瓣周漏介入封堵治疗的安全性和有效性
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摘要
目的探讨瓣周漏(PVL)介入封堵治疗的安全性和有效性。方法采用介入封堵术治疗瓣膜置换术后PVL42例,既往行单纯二尖瓣瓣膜置换术15例,行单纯主动脉瓣瓣膜置换术13例,行主动脉瓣置换及二尖瓣联合置换术9例,行三尖瓣(功能二尖瓣)置换术2例,二尖瓣置换+冠状动脉旁路移植术3例,并发感染性心内膜炎10例,且术前感染性心内膜炎已得到有效控制。二尖瓣PVL 27例,其中机械瓣置换术后PVL 17例,生物瓣置换术后PVL10例;主动脉PVL 15例,其中机械瓣置换术后PVL 8例,生物瓣置换术后PVL 7例。行介入封堵治疗PVL,术后随访1～36个月,主要观察患者介入封堵术前术后瓣周反流量、心功能及心室长、横径等的变化,封堵器植入后封堵器位置及对原有人工瓣膜是否存在影响以及并发症情况。结果全组除2例患者因手术耐受性较差而未能完成手术,手术成功率95%。总体手术时间(122±30) min,其中数字减影血管造影(DSA)照射时间(20±9) min,住院时间(11±10) d。术后主要并发症包括血红蛋白尿2例(5%),急性肾功能衰竭行连续肾替代治疗治疗1例(2%),输血5例(12%)。心脏超声显示封堵器无移位,患者瓣周反流量减少至(0. 5±0. 7) ml(P <0. 05),且不影响人工瓣膜功能。结论介入封堵方法治疗PVL安全有效,创伤小,恢复快,对于具备适应证的患者应可作为首选治疗方法。
AIM To evaluate the safety and efficacy of transcatheter intervention of paravalvular leakage( PVL) after valve replacement. METHODS Between May 2016 to May 2017,42 patients of PVL after valve replacement underwent interventional therapy. There were 24 males and 18 females with mean age of( 51. 5 ± 11. 6) years. Previously,15 patients underwent mitral valve replacement only,13 patients underwent aortic valve replacement only,9 patients had aortic valve replacement and mitral valve replacement,2 patients underwent TVR,3 patients underwent mitral valve replacement and coronary artery bypass grafting. 10 patients had a history of previous infective endocarditis. 25 patients used mechanical valve and the other 17 patients used biological valve. Transcatheter intervention was carried out in the catheterization laboratory or the hybrid operation room with the patient under local anesthesia first. Follow-up evaluation included peri-operational mortality,complications and postoperative residual shunt. The average follow-up time was 1 to 36 months. RESULTS The success rate of transcatheter intervention was 95%,apart from 2 patients who were implanted with no occlusion. The main post-operative complications included 1 case of acute renal failure( 2%),2 cases of hematuria( 5%) and 5 cases of blood transfusion( 12%),During the follow-up,there were no deaths. The regurgitation volume decreased to 0. 54± 0. 74 ml( P < 0. 05). The remaining 40 patients did well,with improved heart function and no serious complications. CONCLUSION Transcatheter intervention of PVL has the advantages of being a simpler and safer approach,less trauma,shorter time of hospitalization,faster post-operative recovery. For patients with appropriate indications,it should be the first choice of treatment.
AIM To evaluate the safety and efficacy of transcatheter intervention of paravalvular leakage( PVL) after valve replacement. METHODS Between May 2016 to May 2017,42 patients of PVL after valve replacement underwent interventional therapy. There were 24 males and 18 females with mean age of( 51. 5 ± 11. 6) years. Previously,15 patients underwent mitral valve replacement only,13 patients underwent aortic valve replacement only,9 patients had aortic valve replacement and mitral valve replacement,2 patients underwent TVR,3 patients underwent mitral valve replacement and coronary artery bypass grafting. 10 patients had a history of previous infective endocarditis. 25 patients used mechanical valve and the other 17 patients used biological valve. Transcatheter intervention was carried out in the catheterization laboratory or the hybrid operation room with the patient under local anesthesia first. Follow-up evaluation included peri-operational mortality,complications and postoperative residual shunt. The average follow-up time was 1 to 36 months. RESULTS The success rate of transcatheter intervention was 95%,apart from 2 patients who were implanted with no occlusion. The main post-operative complications included 1 case of acute renal failure( 2%),2 cases of hematuria( 5%) and 5 cases of blood transfusion( 12%),During the follow-up,there were no deaths. The regurgitation volume decreased to 0. 54± 0. 74 ml( P < 0. 05). The remaining 40 patients did well,with improved heart function and no serious complications. CONCLUSION Transcatheter intervention of PVL has the advantages of being a simpler and safer approach,less trauma,shorter time of hospitalization,faster post-operative recovery. For patients with appropriate indications,it should be the first choice of treatment.
引文
[1] Biner S,Kar S,Siegel RJ,et al. Value of color Doppler three-dimensional transesophageal echocardiography in the percutaneousclosure of mitral prosthesis paravalvular leak[J]. Am J Cardiol,2010,105(7):984-989.
[2]Pate GE,Al Zubaidi A,Chandavimol M,et al. Percutaneous closureof prosthetic paravalvular leaks:case series and review[J]. CatheterCardiovasc Interv,2006,68(4):528-533.
[3]Hourihan M,Perry SB,Mandell VS,et al. Transcatheter umbrellaclosure of valvular and paravalvular leaks[J]. J Am Coll Cardiol,1992,20(6):1371-1377.
[4] Sorajja P,Cabalka AK,Hagler DJ,et al. Long-term follow-up ofpercutaneous repair of paravalvular prosthetic regurgitation[J]. J AmColl Cardiol,2011,58(21):2218-2224.
[5]Ruiz CE,Jelnin V,Kronzon I,et al. Clinical outcomes in patientsundergoing percutaneous closure of periprosthetic paravalvular leaks[J]. J Am Coll Cardiol,2011,58(21):2210-2217.
[6] Hein R,Wunderlich N,Robertson G,et al. Catheter closure ofparavalvular leak[J]. EuroIntervention,2006,2(3):318-325.
[7]Aortic Stenosis Writing Group,Bonow RO,Brown AS,et al. ACC/AATS/AHA/ASE/EACTS/HVS/SCA/SCAI/SCCT/SCMR/STS2017 Appropriate Use Criteria for the Treatment of Patients WithSevere Aortic Stenosis:A Report of the American College of CardiologyAppropriate Use Criteria Task Force,American Association for Tho-racic Surgery,American Heart Association,American Society ofEchocardiography,European Association for Cardio-Thoracic Surgery,Heart Valve Society,Society of Cardiovascular Anesthesiologists,Society for Cardiovascular Angiography and Interventions,Society ofCardiovascular Computed Tomography, Society for CardiovascularMagnetic Resonance,and Society of Thoracic Surgeons[J]. J AmSoc Echocardiogr,2018,31(2):117-147.
[8] Garcia-Borbolla FR,Sancho JM,Calle PG,et al. Percutaneoustreatment of mitral valve periprosthetic leakage. An alternative tohigh-risk surgery?[J]. Rev Esp Cardiol,2009,62(4):438-441.
[9]Kim MS,Casserly IP,Garcia JA,et al. Percutaneous transcatheterclosure of prosthetic mitral paravalvular leaks:are we there yet?[J]. JACC Cardiovasc Interv,2009,2(2):81-90.
[10]Krishnaswamy A,Kapadia SR,Tuzcu EM. Percutaneous paravalvu-lar leak closure-imaging,techniques and outcomes[J]. Circ J,2013,77(1):19-27.
[11]潘文志,周达新,管丽华,等.经导管封堵外科术后心脏瓣周漏的初步经验[J].中国医学前沿杂志(电子版),2013,5(8):6-10.
[12]卢蓉,尚小珂,张刚成,等.经导管封堵二尖瓣瓣周漏1例[J].中国介入心脏病学杂志,2016,24(3):169-170.
[13]徐臣年,刘洋,李晓峰,等.二尖瓣置换术后瓣周漏的介入治疗效果分析[J].中华心血管病杂志,2016,44(3):238-243.
[14]金屏,刘洋,杨剑.介入封堵与外科手术治疗瓣膜置换术后瓣周漏的疗效评估[J].中华胸心外科杂志,2017,(32)10:583-586.
[15]Whelton PK,Carey RM,Aronow WS,et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APh A/ASH/ASPC/NMA/PCNA Guideline forthe Prevention,Detection,Evaluation,and Management of HighBlood Pressure in Adults:Executive Summary:A Report of theAmerican College of Cardiology/American Heart Association TaskForce on Clinical Practice Guidelines[J]. J Am Coll Cardiol,2018,71(19):2199-2269.
[16]Werner N,Kilkowski C,Zahn R. Catheter-based closure of paraval-vular leaks:“Plug the hole”[J]. Herz,2015,40(5):771-777.
[17]Smolka G,Pysz P,Jasinski M,et al. Transapical closure of mitralparavalvular leaks with use of amplatzer vascular plug III[J]. JInvasive Cardiol,2013,25(10):497-501.
[18]Gafoor S,Steinberg DH,Franke J,et al. Tools and techniques--clinical:paravalvular leak closure[J]. EuroIntervention,2014,9(11):1359-1363.
[19]Hansen JW,Gadey G,Piemonte TC. Prosthetic mitral valve para-valvular leak:A problem that requires dexterity[J]. CardiovascRevasc Med,2017,19(1 Pt B):126-132.
[20]Bocksch W,Grossmann B,Geisler T,et al. Clinical outcome andparavalvular leakage of the new balloon-expandable Edwards Sapien3 valve in comparison to its predecessor model(Edwards Sapien XT)in patients undergoing transfemoral aortic valve replacement[J].Catheter Cardiovasc Interv,2016,88(3):466-475.
[21]Schewel D,Frerker C,Schewel J,et al. Clinical impact of paraval-vular leaks on biomarkers and survival after transcatheter aortic valveimplantation[J]. Catheter Cardiovasc Interv,2015,85(3):502-514.
[22]Martens S,Sadowski J,Eckstein FS,et al. Clinical experience withthe ATS 3f Enable(R)Sutureless Bioprosthesis[J]. Eur J Cardio-thorac Surg,2011,40(3):749-755.
[23]Goktekin O,Vatankulu MA,Tasal A,et al. Transcatheter trans-apical closure of paravalvular mitral and aortic leaks using a newdevice:first in man experience[J]. Catheter Cardiovasc Interv,2014,83(2):308-314.
[24]Millan X,Skaf S,Joseph L,et al. Transcatheter reduction of para-valvular leaks:a systematic review and meta-analysis[J]. Can JCardiol,2015,31(3):260-269.
[25]Smolka G,Pysz P,Kozlowski M,et al. Transcatheter closure ofparavalvular leaks using a paravalvular leak device-a prospectivePolish registry[J]. Postepy Kardiol Interwencyjnej,2016,12(2):128-134.
[2]Pate GE,Al Zubaidi A,Chandavimol M,et al. Percutaneous closureof prosthetic paravalvular leaks:case series and review[J]. CatheterCardiovasc Interv,2006,68(4):528-533.
[3]Hourihan M,Perry SB,Mandell VS,et al. Transcatheter umbrellaclosure of valvular and paravalvular leaks[J]. J Am Coll Cardiol,1992,20(6):1371-1377.
[4] Sorajja P,Cabalka AK,Hagler DJ,et al. Long-term follow-up ofpercutaneous repair of paravalvular prosthetic regurgitation[J]. J AmColl Cardiol,2011,58(21):2218-2224.
[5]Ruiz CE,Jelnin V,Kronzon I,et al. Clinical outcomes in patientsundergoing percutaneous closure of periprosthetic paravalvular leaks[J]. J Am Coll Cardiol,2011,58(21):2210-2217.
[6] Hein R,Wunderlich N,Robertson G,et al. Catheter closure ofparavalvular leak[J]. EuroIntervention,2006,2(3):318-325.
[7]Aortic Stenosis Writing Group,Bonow RO,Brown AS,et al. ACC/AATS/AHA/ASE/EACTS/HVS/SCA/SCAI/SCCT/SCMR/STS2017 Appropriate Use Criteria for the Treatment of Patients WithSevere Aortic Stenosis:A Report of the American College of CardiologyAppropriate Use Criteria Task Force,American Association for Tho-racic Surgery,American Heart Association,American Society ofEchocardiography,European Association for Cardio-Thoracic Surgery,Heart Valve Society,Society of Cardiovascular Anesthesiologists,Society for Cardiovascular Angiography and Interventions,Society ofCardiovascular Computed Tomography, Society for CardiovascularMagnetic Resonance,and Society of Thoracic Surgeons[J]. J AmSoc Echocardiogr,2018,31(2):117-147.
[8] Garcia-Borbolla FR,Sancho JM,Calle PG,et al. Percutaneoustreatment of mitral valve periprosthetic leakage. An alternative tohigh-risk surgery?[J]. Rev Esp Cardiol,2009,62(4):438-441.
[9]Kim MS,Casserly IP,Garcia JA,et al. Percutaneous transcatheterclosure of prosthetic mitral paravalvular leaks:are we there yet?[J]. JACC Cardiovasc Interv,2009,2(2):81-90.
[10]Krishnaswamy A,Kapadia SR,Tuzcu EM. Percutaneous paravalvu-lar leak closure-imaging,techniques and outcomes[J]. Circ J,2013,77(1):19-27.
[11]潘文志,周达新,管丽华,等.经导管封堵外科术后心脏瓣周漏的初步经验[J].中国医学前沿杂志(电子版),2013,5(8):6-10.
[12]卢蓉,尚小珂,张刚成,等.经导管封堵二尖瓣瓣周漏1例[J].中国介入心脏病学杂志,2016,24(3):169-170.
[13]徐臣年,刘洋,李晓峰,等.二尖瓣置换术后瓣周漏的介入治疗效果分析[J].中华心血管病杂志,2016,44(3):238-243.
[14]金屏,刘洋,杨剑.介入封堵与外科手术治疗瓣膜置换术后瓣周漏的疗效评估[J].中华胸心外科杂志,2017,(32)10:583-586.
[15]Whelton PK,Carey RM,Aronow WS,et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APh A/ASH/ASPC/NMA/PCNA Guideline forthe Prevention,Detection,Evaluation,and Management of HighBlood Pressure in Adults:Executive Summary:A Report of theAmerican College of Cardiology/American Heart Association TaskForce on Clinical Practice Guidelines[J]. J Am Coll Cardiol,2018,71(19):2199-2269.
[16]Werner N,Kilkowski C,Zahn R. Catheter-based closure of paraval-vular leaks:“Plug the hole”[J]. Herz,2015,40(5):771-777.
[17]Smolka G,Pysz P,Jasinski M,et al. Transapical closure of mitralparavalvular leaks with use of amplatzer vascular plug III[J]. JInvasive Cardiol,2013,25(10):497-501.
[18]Gafoor S,Steinberg DH,Franke J,et al. Tools and techniques--clinical:paravalvular leak closure[J]. EuroIntervention,2014,9(11):1359-1363.
[19]Hansen JW,Gadey G,Piemonte TC. Prosthetic mitral valve para-valvular leak:A problem that requires dexterity[J]. CardiovascRevasc Med,2017,19(1 Pt B):126-132.
[20]Bocksch W,Grossmann B,Geisler T,et al. Clinical outcome andparavalvular leakage of the new balloon-expandable Edwards Sapien3 valve in comparison to its predecessor model(Edwards Sapien XT)in patients undergoing transfemoral aortic valve replacement[J].Catheter Cardiovasc Interv,2016,88(3):466-475.
[21]Schewel D,Frerker C,Schewel J,et al. Clinical impact of paraval-vular leaks on biomarkers and survival after transcatheter aortic valveimplantation[J]. Catheter Cardiovasc Interv,2015,85(3):502-514.
[22]Martens S,Sadowski J,Eckstein FS,et al. Clinical experience withthe ATS 3f Enable(R)Sutureless Bioprosthesis[J]. Eur J Cardio-thorac Surg,2011,40(3):749-755.
[23]Goktekin O,Vatankulu MA,Tasal A,et al. Transcatheter trans-apical closure of paravalvular mitral and aortic leaks using a newdevice:first in man experience[J]. Catheter Cardiovasc Interv,2014,83(2):308-314.
[24]Millan X,Skaf S,Joseph L,et al. Transcatheter reduction of para-valvular leaks:a systematic review and meta-analysis[J]. Can JCardiol,2015,31(3):260-269.
[25]Smolka G,Pysz P,Kozlowski M,et al. Transcatheter closure ofparavalvular leaks using a paravalvular leak device-a prospectivePolish registry[J]. Postepy Kardiol Interwencyjnej,2016,12(2):128-134.
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