PDF(Pubmed)
Abstract：
BACKGROUND: Prior to the approval of the Sapien valve in 2020, there were no commercially available short-frame valves for transapical mitral valve-in-valve (MVIV) implantation. In January 2019, we first attempted the reverse mounted J-valve for transapical MVIV implantation with good clinical results. The present study aimed to explore the safety and effectiveness of transapical MVIV implantation with the J-valve reversely mounted on the delivery system.
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.
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.
摘要：
背景：在2020年批准Sapien瓣膜之前，没有商业上可用的短框架瓣膜用于经心尖二尖瓣瓣膜（MVIV）植入。2019年1月，我们首次尝试反向安装的J形瓣膜用于经心尖MVIV植入，取得了良好的临床效果。本研究旨在探讨将J型瓣膜反向安装在输送系统上的经心尖MVIV植入的安全性和有效性。
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。
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。
