PDF(Pubmed)
Abstract：
UNASSIGNED: Percutaneous transseptal transcatheter mitral valve-in-valve implantation (TMViV) has become an alternative minimally invasive treatment choice for patients with degenerated mitral bioprosthesis and high surgical risk. However, transseptal approach is more technically challenging than transapical approach in TMViV procedures.
UNASSIGNED: The objective of this study was to introduce the experience of applying long pre-curved sheaths in transseptal TMViV procedures and to evaluate the effect of long pre-curved sheath techniques in TMViV procedures.
UNASSIGNED: Between January 2020 and December 2021, 27 patients with degenerated bioprosthetic mitral valve underwent TMViV procedures using a balloon-expandable valve via the transseptal approach. The regular 14/16F expandable sheath were used for low-profile delivery in first 10 cases, and 22F long pre-curved sheath were used in the next 17 cases during procedures. We retrospectively reviewed the catheter techniques, perioperative characteristics, and prognosis. The median follow-up time was 12 (1-21) months. To further scrutinize our data, we divided the group into the early 10 patients using 14/16F expandable sheath and the subsequent 17 patients with long pre-curved sheath in order to assess the impact of different sheaths and procedural details on outcomes.
UNASSIGNED: Procedural success was obtained in all patients with no in-hospital mortality. Seventeen patients received 26 mm prostheses; the remaining ten patients received 29 mm prostheses. Post balloon dilatation was performed in one case. Total procedure time was (96.1 ± 28.2) min, the fluoroscopic time was (27.4 ± 6.5) min, and total contrast volume was (50.7 ± 10.1) mL. One patient received blood transfusion because of hemorrhage at the femoral puncture site. One patient received a permanent pacemaker implantation due to high-degree atrioventricular block at postoperative day 3. There were no other major post-procedure complications and the median length of hospital stay was 4 days. Twenty-five (92.6%) patients improved by ≥ 1 New York Heart Association (NYHA) functional class at 30 days. In subsequent sub analysis, there were shorter procedural time [(85.2 ± 24.3) vs. (115.2 ± 25.6) min, p = 0.0048] and shorter fluoroscopic time [(24.3 ± 5.2) vs. (31.3 ± 5.1) min, p = 0.0073] in cases with the long pre-curved sheath than ones with regular expandable sheath. The iatrogenic atrial septal defect (ASD) closure was performed because of the transeptal large right to left shunt in 2 cases with regular expandable sheath, but no patient needed intraoperative ASD closure in cases with the long pre-curved sheath.
UNASSIGNED: Transseptal TMViV using long pre-curved sheath could simplify transseptal approach with reliable outcomes for patients of degenerated mitral bioprosthesis.
UNASSIGNED: The objective of this study was to introduce the experience of applying long pre-curved sheaths in transseptal TMViV procedures and to evaluate the effect of long pre-curved sheath techniques in TMViV procedures.
UNASSIGNED: Between January 2020 and December 2021, 27 patients with degenerated bioprosthetic mitral valve underwent TMViV procedures using a balloon-expandable valve via the transseptal approach. The regular 14/16F expandable sheath were used for low-profile delivery in first 10 cases, and 22F long pre-curved sheath were used in the next 17 cases during procedures. We retrospectively reviewed the catheter techniques, perioperative characteristics, and prognosis. The median follow-up time was 12 (1-21) months. To further scrutinize our data, we divided the group into the early 10 patients using 14/16F expandable sheath and the subsequent 17 patients with long pre-curved sheath in order to assess the impact of different sheaths and procedural details on outcomes.
UNASSIGNED: Procedural success was obtained in all patients with no in-hospital mortality. Seventeen patients received 26 mm prostheses; the remaining ten patients received 29 mm prostheses. Post balloon dilatation was performed in one case. Total procedure time was (96.1 ± 28.2) min, the fluoroscopic time was (27.4 ± 6.5) min, and total contrast volume was (50.7 ± 10.1) mL. One patient received blood transfusion because of hemorrhage at the femoral puncture site. One patient received a permanent pacemaker implantation due to high-degree atrioventricular block at postoperative day 3. There were no other major post-procedure complications and the median length of hospital stay was 4 days. Twenty-five (92.6%) patients improved by ≥ 1 New York Heart Association (NYHA) functional class at 30 days. In subsequent sub analysis, there were shorter procedural time [(85.2 ± 24.3) vs. (115.2 ± 25.6) min, p = 0.0048] and shorter fluoroscopic time [(24.3 ± 5.2) vs. (31.3 ± 5.1) min, p = 0.0073] in cases with the long pre-curved sheath than ones with regular expandable sheath. The iatrogenic atrial septal defect (ASD) closure was performed because of the transeptal large right to left shunt in 2 cases with regular expandable sheath, but no patient needed intraoperative ASD closure in cases with the long pre-curved sheath.
UNASSIGNED: Transseptal TMViV using long pre-curved sheath could simplify transseptal approach with reliable outcomes for patients of degenerated mitral bioprosthesis.
摘要：
■经皮经中间隔经导管二尖瓣瓣膜植入术（TMViV）已成为退化二尖瓣生物假体和高手术风险患者的替代微创治疗选择。然而,在TMViV手术中,经中隔入路技术上比经心尖入路更具挑战性.
■本研究的目的是介绍经中隔TMViV手术中应用长预弯曲鞘的经验，并评估长预弯曲鞘技术在TMViV手术中的效果。
■在2020年1月至2021年12月期间，27例退化的生物假体二尖瓣患者通过经中间隔入路使用球囊扩张瓣膜接受了TMViV手术。前10例使用常规14/16F可扩张鞘管进行低剖面输送，在接下来的17例中，在手术过程中使用了22F长的预弯曲鞘。我们回顾了导管技术，围手术期特点,和预后。中位随访时间为12(1～21)个月。为了进一步检查我们的数据，我们将该组分为使用14/16F可扩张鞘管的早期10例患者和使用长的预弯曲鞘管的随后17例患者,以评估不同鞘管和手术细节对结局的影响.
■所有无院内死亡的患者均获得了手术成功。17名患者接受了26毫米假体；其余10名患者接受了29毫米假体。在一种情况下进行了球囊后扩张。总手术时间为(96.1±28.2)min,透视时间为（27.4±6.5）min，总对比剂体积为(50.7±10.1)mL。一名患者因股动脉穿刺部位出血接受输血。一名患者在术后第3天因高度房室传导阻滞接受了永久性起搏器植入。没有其他主要的术后并发症，中位住院时间为4天。25例（92.6％）患者在30天时改善了≥1个纽约心脏协会（NYHA）功能等级。在随后的子分析中，手术时间较短[(85.2±24.3)与(115.2±25.6)min,p=0.0048]和更短的透视时间[(24.3±5.2)vs.(31.3±5.1)min,p=0.0073]在具有长预弯曲护套的情况下，与具有规则可扩张护套的情况相比。医源性房间隔缺损(ASD)封堵术因2例经房间隔大的右向左分流,采用常规可扩张鞘管,但是，在使用长预弯曲鞘的情况下，没有患者需要术中闭合ASD。
■使用长的预弯曲鞘的经中隔TMViV可简化经中隔入路，对退化的二尖瓣生物假体患者具有可靠的结局。
■本研究的目的是介绍经中隔TMViV手术中应用长预弯曲鞘的经验，并评估长预弯曲鞘技术在TMViV手术中的效果。
■在2020年1月至2021年12月期间，27例退化的生物假体二尖瓣患者通过经中间隔入路使用球囊扩张瓣膜接受了TMViV手术。前10例使用常规14/16F可扩张鞘管进行低剖面输送，在接下来的17例中，在手术过程中使用了22F长的预弯曲鞘。我们回顾了导管技术，围手术期特点,和预后。中位随访时间为12(1～21)个月。为了进一步检查我们的数据，我们将该组分为使用14/16F可扩张鞘管的早期10例患者和使用长的预弯曲鞘管的随后17例患者,以评估不同鞘管和手术细节对结局的影响.
■所有无院内死亡的患者均获得了手术成功。17名患者接受了26毫米假体；其余10名患者接受了29毫米假体。在一种情况下进行了球囊后扩张。总手术时间为(96.1±28.2)min,透视时间为（27.4±6.5）min，总对比剂体积为(50.7±10.1)mL。一名患者因股动脉穿刺部位出血接受输血。一名患者在术后第3天因高度房室传导阻滞接受了永久性起搏器植入。没有其他主要的术后并发症，中位住院时间为4天。25例（92.6％）患者在30天时改善了≥1个纽约心脏协会（NYHA）功能等级。在随后的子分析中，手术时间较短[(85.2±24.3)与(115.2±25.6)min,p=0.0048]和更短的透视时间[(24.3±5.2)vs.(31.3±5.1)min,p=0.0073]在具有长预弯曲护套的情况下，与具有规则可扩张护套的情况相比。医源性房间隔缺损(ASD)封堵术因2例经房间隔大的右向左分流,采用常规可扩张鞘管,但是，在使用长预弯曲鞘的情况下，没有患者需要术中闭合ASD。
■使用长的预弯曲鞘的经中隔TMViV可简化经中隔入路，对退化的二尖瓣生物假体患者具有可靠的结局。
