经导管封堵治疗外科瓣膜置换术后二尖瓣瓣周漏疗效分析  

Outcomes after transcatheter repair of mitral paravalvular leak

作　　者：邢超凡 潘欣 王小蕾 李艳杰 王承 马兰 何奔[1] XING Chao-fan;PAN Xin;WANG Xiao-lei;LI Yan-jie;WANG Cheng;MA Lan;HE Ben(Department of Cardiology,Shanghai Chest Hospital,Shanghai Jiao Tong University,School of Medicine,Shanghai 200030,China)

机构地区：[1]上海市胸科医院心内科、上海交通大学医学院附属胸科医院,上海200030

出　　处：《中国介入心脏病学杂志》2022年第12期923-929,共7页Chinese Journal of Interventional Cardiology

基　　金：上海市科委科研计划项目(17411970900)。

摘　　要：目的评估经导管封堵外科二尖瓣置换术后瓣周漏(PVL)的有效性和安全性。方法回顾性分析2010年3月至2020年12月在上海市胸科医院心内科经导管介入治疗二尖瓣置换术后PVL患者87例。患者术前经超声心动图筛查且有临床心功能下降和(或)溶血。记录操作路径、技术成功率、并发症和临床事件,完成平均1年随访。结果87例患者平均年龄(55.7±25.8)岁,男46例(52.9%)。单纯二尖瓣置换术64例,二尖瓣和主动脉瓣联合置换术23例。10例(11.5%)为二尖瓣生物瓣置换术后,其余为机械金属瓣。5例(5.7%)经心尖直接穿刺路径,余经皮导管路径。介入技术成功率为64例(73.6%)。3例因介入治疗失败(并发严重溶血1例、封堵器影响人工瓣功能及左心室流入道各1例)转入心外科紧急手术,1例经心尖封堵PVL并发血胸手术开胸止血。封堵术相关性事件为术后溶血16例(18.4%),其中1例随访期间因溶血加重致急性肝肾功能衰竭死亡。多因素Logistic回归分析显示,术前存在溶血(OR 2.1,95%CI 1.3~3.9,P=0.021)、封堵器类型(OR 1.5,95%CI 1.1~2.5,P=0.032)、多枚封堵器置入(OR 0.7,95%CI 0.5~0.9,P=0.041)和金属机械二尖瓣(OR 0.6,95%CI 0.3~0.9,P=0.037)均为术后残余反流导致溶血的独立影响因素。1年平均生存率97.7%,介入治疗后较治疗前患者临床心功能(纽约心脏病协会心功能分级)改善[(1.4±0.4)级比(2.7±0.8)级,P=0.002]。随访期应用超声心动图评估PVL封堵术,提示术后患者左心室收缩末期内径[(31.7±6.9)mm比(36.3±10.1)mm,P=0.028]、左心室舒张末期内径[(51.3±8.4)mm比(54.7±9.5)mm,P=0.043]、左心房内径[58.4(43.7,89.2)mm比63.4(45.2,96.4)mm,P=0.035]均较术前明显缩小,肺动脉收缩压[(35.2±16.7)mmHg比(44.7±18.5)mmHg(1 mmHg=0.133 kPa),P=0.017]较术前下降,差异均有统计学意义。结论经导管封堵二尖瓣PVL在外科中高危患者中可替代手术,改善临床症状,溶血是围术期及随访期主要并Objective This study sought to assess the clinical e ffi cacy and safety of the transcatheter reduction on procedural and mid-term outcomes in patients with mitral paravalvular leak(PVL).Methods A total of 87 patients who diagnosed by clinical and echocardiographic course and underwent treatment of mitral PVL at the Shanghai Chest Hospital between March 2010 and December 2020 were retrospectively analyzed.The main indications for closure were heart failure and hemolysis or both.Utilization trends,procedural details,technical success,clinical events,intervention-related complications in-hospital and mid-term outcomes were assessed.Results The mean age was(55.7±25.8)years,46(52.9%)were male.There were 10 cases were implanted by biological mitral prosthetic valve,while the others by mechanical valve.Single surgical mitral valve replacement was in 64 cases,the others were double valve implantation.Transapical approach was performed in 5 cases,percutaneous transseptal and retrograde transaortic access were in the others.Technical success was achieved in 73.6%of the patients and 3 cases were transferred to cardiac surgery,1 cases by severe hemolytic anemia and the other 2 cases by occluder impinging on prosthesis and intruding on left ventricle infl ow tract respectively.One case experienced urgent thoracic hemostasis due to hemothorax by transapical access.Device-mediated hemolysis was the major complication in our group,of which the incidence was 18.4%(16/87)and 1 case was died of hepatic and renal failure caused by worsen severe hemolysis.In multivariate logistic analysis,the independent predictors for hemolysis in mitral lesions were hemolysis existed before procedure(OR 2.1,95%CI 1.3—3.9,P=0.021),the type of device used(OR 1.5,95%CI 1.1—2.5,P=0.032),the number of devices performed(OR0.7,95%CI 0.5—0.9,P=0.041)and the mechanical valve surgical replacement(OR 0.6,95%CI 0.3—0.9,P=0.037).The mean 1-year estimated for survival was 97.7%.There was a tendency toward a reduction in left ventricular end-diastolic[(

关 键 词：瓣周漏 二尖瓣 介入治疗 随访 

分 类 号：R541[医药卫生—心血管疾病]