Mohammad Sahebjam, Alimohammad Haji Zeinali, Kyomars Abbasi, Solmaz Borjian
{"title":"经导管三尖瓣瓣内置换术治疗退行性生物瓣膜患者的中长期超声心动图随访:来自伊朗的第一份单中心报告。","authors":"Mohammad Sahebjam, Alimohammad Haji Zeinali, Kyomars Abbasi, Solmaz Borjian","doi":"10.18502/jthc.v17i3.10843","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Transcatheter tricuspid valve-in-valve (TTViV) replacement has become an alternative treatment in high-risk patients with bioprosthetic valve degeneration. This is the first report on the mid to long-term echocardiographic findings of patients who underwent TTViV replacement in a cardiac referral center in Iran.</p><p><strong>Methods: </strong>Data of 12 patients, consisting of 11 women and 1 man, who underwent TTViV replacement between 2015 and 2021 were reviewed retrospectively. The patients underwent echocardiography before the procedure and at a mean follow-up time of 3.17±1.75 years.</p><p><strong>Results: </strong>All the patients had New York Heart Association (NYHA) function class III/IV before TTViV. Six patients had tricuspid regurgitation, 1 had tricuspid stenosis, and 5 had both. All the patients had successful TTViV. The mean time from the initial valve surgery to TTViV was 6.25±2.45 years. At follow-up, 2 patients had died: 1 due to COVID-19 pneumonia and 1 without a known cause. The remaining 10 patients experienced improvements in the NYHA functional class. Echocardiographic measures showed significant improvements. Transvalvular mean gradient pressure decreased from 7.08±1.98 mm Hg to 5.29±1.63 mm Hg (P=0.028), tricuspid valve pressure half time decreased from 245.00±49.46 ms to 158.64±57.41 ms (P=0.011), tricuspid regurgitation gradient decreased from 39.91±7.31 mm Hg to 26.72±8.99 mm Hg, and left ventricular ejection fraction increased from 47.71±4.70% to 49.79±4.58% (P=0.046). There was no significant paravalvular or transvalvular leakage at follow-up.</p><p><strong>Conclusion: </strong>This is a single-center report on the mid and long-term echocardiographic follow-up of patients after TTViV replacement. Our study showed that TTViV was a safe and efficient method in treating high-risk patients with degenerated bioprosthetic tricuspid valves and had favorable echocardiographic and clinical results.</p>","PeriodicalId":39149,"journal":{"name":"Journal of Tehran University Heart Center","volume":"17 3","pages":"112-118"},"PeriodicalIF":0.0000,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d7/9f/JTHC-17-112.PMC10222937.pdf","citationCount":"0","resultStr":"{\"title\":\"Mid to Long-Term Echocardiographic Follow-up of Patients Undergoing Transcatheter Tricuspid Valve-in-Valve Replacement for Degenerated Bioprosthetic Valves: First Single-Center Report from Iran.\",\"authors\":\"Mohammad Sahebjam, Alimohammad Haji Zeinali, Kyomars Abbasi, Solmaz Borjian\",\"doi\":\"10.18502/jthc.v17i3.10843\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Transcatheter tricuspid valve-in-valve (TTViV) replacement has become an alternative treatment in high-risk patients with bioprosthetic valve degeneration. This is the first report on the mid to long-term echocardiographic findings of patients who underwent TTViV replacement in a cardiac referral center in Iran.</p><p><strong>Methods: </strong>Data of 12 patients, consisting of 11 women and 1 man, who underwent TTViV replacement between 2015 and 2021 were reviewed retrospectively. The patients underwent echocardiography before the procedure and at a mean follow-up time of 3.17±1.75 years.</p><p><strong>Results: </strong>All the patients had New York Heart Association (NYHA) function class III/IV before TTViV. Six patients had tricuspid regurgitation, 1 had tricuspid stenosis, and 5 had both. All the patients had successful TTViV. The mean time from the initial valve surgery to TTViV was 6.25±2.45 years. At follow-up, 2 patients had died: 1 due to COVID-19 pneumonia and 1 without a known cause. The remaining 10 patients experienced improvements in the NYHA functional class. Echocardiographic measures showed significant improvements. Transvalvular mean gradient pressure decreased from 7.08±1.98 mm Hg to 5.29±1.63 mm Hg (P=0.028), tricuspid valve pressure half time decreased from 245.00±49.46 ms to 158.64±57.41 ms (P=0.011), tricuspid regurgitation gradient decreased from 39.91±7.31 mm Hg to 26.72±8.99 mm Hg, and left ventricular ejection fraction increased from 47.71±4.70% to 49.79±4.58% (P=0.046). There was no significant paravalvular or transvalvular leakage at follow-up.</p><p><strong>Conclusion: </strong>This is a single-center report on the mid and long-term echocardiographic follow-up of patients after TTViV replacement. 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引用次数: 0
摘要
背景:经导管三尖瓣瓣内置换术(TTViV)已成为高危生物瓣膜退行性变患者的替代治疗方法。这是第一份关于在伊朗心脏转诊中心接受TTViV置换的患者中长期超声心动图结果的报告。方法:回顾性分析2015 - 2021年间行TTViV置换术的12例患者的资料，其中11例为女性，1例为男性。患者术前行超声心动图检查，平均随访时间3.17±1.75年。结果:所有患者在TTViV前均为纽约心脏协会(NYHA)功能III/IV级。6例有三尖瓣反流，1例有三尖瓣狭窄，5例两者皆有。所有患者均成功进行了TTViV治疗。从首次瓣膜手术到TTViV的平均时间为6.25±2.45年。随访时，2例患者死亡:1例死于COVID-19肺炎，1例死因不明。其余10例患者的NYHA功能分级有所改善。超声心动图显示明显改善。经瓣平均梯度压由7.08±1.98 mm Hg降至5.29±1.63 mm Hg (P=0.028)，三尖瓣压力半时间由245.00±49.46 ms降至158.64±57.41 ms (P=0.011)，三尖瓣反流梯度由39.91±7.31 mm Hg降至26.72±8.99 mm Hg，左室射血分数由47.71±4.70%上升至49.79±4.58% (P=0.046)。随访时无明显的瓣旁或跨瓣渗漏。结论:这是一篇关于TTViV置换术后患者中长期超声心动图随访的单中心报告。我们的研究表明，TTViV是一种安全有效的治疗高危生物假体三尖瓣退行性变的方法，超声心动图和临床结果良好。
Mid to Long-Term Echocardiographic Follow-up of Patients Undergoing Transcatheter Tricuspid Valve-in-Valve Replacement for Degenerated Bioprosthetic Valves: First Single-Center Report from Iran.
Background: Transcatheter tricuspid valve-in-valve (TTViV) replacement has become an alternative treatment in high-risk patients with bioprosthetic valve degeneration. This is the first report on the mid to long-term echocardiographic findings of patients who underwent TTViV replacement in a cardiac referral center in Iran.
Methods: Data of 12 patients, consisting of 11 women and 1 man, who underwent TTViV replacement between 2015 and 2021 were reviewed retrospectively. The patients underwent echocardiography before the procedure and at a mean follow-up time of 3.17±1.75 years.
Results: All the patients had New York Heart Association (NYHA) function class III/IV before TTViV. Six patients had tricuspid regurgitation, 1 had tricuspid stenosis, and 5 had both. All the patients had successful TTViV. The mean time from the initial valve surgery to TTViV was 6.25±2.45 years. At follow-up, 2 patients had died: 1 due to COVID-19 pneumonia and 1 without a known cause. The remaining 10 patients experienced improvements in the NYHA functional class. Echocardiographic measures showed significant improvements. Transvalvular mean gradient pressure decreased from 7.08±1.98 mm Hg to 5.29±1.63 mm Hg (P=0.028), tricuspid valve pressure half time decreased from 245.00±49.46 ms to 158.64±57.41 ms (P=0.011), tricuspid regurgitation gradient decreased from 39.91±7.31 mm Hg to 26.72±8.99 mm Hg, and left ventricular ejection fraction increased from 47.71±4.70% to 49.79±4.58% (P=0.046). There was no significant paravalvular or transvalvular leakage at follow-up.
Conclusion: This is a single-center report on the mid and long-term echocardiographic follow-up of patients after TTViV replacement. Our study showed that TTViV was a safe and efficient method in treating high-risk patients with degenerated bioprosthetic tricuspid valves and had favorable echocardiographic and clinical results.
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