Nicz Pedro Felipe Gomes, Melo Pedro Henrique M Craveiro de, Brito Pedro Henrique Ferro de, Lima Eliane Nogueira, Silva Ricardo Cavalcante E, Prudente Maurício Lopes, Fernandes Fernando Henrique, Deininger Maurilio Onofre, Lopes Marcelo Antônio Cartaxo Queiroga, Petrucci Fúlvio Soares, Reis Filho Fernando Roquette, Marino Marcos Antonio, Bernardes Rodrigo de Castro, Melo Eduardo Pessoa de, Oliveira Marco Antonio Praça, Mangione José Armando, Mangione Fernanda Marinho, Falcão Carlos Henrique Eiras, Martins Estêvão Carvalho de Campos, Lunardi Walter, Bacal Fernando, Tarasoutchi Flávio, Brito Fábio Sândoli de
Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas Instituto do Coração - Hemodinâmica, São Paulo, SP - Brasil.
Hospital São Camilo Pompeia - Cardiologia Intervencionista, São Paulo, SP - Brasil.
Arq Bras Cardiol. 2020 Sep;115(3):515-524. doi: 10.36660/abc.20190252.
Percutaneous intervention in patients with bioprosthetic mitral valve dysfunction is an alternative to conventional surgical treatment.
To report the first Brazilian experience with transseptal transcatheter bioprosthetic mitral valve-in-valve implantation (transseptal-TMVIV).
Patients with surgical bioprosthetic dysfunction submitted to transseptal-TMVIV in 12 Brazilian hospitals were included. The significance level adopted was p<0.05.
From June/2016 to February/2019, 17 patients underwent transseptal-TMVIV. Their median age was 77 years (IQR,70-82) and median Society of Thoracic Surgeons predicted risk of mortality (STS-PROM) score was 8.7% (IQR,7.2-17.8). All patients had limiting symptoms of heart failure (FC≥III) and 5 (29.4%) had undergone more than one previous thoracotomy. Transseptal-TMVIV was successful in all patients. Echocardiographic assessment showed a significant reduction in mean mitral valve gradient (pre-intervention, 12±3.8 mmHg; post-intervention, 5.3±2.6 mmHg; p<0.001), in addition to an increase in mitral valve area (pre-intervention, 1.06±0.59 cm2; post-intervention, 2.18±0.36 cm2; p<0.001) sustained for 30 days. There was a significant and immediate reduction in the pulmonary artery systolic pressure, with an additional reduction in 30 days (pre-intervention, 68.9±16.4 mmHg; post-intervention, 57.7±16.5 mmHg; 30 days, 50.9±18.7 mmHg; p<0.001). During follow-up (median, 162 days; IQR, 102-411), significant clinical improvement (FC≤II) was observed in 87.5% of the patients. One patient (5.9%) had left ventricular outflow tract (LVOT) obstruction and died right after the procedure, and another died at 161 days of follow-up.
The first Brazilian experience with transseptal-TMVIV shows the safety and effectivity of the new technique. The LVOT obstruction is a potentially fatal complication, reinforcing the importance of patients' selection and of procedural planning. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).
对生物瓣二尖瓣功能障碍患者进行经皮介入治疗是传统外科治疗的一种替代方法。
报告巴西首例经房间隔经导管生物瓣二尖瓣瓣中瓣植入术（经房间隔-TMVIV）的经验。
纳入在巴西12家医院接受经房间隔-TMVIV治疗的外科生物瓣功能障碍患者。采用的显著性水平为p<0.05。
2016年6月至2019年2月，17例患者接受了经房间隔-TMVIV治疗。他们的中位年龄为77岁（四分位间距，70 - 82岁），胸外科医师协会预测的中位死亡风险（STS-PROM）评分为8.7%（四分位间距，7.2 - 17.8%）。所有患者均有心力衰竭的限制性症状（心功能分级≥III级），5例（29.4%）曾接受过不止一次开胸手术。经房间隔-TMVIV在所有患者中均获成功。超声心动图评估显示二尖瓣平均压差显著降低（干预前，12±3.8 mmHg；干预后，5.3±2.6 mmHg；p<0.001），二尖瓣面积增加（干预前，1.06±0.59 cm²；干预后，2.18±0.36 cm²；p<0.001），且持续30天。肺动脉收缩压显著且即刻降低，30天时进一步降低（干预前，68.9±16.4 mmHg；干预后，57.7±16.5 mmHg；30天时，50.9±18.7 mmHg；p<0.001）。在随访期间（中位时间，162天；四分位间距，102 - 411天），87.5%的患者临床症状显著改善（心功能分级≤II级）。1例患者（5.9%）发生左心室流出道（LVOT）梗阻，术后即刻死亡，另1例在随访161天时死亡。
巴西首例经房间隔-TMVIV经验显示了这项新技术的安全性和有效性。LVOT梗阻是一种潜在的致命并发症，强化了患者选择和手术规划的重要性。（《巴西心脏病学杂志》。2020年；[网络版]。预印本，PP.0 - 0）
