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心脏移植后左侧瓣膜性心脏病的经导管治疗

Transcatheter management of left-sided valvular heart disease following heart transplantation.

作者信息

Hinkov Hristian, Roehrich Luise, Lee Chong Bin, Klein Christoph, Kukucka Marian, Merke Nicolas, Falk Volkmar, Dreger Henryk, Knosalla Christoph, Schoenrath Felix, Unbehaun Axel

机构信息

Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany.

Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.

出版信息

Eur J Cardiothorac Surg. 2025 Jun 3;67(6). doi: 10.1093/ejcts/ezaf191.

Abstract

OBJECTIVES

Aortic stenosis (AS) and mitral regurgitation (MR) are rare in heart transplant (HTx) recipients, but their incidence increases with extended post-transplant survival. This study assesses the safety, efficacy and outcomes of transcatheter interventions in this high-risk population.

METHODS

An institutional series of HTx patients undergoing a transcatheter aortic valve implant (TAVI) or mitral transcatheter edge-to-edge repair (M-TEER) from March 2015 through April 2024 was analysed retrospectively. Both elective cases and patients in cardiac decompensation/cardiogenic shock were included. There were no exclusion criteria. Primary outcomes were echocardiographic allograft function and Valve Academic Research Consortium 3 (VARC-3)/Mitral Valve Academic Research Consortium (MVARC) success and safety composite end points. Secondary outcomes included symptom change, complications and survival.

RESULTS

A total of 15 consecutive patients were included in the analysis. Nine patients underwent TAVI and 6 had M-TEER. The median age was 56 years, with a median of 17 years from HTx to valve intervention. A total of 46.7% (7/15) of the procedures were considered urgent/emergency. Improvements were noted in the left ventricular ejection fraction, systolic pulmonary artery pressure and tissue Doppler peak contraction velocity. The VARC-3/MVARC technical success was 100%; device success for TAVI was 93.3% and 83.3% for M-TEER. VARC-3 early safety was 66.7% for TAVI, and MVARC procedural success was 83.3% for M-TEER; 86.7% showed improved functional status. Median survival was 800 days.

CONCLUSIONS

TAVI and M-TEER were feasible and efficient in improving echocardiographic allograft function. Elective procedures were associated with a median survival of over 2 years. Survival outcomes varied based on procedure urgency. Close monitoring of AS/MR seems crucial in HTx patients, with timely intervention prior to decompensation/shock. Further multicentre studies are needed to establish management guidelines for AS/MR in HTx recipients.

摘要

目的

主动脉瓣狭窄(AS)和二尖瓣反流(MR)在心脏移植(HTx)受者中较为罕见,但随着移植后生存期延长,其发生率会增加。本研究评估了在这一高危人群中经导管介入治疗的安全性、有效性和结局。

方法

回顾性分析了2015年3月至2024年4月期间在本机构接受经导管主动脉瓣植入术(TAVI)或二尖瓣经导管缘对缘修复术(M-TEER)的一系列HTx患者。纳入了择期病例以及处于心脏失代偿/心源性休克的患者。没有排除标准。主要结局是超声心动图显示的移植心脏功能以及瓣膜学术研究联盟3(VARC-3)/二尖瓣学术研究联盟(MVARC)成功和安全复合终点。次要结局包括症状变化、并发症和生存率。

结果

分析共纳入了15例连续患者。9例患者接受了TAVI,6例接受了M-TEER。中位年龄为56岁,从HTx到瓣膜介入的中位时间为17年。共有46.7%(7/15)的手术被视为紧急/急诊。左心室射血分数、收缩期肺动脉压和组织多普勒峰值收缩速度均有改善。VARC-3/MVARC技术成功率为100%;TAVI的器械成功率为93.3%,M-TEER为83.3%。TAVI的VARC-3早期安全性为66.7%,M-TEER的MVARC手术成功率为83.3%;86.7%的患者功能状态得到改善。中位生存期为800天。

结论

TAVI和M-TEER在改善超声心动图显示的移植心脏功能方面是可行且有效的。择期手术的中位生存期超过2年。生存结局因手术紧急程度而异。对HTx患者密切监测AS/MR似乎至关重要,在失代偿/休克前及时进行干预。需要进一步开展多中心研究以建立HTx受者AS/MR的管理指南。

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