背景:经导管肺动脉瓣置换术(TPVR)的研究显示了良好的临床和血流动力学结果。我们的研究分析了东南亚接受旋律瓣膜植入术患者的中期临床和血流动力学结果。
方法:招募患有环形导管或生物瓣膜并经历术后右心室流出道(RVOT)功能障碍的患者进行旋律TPVR。
结果:我们的队列(n=14)在儿童和成人患者之间平均分配。中位年龄为19岁(8-38岁),男女比例为6:1,中位随访期为48个月(16-79个月),最小的病人是一个8岁的男孩,体重18公斤。所有TPVR手术都顺利且成功,没有立即死亡或导管破裂。植入物的主要适应症是合并狭窄和反流。平均导管直径为21±2.3mm。71.4%的无旋律瓣膜支架骨折(MSFs)患者同时进行支架置入术。植入瓣膜尺寸包括22-mm(64.3%),20毫米(14.3%),和18毫米(21.4%)。在TPVR之后,在出院时,整个RVOT的平均梯度从41mmHg(10-48mmHg)显着降低到16mmHg(6-35mmHg),p<0.01。2例(14.3%)被诊断为晚期随访感染性心内膜炎(IE)。在79个月的随访中,IE的总体自由度为86%。三名患者(21.4%)出现进行性RVOT梯度。
结论:对于东南亚患有RVOT功能障碍的患者,在血流动力学和临床改善方面,旋律TPVR结果与美国患者报告的结果相似。采用支架置入前策略,未观察到MSF。植入后的残余狭窄和RVOT的进行性狭窄需要长期监测和再干预。最后,尽管积极预防和围手术期预防细菌性心内膜炎,IE仍然是一个值得关注的问题。
BACKGROUND: Studies of transcatheter pulmonary valve replacement (TPVR) with the Melody valve have demonstrated good clinical and hemodynamic outcomes. Our study analyzes the midterm clinical and hemodynamic outcomes for patients who underwent Melody valve implantation in Southeast Asia.
METHODS: Patients with circumferential conduits or bioprosthetic valves and experiencing post-operative right ventricular outflow tract (RVOT) dysfunction were recruited for Melody TPVR.
RESULTS: Our cohort (n = 14) was evenly divided between pediatric and adult patients. The median age was 19 years (8-38 years), a male-to-female ratio of 6:1 with a median follow-up period of 48 months (16-79 months), and the smallest patient was an 8-year-old boy weighing 18 kg. All TPVR procedures were uneventful and successful with no immediate mortality or conduit rupture. The primary implant indication was combined stenosis and regurgitation. The average conduit diameter was 21 ± 2.3 mm. Concomitant pre-stenting was done in 71.4% of the patients without Melody valve stent fractures (MSFs). Implanted valve size included 22-mm (64.3%), 20-mm (14.3%), and 18-mm (21.4%). After TPVR, the mean gradient across the RVOT was significantly reduced from 41 mmHg (10-48 mmHg) to 16 mmHg (6-35 mmHg) at discharge, p < 0.01. Late follow-up infective endocarditis (IE) was diagnosed in 2 patients (14.3%). Overall freedom from IE was 86% at 79 months follow-up. Three patients (21.4%) developed progressive RVOT gradients.
CONCLUSIONS: For patients in Southeast Asia with RVOT dysfunction, Melody TPVR outcomes are similar to those reported for patients in the US in terms of hemodynamic and clinical improvements. A pre-stenting strategy was adopted and no MSFs were observed. Post-implantation residual stenosis and progressive stenosis of the RVOT require long term monitoring and reintervention. Lastly, IE remained a concern despite vigorous prevention and peri-procedural bacterial endocarditis prophylaxis.