Transcatheter mitral valve-in-valve implantation: reports of the first 50 cases from a Latin American Centre.
- 作者列表："da Costa LPN","Palma JH","Barbosa Ribeiro H","Sampaio RO","Viotto G","Medeiros Santos R","Freitas Tenório D","Saito VT","Egypto Rosa VE","Pinho Moreira LF","Tarasoutchi F","Pomerantzeff PM","Biscegli Jatene F
OBJECTIVES:Our goal was to analyse the initial results of the first 50 transapical transcatheter mitral valve-in-valve procedures performed in a single Latin American centre. METHODS:A prospective, single centre, database analysis was conducted to evaluate immediate, 30-day and 1-year postoperative results of 50 consecutive patients who had a transcatheter mitral valve-in-valve procedure from May 2015 to June 2018. All patients were operated on in a hybrid operating room and received a balloon-expandable valve via the transapical approach. Preoperative and postoperative characteristics were analysed and compared between the first 25 and the second 25 patients to evaluate the impact of the learning curve. Twenty patients had a follow-up examination at 1 year. RESULTS:There was a 98% device success rate. The patients had a mean age of 64.8 years; 72% were women; 80% were in New York Heart Association functional class ≥III preoperatively; and 36% of the procedures were urgent. The mean Society of Thoracic Surgeons scores and EuroSCORE II were 8.3% and 12.4%, respectively. Patients had a median of 2 previous operations; valve durability was 12.1 years; and 64% mitral valve disease of rheumatic fever aetiology. Echocardiography showed decreases in the maximum and mean mitral gradients from 23.5 to 14.6 and 11.5 to 6.4 mmHg postoperatively; the overall mean hospitalization period was 15 days. The overall mortality rate at 30 days was 14%, with 1 intraprocedural death. Further subanalyses between the first and the second half of the cases showed a drop in the mortality rate from 20% to 8% (P < 0.01). CONCLUSION:The transcatheter mitral valve-in-valve procedure was shown to be a safe and effective procedure to treat bioprosthetic dysfunction, with potential benefits in patients with rheumatic disease.
目的: 我们的目标是分析在一个拉丁美洲中心进行的前50例经心尖经导管二尖瓣瓣膜内手术的初步结果。 方法: 对2015年5月至2018年6月接受经导管二尖瓣内瓣手术的50例患者进行前瞻性、单中心、数据库分析，以评估术后即刻、30天和1年的结果。所有患者均在混合手术室进行手术，并通过经心尖入路接受球囊扩张瓣膜。分析和比较前25例和后25例患者的术前和术后特征，以评估学习曲线的影响。20例患者在1年时进行随访检查。 结果: 器械成功率为98%。患者的平均年龄为64.8岁; 72% 为女性; 80% 为纽约心脏协会术前功能分级 ≥ iii级; 36% 的手术是紧急的.平均胸外科医师协会评分和EuroSCORE II分别为8.3% 和12.4%。患者的中位既往手术史为2次; 瓣膜耐久性为12.1 年; 风湿发热病因的二尖瓣疾病占64%。超声心动图显示术后最大和平均二尖瓣梯度从23.5降至14.6，从11.5降至6.4 mmhg; 总的平均住院时间为15天。30天的总死亡率为14%，术中死亡1例。第一和后半部分病例之间的进一步子分析显示，死亡率从20% 下降到8% (p <0.01)。 结论: 经导管二尖瓣内瓣手术是一种安全有效的治疗生物假体功能障碍的方法，对风湿病患者有潜在的益处。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.