经导管“瓣中瓣”置换术治疗二尖瓣置换术后生物瓣衰败的疗效评价  

Clinical Efficacy of Transcatheter Mitral Valve-in-valve Replacement in Patients With Degenerated Bioprosthesis

作　　者：张靖男 万俊义 宋会军 张旌 潘家华 吴永健 潘湘斌 张戈军 ZHANG Jingnan;WAN Junyi;SONG Huijun;ZHANG Jing;PAN Jiahua;WU Yongjian;PAN Xiangbin;ZHANG Gejun(Structural Heart Diasease Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)

机构地区：[1]中国医学科学院、北京协和医学院、国家心血管病中心、阜外医院结构性心脏病中心,北京市100037 [2]中国医学科学院阜外医院深圳医院结构性心脏病中心 [3]云南省阜外心血管病医院心内科

出　　处：《中国循环杂志》2023年第2期165-170,共6页Chinese Circulation Journal

基　　金：2017年国家重点研发计划(2017-ZDYF09)。

摘　　要：目的:评价经导管“瓣中瓣”置换术治疗二尖瓣置换术后生物瓣衰败的疗效。方法:共纳入2021年1月至2022年4月行经导管“瓣中瓣”置换术治疗二尖瓣置换术后生物瓣衰败外科手术高危患者11例,回顾性分析疗效及不良事件。结果:11例“瓣中瓣”置换术均通过股静脉入路、穿刺房间隔途径进行,手术成功率100%,1例在置入瓣膜成功后出现左心室穿孔导致心脏压塞行开胸探查术;1例并发脑卒中。术后无瓣膜功能不全病例,二尖瓣平均跨瓣压差降低[(13.1±3.9)mmHg vs.(7.8±2.0)mmHg,1 mmHg=0.133 kPa,P=0.001],NYHA心功能分级Ⅲ或Ⅳ级患者明显减少(100%vs.9%,P<0.001)。6例患者完成术后30 d随访,1例因肺部感染死亡,余患者瓣膜功能良好,未见其他不良事件发生。结论:二尖瓣置换术后生物瓣衰败的“瓣中瓣”置换术成功率高,可作为再次外科手术高风险人群的有效替代治疗手段。Objectives:To evaluate the clinical efficacy of transcatheter mitral valve-in-valve replacement in treating degenerated bioprosthesis.Methods:A total of 11 patients,who received transcatheter valve-in-valve replacement from January 2021 to April 2022,were included in this study,and the efficacy and adverse events were retrospectively analyzed.Results:Transseptal approaches through the femoral vein were achieved in all cases and the technical success rate was 100%.One patient underwent thoracotomy due to pericardial tamponade after valve releasing and aother patient suffered from cerebral infarction.There was no postoperative valve dysfunction,and the mean mitral valve gradient declined from(13.1±3.9)mmHg(1 mmHg=0.133 kPa)to(7.8±2.0)mmHg(P=0.001).Patients with NYHA classificationⅢor IV were significantly reduced post procedure(100%vs.9%,P<0.001).The 30 d postoperative follow-up was finished in 6 patients:one patient died due to pulmonary infection,and no valve dysfunction and major cardiovascular events occurred in the rest 5 patients.Conclusions:Transcatheter valve-in-valve replacement is associated with high technical success rate and may serve as an alternative to surgical replacement for high-risk patients with degenerated bioprosthesis.

关 键 词：二尖瓣反流 生物瓣 经导管二尖瓣“瓣中瓣”置换术 

分 类 号：R54[医药卫生—心血管疾病]