在增大的自体右心室流出道中植入 Edwards SAPIEN XT 和 SAPIEN 3 瓣膜以治疗肺动脉瓣位置异常。
Implantation of the Edwards SAPIEN XT and SAPIEN 3 valves for pulmonary position in enlarged native right ventricular outflow tract.
机构信息
Departments of Pediatric Cardiology İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital; İstanbul-Turkey.
Department of Pediatric Cardiac Anesthesia, University Of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic And Cardiovascular Surgery Education And Research Hospital, Istanbul, Turkey.
出版信息
Anatol J Cardiol. 2021 Feb;25(2):96-103. doi: 10.14744/AnatolJCardiol.2020.46024.
OBJECTIVE
Percutaneous pulmonary valve implantation (PPVI) into right ventricle-to-pulmonary artery conduits is increasingly being performed, but a few options are available for patients with a dilated native right ventricular outflow tract (RVOT), among which is the off-label use of Ed-wards SAPIEN® valves. This study reviews the results of the SAPIEN XT and SAPIEN 3 (S3) valve implantations in the pulmonary position in patients with a dilated native RVOT.
METHODS
Between January 2015 and March 2020, PPVI procedures were performed on 129 patients. Among them, 103 (80%) had dilated native RVOT, 86 of whom were eligible for PPVI prestenting and valve implantation. Retrospective analysis was performed on 84 patients who have undergone successful PPVI implantation using the SAPIEN XT or S3 valves with dilated native RVOT.
RESULTS
The procedural success rate was 84/86 (98%). The median age was 18.7 years (8-46 years), and the median weight was 57 kg (22-102 kg). The primary underlying diagnosis was tetralogy of Fallot (n=77/84). Stenting was performed simultaneously with valve implantation in 50/84 (60%) cases-six of which were hybrid procedures-whereas prestenting was performed 3 to 14 weeks earlier in 34/84 cases. Before valve im-plantation, the median right anterior oblique and lateral diameters of the stents were 26 mm (20-32 mm) and 28 mm (21-32 mm). Valve sizes were 26 mm (n=13) and 29 mm (n=64) for XT and 29 mm (n=7) for S3. In 59 patients, an additional 1-5 ml (median 2 ml) volume was added to the valves' balloons for stabilization. In all hybrid procedures, the stent and valve were implanted in the same session. During follow-ups of 1 to 59 months (median 14 months), no deaths were reported, 3 patients developed tricuspid regurgitation secondary to the procedure, and valves continued to function in all patients.
CONCLUSION
The Edwards SAPIEN XT and S3 valves may be an alternative to PPVI in patients with dilated native RVOT.
目的
经皮肺动脉瓣植入术（PPVI）于右心室至肺动脉通道中越来越多地被施行，但对于右心室流出道（RVOT）扩张的患者，仅有少数选择，其中包括对 Edwards SAPIEN®瓣膜的超适应证使用。本研究回顾了在 RVOT 扩张的患者中施行肺动脉瓣位置的 SAPIEN XT 和 SAPIEN 3（S3）瓣膜植入术的结果。
方法
2015 年 1 月至 2020 年 3 月，对 129 例患者施行 PPVI 手术。其中，103 例（80%）患者 RVOT 扩张，86 例患者符合行 PPVI 预扩张和瓣膜植入术的标准。对 84 例使用 SAPIEN XT 或 S3 瓣膜成功施行 PPVI 植入术的患者进行回顾性分析，这些患者的 RVOT 扩张。
结果
手术成功率为 84/86（98%）。中位年龄为 18.7 岁（8-46 岁），中位体重为 57kg（22-102kg）。主要的基础诊断为法洛四联症（n=77/84）。50/84（60%）例患者同时施行支架置入术和瓣膜植入术，其中 6 例为杂交手术；34/84 例患者在瓣膜植入术前 3 至 14 周进行了预扩张术。在瓣膜植入前，支架的中位右前斜位和侧位直径为 26mm（20-32mm）和 28mm（21-32mm）。瓣膜尺寸为 XT 26mm（n=13）和 29mm（n=64），S3 为 29mm（n=7）。在 59 例患者中，为了稳定瓣膜，向瓣膜球囊中额外添加了 1-5ml（中位数 2ml）容量。在所有杂交手术中，支架和瓣膜均在同一时段植入。在 1 至 59 个月（中位数 14 个月）的随访期间，无死亡病例报告，3 例患者因该手术继发三尖瓣反流，所有患者的瓣膜均持续正常工作。
结论
Edwards SAPIEN XT 和 S3 瓣膜可能是 RVOT 扩张患者行 PPVI 的另一种选择。
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