主动脉瓣及二尖瓣双瓣置换术后二尖瓣生物瓣衰败的经心尖经导管瓣中瓣治疗  

Transapical transcatheter valve-in-valve implantation treatment for patients with deteriorated mitral bioprosthesis after aortic-mitral double valve replacement

作　　者：魏培坚 刘健[1] 谢年谨[3] 谭桐 马介旭 陈钊 刘彦俊 吴宏祥 黄焕雷[1] 陈寄梅[1] 庄建[1] 郭惠明[1] WEI Peijian;LIU Jian;XIE Nianjin;TAN Tong;MA Jiexu;CHEN Zhao;LIU Yanjun;WU Hongxiang;HUANG Huanlei;CHEN Jimei;ZHUANG Jian;GUO Huiming(Department of Cardiovascular Surgery,Guangdong Cardiovascular Institute,Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences,Guangzhou,510080,P.R.China;Shantou University Medical College,Shantou,515041,Guangdong,P.R.China;Department of Cardiology,Guangdong Cardiovascular Institute,Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences,Guangzhou,510080,P.R.China)

机构地区：[1]广东省人民医院广东省医学科学院,广东省心血管病研究所心外科,广州510080 [2]汕头大学医学院,广东汕头515041 [3]广东省人民医院,广东省医学科学院,广东省心血管病研究所心内科,广州510080

出　　处：《中国胸心血管外科临床杂志》2021年第8期901-907,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家重点研发计划(2018YFC1002600);广州市科技项目(202002030039)。

摘　　要：目的明确心尖入路经导管瓣中瓣技术治疗主动脉瓣及二尖瓣双瓣置换术后二尖瓣衰败的临床效果。方法回顾性分析2020年5月至2021年1月我院9例主动脉瓣及二尖瓣双瓣置换术后因二尖瓣生物瓣衰败接受心尖入路经导管二尖瓣瓣中瓣技术治疗患者的临床资料。其中男4例、女5例,平均年龄(72.44±7.57)岁。结果所有患者均顺利完成手术,无中转正中开胸。手术时间(101.33±48.49)min,机械通气时间(23.11±26.54)h,ICU观察时间(1.89±1.05)d,术后住院时间(6.11±2.01)d。术后仅1例患者存在轻度二尖瓣反流,1例患者术后需要输血,无严重术后并发症。术后90 d无死亡病例。结论对于主动脉瓣及二尖瓣双瓣置换术后二尖瓣衰败的患者,心尖入路经导管二尖瓣瓣中瓣植入不会增加术后左室流出道梗阻的风险,能有效改善患者的血流动力学,临床治疗效果良好。Objective To determine the clinical efficacy of transapical transcatheter mitral valve-in-valve treatment for patients with deteriorated mitral bioprosthesis after aortic-mitral double valve replacement.Methods The clinical data of 9 patients who underwent transapical transcatheter mitral valve-in-valve implantation after aortic-mitral double valve replacement due to mitral bioprosthesis deterioration from May 2020 to January 2021 in our hospital were retrospectively analyzed,including 4 males and 5 females with a mean age of 72.44±7.57 years.Results Surgeries were performed successfully in all patients with no conversion to median sternotomy.The mean procedural time was 101.33±48.49 min,the mechanical ventilation time was 23.11±26.54 h,the ICU stay was 1.89±1.05 d and the postoperative hospital stay was 6.11±2.02 d.Residual mild mitral regurgitation was only observed in 1 patient.Only 1 patient needed postoperative blood transfusion.No major complications were observed in all patients.There was no death in postoperative 90 days.Conclusion For patients with deteriorated mitral bioprosthesis after aortic-mitral double valve replacement,transapical transcatheter mitral valve-in-valve implantation achieves good clinical results and effectively improves the hemodynamics without increasing the risk of postoperative left ventricular outflow tract obstruction.The surgery is feasible and effective.

关 键 词：经心尖经导管治疗 瓣中瓣 主动脉瓣及二尖瓣双瓣置换术 生物瓣衰败 

分 类 号：R654.2[医药卫生—外科学]