经导管二尖瓣生物瓣毁损的瓣中瓣治疗技术
Transcatheter valve in valve implantation treatment for the mitral bioprothesis deterioration
目的 探讨总结我院创新性使用经导管J Valve瓣中瓣技术治疗二尖瓣生物瓣毁损的临床效果.方法 二尖瓣生物瓣毁损患者经过评估外科常规开胸体外循环手术较高风险者,知情同意后于全麻杂交手术室心尖区穿刺,透视下经食管超声心动图监测.支撑导丝引导反向安装改良的J Valve支架瓣膜系统,心脏搏动下置入二尖瓣生物瓣内.结果 2019年1月至3月完成9例二尖瓣毁损瓣中瓣的经导管J Valve瓣膜置入术,STS评分在6~8分以上.既往手术二尖瓣Hancock瓣膜3例,Perimount瓣膜3例,Epic瓣膜2例,Baxiter瓣膜1例;瓣膜大小27号6例,25号3例.成功率100%,病死率0,随访患者恢复顺利,无严重并发症,平均二尖瓣跨瓣压差(8±2)mmHg(1mmHg=0.133kPa).结论 创新性使用经导管J Valve瓣中瓣技术治疗二尖瓣生物瓣毁损临床效果良好,值得进一步深入研究和技术推广.
更多Objective To explore the clinic results of our new designed transcatheter valve in valve for the mitral biopro-thesis deterioration.Methods Mitral bioprothesis deterioration patients with high risk for the routine bypass surgery got con-sent.After general anesthesia in the hybrid operation the left ventricle apical puncture was performed with guidance of 3D echo and X-ray.The retro-preset J Valve system was guided into the left atrium and the mitral bioprothesis with the beating heart . Results There were total 9 cases between Jan 2019 to Mar 2019 which had STS score above 6-8.The mitral bioprothesis in-cluded Hancock valve 3 cases, Perimount valve 3 cases, Epic valve 2 cases, Baxiter valve 1 case.The mitral bioprosthesis size included 27 for 6 cases and 25 for 3 cases.The successful implant rate was 100%, mortality rate 0, and all the patients recov-ered well without any main complications.The mean tran-valular pressure was only(8 ±2) mmHg (1 mmHg=0.133 kPa). Conclusion This innovative mitral valve in valve technique with retro-preset J Valve system got very good clinic results and worthy of deep research.
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