Taha Fatma A, Naeim Hesham, Alnozha Fareed, Amoudi Osama, Abuelatta Reda
Adult Cardiology Department, Madinah Cardiac Center, Madinah, Saudi Arabia.
Cardiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
J Interv Cardiol. 2022 Jun 22;2022:6587036. doi: 10.1155/2022/6587036. eCollection 2022.
Re-operative mitral valve (MV) replacement is a high-risk procedure, therefore, transcatheter MV replacement (TMVR) is a promising therapeutic option.
In this study, we aimed to evaluate the feasibility and safety of TMVR in patients with high surgical risk with degenerated mitral bioprostheses (TMViV), failed surgical rings (TMViR), and mitral annular calcification (TMViMAC).
This is a retrospective cohort study that enrolled patients with high surgical risk who underwent TMVR from February 2017 to September 2020. The TMVR procedure was performed using Edwards SAPIEN-3 valves through the transseptal approach.
Sixty-four patients aged 62.7 ± 16.1 years with an STS score of 9.2 ± 3.7% underwent TMVR [35 (55%) TMViV, 16 (25%) TMViR, and 13 (20%) TMViMAC]. Mitral stenosis was more frequent in TMViV, mitral regurgitation was more frequent in TMViR, and combined mitral stenosis and regurgitation were more frequent in TMViMAC ( < 0.05). The MV gradient was 14.3 ± 5.3 mmHg and the MV area was 1.5±0.6 cm. The 29 mm valve was frequently used in TMViV and TMViMAC, while the 23 mm valve was frequently used in TMViR (=0.003 ). The procedural and fluoroscopy times were 58.7 ± 8.9 and 41.1 ± 8.2 minutes, respectively. Technical success was reported in 62 (98.4%) patients; 1 TMViR patient experienced valve embolization and salvage surgery, and 1 TMViMAC patient experienced slight valve malposition. At 3 months, 2 (3.1%) patients showed valve thrombosis (treated with anticoagulation), and 1 (1.6%) patient developed a paravalvular leak (underwent surgical MV replacement). At 6 months, 3 (4.7%) patients showed valve degeneration (underwent surgical MV replacement). Throughout follow-up, no patient exhibited mortality.
TMVR is a feasible and safe approach in patients with high surgical risk. TMViV and TMViR are reasonable as the first treatment approaches, and TMViMAC seems encouraging.
再次二尖瓣置换术是一项高风险手术，因此，经导管二尖瓣置换术（TMVR）是一种有前景的治疗选择。
在本研究中，我们旨在评估经导管二尖瓣置换术在二尖瓣生物瓣退化（TMViV）、手术环失败（TMViR）和二尖瓣环钙化（TMViMAC）的高手术风险患者中的可行性和安全性。
这是一项回顾性队列研究，纳入了2017年2月至2020年9月接受TMVR的高手术风险患者。TMVR手术通过经房间隔途径使用爱德华SAPIEN-3瓣膜进行。
64例年龄为62.7±16.1岁、STS评分9.2±3.7%的患者接受了TMVR[35例（55%）TMViV、16例（25%）TMViR和13例（20%）TMViMAC]。二尖瓣狭窄在TMViV中更常见，二尖瓣反流在TMViR中更常见，二尖瓣狭窄合并反流在TMViMAC中更常见（<0.05）。二尖瓣梯度为14.3±5.3mmHg，二尖瓣面积为1.5±0.6cm²。29mm瓣膜在TMViV和TMViMAC中常用，而23mm瓣膜在TMViR中常用（=0.003）。手术时间和透视时间分别为58.7±8.9分钟和41.1±8.2分钟。62例（98.4%）患者手术成功；1例TMViR患者发生瓣膜栓塞并接受挽救手术，1例TMViMAC患者出现轻微瓣膜位置异常。3个月时，2例（3.1%）患者出现瓣膜血栓形成（接受抗凝治疗），1例（1.6%）患者发生瓣周漏（接受二尖瓣置换手术）。6个月时，3例（4.7%）患者出现瓣膜退化（接受二尖瓣置换手术）。在整个随访期间，无患者死亡。
TMVR对于高手术风险患者是一种可行且安全的方法。TMViV和TMViR作为首选治疗方法是合理的，TMViMAC似乎前景良好。
