Owais Tamer, El Garhy Mohammad, Elvinger Sebastian, Harmel Eva, Gross Tatiana Maria Sequeria, Lapp Harald, Kuntze Thomas, Von Scheidt Wolfgang, Girdauskas Evaldas, Al-Jassem Mahmoud, Lauten Philipp
Department of Cardiac Surgery, University Hospital Augsburg, Stenglin Street 2, 86156, Augsburg, Germany.
Department of Cardiothoracic Surgery, Cairo University, Giza City, Egypt.
Egypt Heart J. 2022 Mar 28;74(1):19. doi: 10.1186/s43044-022-00257-x.
Transcatheter mitral valve-in-valve (TMVIV) or valve-in-ring (TMVIR) replacement offer an alternative therapy for high risk patients. We aimed to highlight the operative and postoperative results of TMVIV and TMVIR procedures.
We included all patients underwent TMVIV and TMVIR procedures between 2017 and 2020 at two heart centers in Germany. We included a total of 36 high risk patients in our study where 12 received TMVIV and 24 received TMVIR. All patients underwent TMVIV or TMVIR with Edwards Sapien XT or S3 transcatheter valves (Edwards Lifesciences). The mean age was 79 (75-83 years old). The median (IQR) preoperative STS score was 9 (7-13)% and EuroSCORE II was 14.5% (12-16). The majority of our patients were operated via transapical approach (n = 26) and the minority via transseptal approach (n = 10). Out of our records, none of our patients required reopening for bleeding or any other surgical complications. None of our patients required reintervention during the 6 months follow-up period. One mortality was recorded on fifth postoperative day due to low cardiac output syndrome (obviously because of LVOT obstruction by the anterior mitral leaflet). The average blood loss was 200 ml in the first 24 h in patients underwent transapical approach. Average operative time was 93 min and all patients were immediately extubated after the procedure in the operating room (even the patient with echocardiographically documented LVOT obstruction who died on the fifth postoperative day). Length of Intensive Care Unit stay was 2 ± 1.2 days and length of hospital stay was 4.1 ± 1.2 days. In the follow up period, echocardiograms showed normal prosthetic valve function with low transvalvular gradients, no LVOT obstruction in TMVIR cases and no evidence of valve migration or thrombosis (except in one patient). Concerning 6 months readmission, it was recorded in 2 patients due to right sided heart failure symptoms due to preexisting high degree of tricuspid valve regurge which did not disappear or even decrease after the operation and the other patient due to gastrointestinal bleeding.
TMVIV and TMVIR offer an efficient, safe and less invasive alternative in high surgical risk patients.
经导管二尖瓣瓣中瓣（TMVIV）或瓣中环（TMVIR）置换术为高危患者提供了一种替代治疗方法。我们旨在强调TMVIV和TMVIR手术的手术及术后结果。
我们纳入了2017年至2020年期间在德国两个心脏中心接受TMVIV和TMVIR手术的所有患者。我们的研究共纳入36例高危患者，其中12例接受TMVIV，24例接受TMVIR。所有患者均使用爱德华兹Sapien XT或S3经导管瓣膜（爱德华兹生命科学公司）进行TMVIV或TMVIR手术。平均年龄为79岁（75 - 83岁）。术前STS评分中位数（IQR）为9%（7% - 13%），欧洲心脏手术风险评估系统（EuroSCORE）II为14.5%（12% - 16%）。我们的大多数患者通过经心尖途径进行手术（n = 26），少数通过经房间隔途径（n = 10）。在我们的记录中，没有患者因出血或任何其他手术并发症需要再次手术。在6个月的随访期内，没有患者需要再次干预。术后第5天记录到1例死亡，原因是低心排血量综合征（显然是由于二尖瓣前叶导致左心室流出道梗阻）。经心尖途径的患者在术后最初24小时内平均失血量为200毫升。平均手术时间为93分钟，所有患者在手术室手术后立即拔管（即使是术后第5天死亡的经超声心动图证实存在左心室流出道梗阻的患者）。重症监护病房住院时间为2 ± 1.2天，住院时间为4.1 ± 1.2天。在随访期间，超声心动图显示人工瓣膜功能正常，跨瓣压差低，TMVIR病例中无左心室流出道梗阻，且无瓣膜移位或血栓形成的证据（1例患者除外）。关于6个月再入院情况，2例患者因术前存在高度三尖瓣反流，术后未消失甚至加重导致的右侧心力衰竭症状而再入院，另1例患者因胃肠道出血而再入院。
TMVIV和TMVIR为高手术风险患者提供了一种有效、安全且侵入性较小的替代方法。
