METHODS: Patients who underwent transapical MVIV implantation using the J-valve were analyzed from January 2019 to December 2020 with a 1-year follow-up. Before the procedure, computed tomography (CT) angiography data were analyzed to determine the inner diameter, left ventricular outflow tract (LVOT), and coaxial angel. An oversize rate of 5-10% was used to select the J-valve depending on the scanned inner diameter of the original mitral bioprosthesis. During the procedure, the three U-shape graspers were one-to-one buckled with the three tissue valve struts with the assist of echo and fluoroscopy. The implant depth into the left atrium was a 0-20% part of the J-valve, and the valve was then released under rapid pacing. Post-balloon dilatation was used when needed.
RESULTS: Nineteen patients (mean age 70.05±11.19 years), with a mean Society of Thoracic Surgeons score of 8.01%±4.20%, were included. By transesophageal echocardiography, we found that the mean transvalvular gradient was 6.21±2.63 mmHg. The mean follow-up time was 20.31±7.23 months, and the survival rate was 94.74% at the last follow-up. The transvalvular gradient decreased from 15.06±3.00 mmHg at basal to 7.13±2.28 mmHg at the 1-year follow-up (P<0.001). The left ventricular ejection fractions (LVEF) increased from 60.31%±7.30% to 59.94%±7.72% at the 1-year follow-up (P=0.863). Thirteen (81.25%) patients had no or trace paravalvular leak (PVL), two (12.50%) patients had minor PVL, one (6.25%) patient had moderate PVL, and there were no cases of major regurgitation at the 1-year transthoracic echocardiography (TTE) examination results.
CONCLUSIONS: The J-valve reversely mounted on the delivery system can be used for transapical MVIV implantation with less operative morbidity and favourable outcomes.
方法:从2019年1月至2020年12月,对使用J瓣进行经心尖MVIV植入的患者进行了分析,并进行了1年的随访。在程序之前,计算机断层扫描(CT)血管造影数据分析,以确定内径,左心室流出道(LVOT),和共轴天使。根据原始二尖瓣生物假体的扫描内径,使用5-10%的超大比例选择J瓣。在手术过程中,在回波和透视辅助下,3个U形抓紧器与3个组织瓣膜支柱一对一扣紧.植入到左心房的深度是J形瓣膜的0-20%部分,然后在快速起搏下释放瓣膜。在需要时使用球囊后扩张。
结果:19例患者(平均年龄70.05±11.19岁),胸外科医师协会平均得分为8.01%±4.20%,包括在内。通过经食管超声心动图,我们发现平均跨瓣梯度为6.21±2.63mmHg.平均随访时间为20.31±7.23个月,末次随访生存率为94.74%。经瓣膜梯度从基础的15.06±3.00mmHg下降至1年随访的7.13±2.28mmHg(P<0.001)。随访1年,左心室射血分数(LVEF)由60.31%±7.30%上升至59.94%±7.72%(P=0.863)。13例(81.25%)患者无瓣周漏或有微量瓣周漏(PVL),两名(12.50%)患者有轻微PVL,1例(6.25%)患者有中度PVL,1年经胸超声心动图(TTE)检查结果无严重反流病例。
结论:反向安装在输送系统上的J瓣可用于经心尖MVIV植入,手术发病率较低,预后良好。