二尖瓣瓣环钙化时的经导管瓣膜直接植入术：一项多中心研究

IF 3.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Thoracic Surgery Pub Date : 2025-01-01 DOI:10.1016/j.athoracsur.2024.09.036

Ali Fatehi Hassanabad MD, MS , Mohamad Rabbani MD, MS , Derrick Y. Tam MD, PhD , Gianluigi Bisleri MD , David Latter MD , Ray Guo MD , Michael W.A. Chu MD, MS , William D.T. Kent MD, MS , Corey Adams MD, MS

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引用次数: 0

摘要

背景：严重瓣环钙化（MAC）情况下的二尖瓣置换术（MVR）与高发病率和高死亡率相关。通过经心房方法直接手术植入经导管心脏瓣膜（THV）是降低手术风险的一种策略。本研究报告了加拿大三家中心使用经导管心脏瓣膜对重度环形 MAC 患者进行 MVR 的围手术期和 1 年疗效：方法：对 2018 年 1 月 1 日至 2023 年 9 月 30 日期间的病历进行审查，以确定接受过 THV 直接植入术的重度环周性 MAC 患者。主要结果为 30 天死亡率、中风致残率和 1 年死亡率。次要结果包括左室流出道梗阻（LVOTO）、PVL程度、跨瓣平均压力梯度和住院时间：三个中心的22名患者接受了THV直接植入术。19名患者为女性，平均年龄（70.41±9.33）岁。所有患者都成功植入了 THV。有两名患者在 30 天后死亡。4 名患者在术后 1 年死于非心脏原因，1 名患者术后中风。17名患者（77%）无/微量瓣膜旁漏，4名患者有轻度瓣膜旁漏，1名患者有轻中度瓣膜旁漏。平均跨瓣梯度为（4.42±4.40）。没有发生 LVOTO：结论：在重度 MAC 患者中直接部署 THV 可能是一个合理的选择。30天和1年的死亡率分别为9%和18%，这表明这种方法应保留给无法接受传统策略的高危患者。

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Direct Implantation of Transcatheter Valve in Mitral Annular Calcification: A Multicenter Study

Background

Mitral valve replacement in the setting of severe annular calcification (MAC) is associated with high morbidity and mortality. Direct surgical implantation of a transcatheter heart valve (THV) through a transatrial approach is a strategy to mitigate surgical risk. This study reports the perioperative and 1-year outcomes of mitral valve replacement using a THV in patients with severe circumferential MAC at 3 Canadian centers.

Methods

Charts were reviewed between January 1, 2018 and September 30, 2023 to identify patients with severe circumferential MAC who had undergone direct implantation of a THV. Primary outcomes were 30-day mortality, debilitating stroke, and 1-year mortality. Secondary outcomes included left ventricular outflow tract obstruction, degree of paravalvular leak (PVL), transvalvular mean pressure gradient, and length of stay.

Results

Twenty-two patients at the 3 centers underwent direct implantation of a THV. Nineteen patients were female, with mean age of 70.41 ± 9.33 years. A THV was successfully implanted in all patients. There were 2 deaths at 30 days. Four patients died of noncardiac causes at 1 year, and 1 patient had a postoperative stroke. Seventeen (77%) patients had no PVL or trace PVL, 4 had mild PVL, and 1 patient had mild-moderate PVL. The mean transvalvular gradient was 4.42 ± 4.40 mm Hg. There were no cases of left ventricular outflow tract obstruction.

Conclusions

Direct deployment of a THV in patients with severe MAC may be a reasonable option. Thirty-day and 1-year mortality rates of 9% and 18%, respectively, suggest that this approach should be reserved for high-risk patients who are not able to undergo conventional strategies.

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来源期刊

Annals of Thoracic Surgery 医学-呼吸系统

CiteScore

6.40

自引率

13.00%

发文量

1235

审稿时长

42 days

期刊介绍： The mission of The Annals of Thoracic Surgery is to promote scholarship in cardiothoracic surgery patient care, clinical practice, research, education, and policy. As the official journal of two of the largest American associations in its specialty, this leading monthly enjoys outstanding editorial leadership and maintains rigorous selection standards. The Annals of Thoracic Surgery features: • Full-length original articles on clinical advances, current surgical methods, and controversial topics and techniques • New Technology articles • Case reports • "How-to-do-it" features • Reviews of current literature • Supplements on symposia • Commentary pieces and correspondence • CME • Online-only case reports, "how-to-do-its", and images in cardiothoracic surgery. An authoritative, clinically oriented, comprehensive resource, The Annals of Thoracic Surgery is committed to providing a place for all thoracic surgeons to relate experiences which will help improve patient care.