux de Paris (AP-HP), 75015 Paris, France.
出版信息
Arch Cardiovasc Dis. 2020 Feb;113(2):113-120. doi: 10.1016/j.acvd.2019.12.004. Epub 2020 Feb 18.
BACKGROUND
The indications for percutaneous pulmonary valve implantation (PPVI) have been extended to include large dysfunctional right ventricular outflow tracts (RVOTs). Prestenting of the RVOT is commonly performed before PPVI in order to ensure a stable landing zone. The AndraStent XXL (AndraMed GmbH, Reutlingen, Germany), a cobalt-chromium stent with semi-open cell design, has unique mechanical properties in this indication but is no longer available in France.
AIMS
To assess the efficiency of AndraStent XXL before PPVI.
METHODS
In this retrospective multicentre cohort study, 86 AndraStents XXL were implanted in 77 patients in 6 centres.
RESULTS
PPVI was indicated mainly for pulmonary regurgitation (75.3%) in native or patched RVOT (88.3%). The stents were manually mounted on balloon catheters and delivered through sheaths using a conventional femoral approach. PPVI was performed successfully in 97.4% of patients after successful prestenting, generally during the same procedure (77.9%). There were no deaths associated with stent implantation, and four patients experienced five complications, mainly stent embolization, including one requiring surgery. Neither stent fracture nor dysfunction were observed in any patient during a mean follow-up of 19.2±8.7months. Stent analysis showed an excellent maximal stent expansion (97.1%) regardless of balloon size. A 22.3%±3.4 stent shortening with a 30mm balloon was observed.
CONCLUSIONS
Implantation of large cobalt-chromium AndraStent XXL stents is efficient for prestenting before PPVI.
背景
经皮肺动脉瓣植入术（PPVI）的适应证已扩展至包括功能不良的大型右心室流出道（RVOT）。为确保稳定的着陆区，通常在 PPVI 之前对 RVOT 进行预支架置入。AndraStent XXL（AndraMed GmbH，德国雷廷根）是一种具有半开放式单元格设计的钴铬支架，在该适应证中具有独特的机械性能，但在法国已不再供应。
目的
评估 PPVI 前 AndraStent XXL 的效果。
方法
在这项回顾性多中心队列研究中，在 6 家中心的 77 名患者中植入了 86 个 AndraStent XXL。
结果
PPVI 的适应证主要为原发性或修补后的 RVOT 的肺动脉瓣反流（75.3%）（88.3%）。支架通过手动安装在球囊导管上，并通过传统的股动脉入路通过鞘管输送。在成功预支架置入后，97.4%的患者成功进行了 PPVI，通常在同一手术过程中（77.9%）。支架植入术无死亡相关并发症，4 名患者发生了 5 种并发症，主要是支架栓塞，其中 1 例需要手术。在平均 19.2±8.7 个月的随访期间，任何患者均未观察到支架断裂或功能障碍。支架分析显示，无论球囊大小如何，最大支架扩张均表现出色（97.1%）。观察到支架缩短了 22.3%±3.4%，使用 30mm 球囊。
结论
在 PPVI 之前，植入大型钴铬 AndraStent XXL 支架进行预支架置入是有效的。
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