Cardiothoracic Surgery, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia.
Cardiothoracic Surgery, Department of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
ANZ J Surg. 2022 Dec;92(12):3298-3303. doi: 10.1111/ans.18076. Epub 2022 Oct 6.
Rheumatic heart disease (RHD) in young people presents a complex management problem. In Australia a significant proportion of those affected are Aboriginal and Torres Strait Islanders. Transcatheter mitral valve-in-valve (TMViV) replacement has emerged as an alternative to redo surgery in high-risk patients with degenerated mitral bioprostheses. The aim of this study is to review outcomes of TMViV replacement in young patients with RHD.
A single-centre, retrospective review of prospectively collected data on patients undergoing TMViV from December 2017 to June 2021. Primary outcome was major adverse cardiovascular events. Secondary outcome was post-operative trans-thoracic echocardiogram (TTE) results.
There were seven patients with a mean age of 33 years and predominantly female (n = 5). Pre-operative comorbidities included diabetes (29%), chronic obstructive pulmonary disease (43%), left ventricular dysfunction (43%) and current smoking status (80%). Post-operative median length of hospital stay was 4 days with no post-operative renal failure, stroke, return to theatre, valve embolization or in hospital mortality. Post-operative TTE showed either nil or trivial central mitral regurgitation, no paravalvular leak and a median gradient of 5 mmHg (IQR 4.5, 7) across the new bioprosthesis; sustained at median follow-up of 22 months.
Current literature of TMViV replacement is focused on an older population with concurrent comorbidities. This study provides a unique insight into TMViV replacement in a young cohort of patients with complex social and geographical factors which sometimes prohibits the use of a mechanical valve. The prevalence of RHD remains high for Aboriginal and Torres Strait Islanders, planning for future repeat valve operations should be considered from the outset. We consider TMViV as a part of a staged procedural journey for young patients with RHD.
年轻人风湿性心脏病（RHD）呈现出复杂的管理问题。在澳大利亚，受影响的患者中有相当一部分是原住民和托雷斯海峡岛民。经导管二尖瓣瓣中瓣（TMViV）置换术已成为退行性二尖瓣生物瓣高危患者再次手术的替代方法。本研究旨在回顾 RHD 年轻患者 TMViV 置换术的结果。
对 2017 年 12 月至 2021 年 6 月期间接受 TMViV 的患者进行前瞻性收集数据的单中心回顾性研究。主要结果是主要不良心血管事件。次要结果是术后经胸超声心动图（TTE）结果。
有 7 名患者，平均年龄 33 岁，主要为女性（n=5）。术前合并症包括糖尿病（29%）、慢性阻塞性肺疾病（43%）、左心室功能障碍（43%）和当前吸烟状况（80%）。术后中位住院时间为 4 天，无术后肾功能衰竭、中风、重返手术室、瓣周漏或院内死亡。术后 TTE 显示新生物瓣无或轻微中心二尖瓣反流、无瓣周漏，新生物瓣跨瓣梯度为 5mmHg（四分位距 4.5，7）；中位随访 22 个月后仍保持稳定。
目前 TMViV 置换术的文献主要集中在伴有合并症的老年人群。本研究提供了一个独特的视角，了解了具有复杂社会和地理因素的年轻患者 TMViV 置换术，有时这些因素会妨碍使用机械瓣。原住民和托雷斯海峡岛民的 RHD 患病率仍然很高，应从一开始就考虑为未来的重复瓣膜手术做好计划。我们认为 TMViV 是 RHD 年轻患者分阶段手术治疗的一部分。
