Liu Yang, Xu Chennian, Jin Ping, Zhai Mengen, Tang Hao, Tian Zhiyuan, Wen Anguo, Qiao Rui, Yang Jian
Department of Cardiovascular Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi Province, China.
Department of Pharmacology, Key Laboratory of Gastrointestinal Pharmacology of Chinese Materia Medica of the State Administration of Traditional Chinese Medicine, School of Pharmacy, Air Force Medical University, Xi'an, Shaanxi Province, China.
Medicine (Baltimore). 2024 Nov 22;103(47):e40600. doi: 10.1097/MD.0000000000040600.
Transcatheter closure of percutaneous paravalvular leak (PVL) is a technically challenging procedure, especially after surgical mechanical valve replacements (SMVR), as the risk of interference with the prosthetic valve discs and the complex interventional techniques required for mitral PVL closure. Our study was designed to review the results with transcatheter closure of PVL after SMVR.
From January 2018 through December 2023, a total of 64 patients with PVL after SMVR underwent transcatheter closure with the help of preoperative 3-dimensional printing model and simulator for image evaluation. We reviewed the catheter techniques, perioperative characteristics, and prognosis.
The median follow-up was 28 (3-58) months. The procedure was successful in 60/64 (93.8%) patients. There were 36 aortic PVLs, 27 mitral PVLs, and 1 combined aortic and mitral PVL which were repaired by the transcatheter approach. A total of 24 patients had aortic valve replacements and 20 patients had mitral valve replacements, while 20 patients had previously combined aortic and mitral valve replacements. Procedural time was 35 to 300 (106.6±51.2) minutes. Fluoroscopic time was 8 to 50 (17.6±11.3) minutes. The hospital stay was 5 to 21 (8.1±3.5) days. A total of 47 (78.3%) patients improved by ≥1 New York Heart Association functional class at the 1-year follow-up.
Complex catheter techniques were included in percutaneous closure of mechanical PVL. However, this minimally closure treatment could provide reliable outcomes and shorter hospital stays in selected patients.
经导管闭合经皮瓣周漏（PVL）是一项技术上具有挑战性的操作，尤其是在外科机械瓣膜置换术（SMVR）之后，因为存在干扰人工瓣膜瓣叶的风险以及二尖瓣PVL闭合所需的复杂介入技术。我们的研究旨在回顾SMVR后经导管闭合PVL的结果。
从2018年1月至2023年12月，共有64例SMVR后发生PVL的患者在术前三维打印模型和模拟器的帮助下进行图像评估后接受经导管闭合治疗。我们回顾了导管技术、围手术期特征和预后情况。
中位随访时间为28（3 - 58）个月。60/64（93.8%）例患者手术成功。有36例主动脉瓣PVL、27例二尖瓣PVL以及1例主动脉和二尖瓣联合PVL通过经导管方法修复。共有24例患者进行了主动脉瓣置换，20例患者进行了二尖瓣置换，而20例患者此前进行了主动脉和二尖瓣联合置换。手术时间为35至300（106.6±51.2）分钟。透视时间为8至50（17.6±11.3）分钟。住院时间为5至21（8.1±3.5）天。在1年随访时，共有47（78.3%）例患者纽约心脏协会功能分级改善≥1级。
机械性PVL的经皮闭合包括复杂的导管技术。然而，这种微创闭合治疗可为选定患者提供可靠的结果并缩短住院时间。
