Spigel Zachary A, Adachi Iki, Binsalamah Ziyad M, Parekh Dhaval, Qureshi Athar M
Department of Surgery, Allegheny Health Network, Pittsburgh, PA, USA.
Department of Surgery, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA.
Ann Cardiothorac Surg. 2021 Sep;10(5):658-666. doi: 10.21037/acs-2021-tviv-28.
Transcatheter pulmonary valve replacement (TPVR) is now an established modality for pulmonary valve replacement in suitable candidates. We aim to describe our experience with TPVR in adults.
This is a descriptive study of all TPVR performed in adults with congenital heart disease at a single institution from 2010-2020. All adult patients (defined as 18 years old or older at TPVR) were included. Time-to-event outcomes were described using Kaplan-Meier estimates with 95% confidence intervals (CIs).
Out of a total of 200 patients that had undergone TPVR, 81 patients (57% male) met the inclusion criteria, with a median age and weight of 26 years (IQR 21-37) and 71.0 kg (IQR 54.6-89.0), respectively. In the cohort, 45 (56%) patients had tetralogy of Fallot. While 53 (65%) patients received a Melody valve, a Sapien valve (S3 in 20, XT in eight) was implanted in the rest. Pre-stenting was performed in 49 (52%) patients. One patient died of severe heart failure a year following TPVR. One patient had a second TPVR performed 2.2 years following initial TPVR for severe pulmonary regurgitation. Valve survival at 2.2 years was 94% (95% CI: 87-100%). Four patients developed endocarditis. Endocarditis-free survival was 89% (95% CI: 80-100%) at three years.
Our experience suggests favorable results of TPVR in adults with congenital heart disease. Additional research would be warranted with a focus on total valve longevity and patient reported outcomes, in order to improve the understanding of TPVR in this population and further refine this technology.
经导管肺动脉瓣置换术（TPVR）现已成为适合患者进行肺动脉瓣置换的既定方式。我们旨在描述我们在成人患者中进行TPVR的经验。
这是一项对2010年至2020年在单一机构对患有先天性心脏病的成人进行的所有TPVR的描述性研究。纳入所有成年患者（定义为TPVR时年龄为18岁及以上）。使用Kaplan-Meier估计值及95%置信区间（CI）描述事件发生时间结局。
在总共200例接受TPVR的患者中，81例患者（57%为男性）符合纳入标准，中位年龄和体重分别为26岁（IQR 21 - 37）和71.0 kg（IQR 54.6 - 89.0）。在该队列中，45例（56%）患者患有法洛四联症。53例（65%）患者接受了Melody瓣膜，其余患者植入了Sapien瓣膜（20例为S3型，8例为XT型）。49例（52%）患者进行了预支架置入。1例患者在TPVR后1年死于严重心力衰竭。1例患者在初次TPVR后2.2年因严重肺动脉反流接受了第二次TPVR。2.2年时瓣膜生存率为94%（95% CI：87 - 100%）。4例患者发生了心内膜炎。3年时无心内膜炎生存率为89%（95% CI：80 - 100%）。
我们的经验表明TPVR在患有先天性心脏病的成人中取得了良好效果。有必要进行更多研究，重点关注瓣膜总寿命和患者报告的结局，以增进对该人群中TPVR的理解并进一步完善这项技术。
