经心尖二尖瓣瓣中瓣手术的早期结果  

Early outcomes of transapical mitral valve-in-valve procedure

作　　者：谢旭晶[1] 李力夫 黄焕雷[2] 刘健[2] 何标川 陈泽锐[2] 赵俊飞[2] 郭惠明[2] 陈寄梅[2] Xie Xujing;Li Lifu;Huang Huanlei;Liu Jian;He Biaochuan;Chen Zerui;Zhao Junfei;Guo Huiming;Chen Jimei(Department of Cardiology,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of Cardiovascular Surgery,Guangdong Cardiovascular Institute,Guangdong Provincial People’s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510100,China)

机构地区：[1]中山大学第三附属医院心内科,广州510630 [2]广东省心血管病研究所广东省人民医院(广东省医学科学院)心外科,广州510080

出　　处：《中华胸心血管外科杂志》2021年第10期600-605,共6页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：广东省基础与应用基础研究基金重点项目(2019B1515120071)。

摘　　要：目的总结在生物瓣衰败患者采用J-Valve瓣膜行二尖瓣瓣中瓣手术的经验和早期结果。方法回顾性分析2020年4月至2021年3月在广东省人民医院心外科采用J-Valve瓣膜行二尖瓣瓣中瓣手术的29例患者临床资料。男16例,女13例,平均年龄(72.0±11.6)岁。既往手术置换HancockⅡ瓣膜17例,Edwards SAV瓣膜7例,Edwards Perimount瓣膜3例,佰仁思瓣膜1例,Mosaic瓣膜1例。瓣膜型号25号8例,27号17例,29号4例。手术于杂交手术室完成,在X线透视和TEE监测下经左侧肋间和心尖,将反向安装的J-Valve瓣膜在导丝的引导下置入二尖瓣生物瓣内。结果1例患者因介入瓣膜移位,紧急转正中开胸,在体外循环心脏停搏下经右心房及房间隔切口复位。28例完成经心尖瓣中瓣手术,死亡1例,手术操作成功率96.6%(28/29)。二尖瓣平均跨瓣压差(7.6±2.2)mmHg(1 mmHg=0.133 kPa),术后随访无死亡及严重并发症发生。结论采用J-Valve介入瓣膜在生物瓣衰败损毁的患者中行二尖瓣瓣中瓣手术可获得良好的早期效果,即使患者在前次手术置换的是小号生物瓣,仍可取得满意的血流动力学效果。Objective To summarize the experience and early outcomes of transapical mitral valve-in-valve procedure with J-Valve in patients with bioprostheses degeneration.Methods The clinical data of 29 patients who underwent mitral transcatheter valve-in-valve implantation with J-Valve from April 2020 to March 2021 were retrospectively analyzed.There were male 16 and female 13 patients with average age(72.0±11.6)years.Patients underwent previous mitral valve replacement with bioprostheses of HancockⅡin 17,Edwards SAV in 7,Edwards Perimount in 3,Balmedic in 1,Mosaic in 1.The size of mitral bioprostheses included 25#for 8 patients,27#for 17 patients,and 29#for other 4 patients.The operations were performed in the hybrid operation room.Under X-ray fluoroscopy and TEE monitoring,the retro-preseted J-valve was implanted into the mitral bioprosthetic valve via the intercostal space and apical puncture.Results One patient was converted urgently to mediate sternotomy,and the transcatheter mitral valve was reset after opening left atrium on cardiopulmonary bypass due to the migration of transcatheter valve.twenty eight patients were successfully completed transcatheter mitral valve-in-valve procedure with technical success achieving in 96.6%.Among the 28 patients who successfully were completed valve-in-valve procedure,1 died and 27 were discharged in well condition.The mean mitral transvalvular gradient was(7.6±2.2)mmHg(1 mmHg=0.133 kPa),no death or other major complications occurred during the follow-up.Conclusion The application of J-Valve interventional valve in patients with bioprosthesis degeneration can achieve favourable early outcomes,even if the patient was replaced with a small bioprosthesis in the previous operation,the hemodynamic effect was still satisfactory.

关 键 词：二尖瓣 生物瓣衰败 经心尖二尖瓣瓣中瓣 

分 类 号：R654.2[医药卫生—外科学]