二尖瓣生物瓣毁损的J-Valve介入瓣中瓣技术短期随访临床经验  

Transcatheter valve-in-valve implantation treatment for mitral bioprosthesis deterioration:short-term follow-up

作　　者：张海波[1] 孟旭[1] 王胜洵[1] 郑帅[1] 孟斐[1] 吴凯胜 刘巍[2] 周玉杰[2] ZHANG Haibo;MENG Xu;WANG Shengxun;ZHENG Shuai;MENG Fei;WU Kaisheng;LIU Wei;ZHOU Yujie(Cardiac Surgery Department,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,P.R.China;Cardiology Department,Beijing Anzhen Hospital Capital Medical University,Beijing 100029,P.R.China)

机构地区：[1]首都医科大学附属北京安贞医院心外科,北京100029 [2]首都医科大学附属北京安贞医院心内科,北京100029

出　　处：《华西医学》2020年第9期1108-1112,共5页West China Medical Journal

基　　金：首都医学发展科研基金(2020-2-2065)。

摘　　要：目的探讨J-Valve介入瓣中瓣技术治疗二尖瓣生物瓣毁损短期随访的临床效果。方法回顾总结单中心2019年1月-2020年5月因二尖瓣生物瓣毁损接受经心尖途径J-Valve介入瓣中瓣技术治疗的老年患者的手术及短期随访情况。手术方法:在患者全身麻醉单腔气管插管后,左侧肋间小切口心尖区缝荷包,透视和三维食道超声检测下穿刺,导丝通过二尖瓣生物瓣进入左心房,导管交换加硬支撑导丝;引导反向安装反向释放的J-Valve介入瓣膜系统,心脏跳动下植入二尖瓣生物瓣内;调整合适植入深度,快速起搏下进行支架瓣释放;必要时进行瓣膜的球囊后扩张。结果该时段共20例二尖瓣生物瓣毁损患者完成经导管J-Valve瓣膜瓣中瓣植入,术前评估均为外科常规开胸体外循环手术较高风险(美国胸外科医师协会评分在6分以上);既往二尖瓣手术瓣膜类型:Hancock瓣膜6例,Perimount瓣膜7例,Epic瓣膜6例,Baxiter瓣膜1例;既往二尖瓣手术瓣膜大小:29号2例,27号11例,25号7例。早期有1例发生瓣膜脱落入左心室;1例术中出现瓣膜轻度移位,同时植入第2枚瓣膜;瓣中瓣植入成功率95%。监护室观察时间<6 h者5例,6~24 h者13例,24~48 h者1例,>48 h者1例。术后无二尖瓣中度及以上反流,平均二尖瓣跨瓣压差(5.2±2.3)mm Hg(1 mm Hg=0.133 kPa)。患者瓣中瓣术后恢复顺利,围手术期1个月无死亡;随访中1例患者合并感染和多脏器功能衰竭死亡,其余患者恢复顺利,无严重并发症。结论经心尖途径J-Valve介入瓣中瓣技术治疗二尖瓣生物瓣毁损临床效果良好,心脏跳动下完成植入,避免体外循环和常规开胸心脏停跳切开等创伤,值得继续观察随访。Objective To explore the short-term follow-up clinical effect of transcatheter valve-in-valve implantation treatment for mitral bioprosthesis deterioration.Methods The single center data of elderly patients with mitral valve bioprosthetic dysfunction who received transapical J-Valve intervention between January 2019 and May 2020 were reviewed and summarized.After the informed consent was signed,single lumen endotracheal intubation was performed under general anesthesia in hybrid operating room.The left intercostal small incision was used to explore the apical area.Fluoroscopy and three-dimensional esophageal ultrasound were used to guide the puncture needle.Then the guide wire entered the left atrium through the mitral valve biological valve.The catheter was exchanged,and the rigid support wire was exchanged.The reverse loaded J-Valve system was guided and implanted into the biological mitral valve with beating heart.The appropriate implantation depth was adjusted,and stent valve was released under rapid pacing.Post balloon dilation of the valve was performed if necessary.Results From January 2019 to May 2020,transcatheter J-Valve implantation was completed in 20 patients with mitral valve dysfunction and high-risk evaluation of routine thoracotomy and cardiopulmonary bypass(the Society of Thoracic Surgeon score above 6).In terms of the type of the the mitral bioprosthesis,there were 6 cases of Hancock valves,7 cases of Perimount valves,6 cases of Epic valves,and1 case of Baxiter valve.In terms of the size of the the mitral bioprosthesis,there were 2 cases of size 29 valves,11 cases of size 27 valves,and 7 cases of size 25 valves.One valve fell into the left ventricle at early stage.One patient had mild valve displacement during operation,and a second valve was implanted at the same time.The success rate of valve-invalve implantation was 95%.The length of stay in intensive care unit was less than 6 h in 5 cases,6-24 h in 13 cases,24-48 h in 1 case,and more than 48 h in 1 case.No patient’s postoperative mitral r

关 键 词：二尖瓣 生物瓣毁损 经导管手术 瓣中瓣技术 

分 类 号：R654.2[医药卫生—外科学]