国产球囊扩张式瓣膜的临床应用初探First clinical application of domestic balloon expandable transcatheter valve made in China
马燕燕,刘洋,金屏,李兰兰,徐臣年,孟欣,陈敏,虞奇峰,刘金成,杨剑
摘要(Abstract):
探讨国产球囊扩张式瓣膜治疗主动脉瓣狭窄及二尖瓣生物瓣衰败的应用及治疗效果。主动脉瓣狭窄及二尖瓣生物瓣衰败的2例老年高危瓣膜病患者,于2020年在空军军医大学第一附属医院接受经股动脉入径行经导管主动脉瓣置换术(TAVR)及经股静脉房间隔穿刺入径行经导管二尖瓣置换术(TMVR),首次置入国产球囊扩张式瓣膜,进行安全性及有效性评价。2例老年高危瓣膜病患者成功接受TAVR及TMVR。术后通过影像学及3D打印模型可见,球囊扩张式瓣膜在主动脉瓣和二尖瓣处形态、位置分布良好。患者术后血流动力学得到显著改善,心功能明显好转。国产球囊扩张式瓣膜在治疗主动脉瓣狭窄及二尖瓣生物瓣衰败等瓣膜病中,有着明显的优势及广阔的应用前景。
关键词(KeyWords): 主动脉瓣狭窄;经导管主动脉瓣置换术;球囊扩张式瓣膜;3D打印
基金项目(Foundation): 陕西省自然科学基础研究计划杰出青年科学基金项目(S2018-JC-JQ-0094);; 陕西省创新能力支撑计划-科技创新团队项目(2020TD-034);; 国家重点研发计划项目(2020YFC2008100)
作者(Author): 马燕燕,刘洋,金屏,李兰兰,徐臣年,孟欣,陈敏,虞奇峰,刘金成,杨剑
参考文献(References):
- [1] Lachell A, Henry L. Transcatheter aortic valve replacement options for severe aortic stenosis in high-risk patients. J Cardiovasc Nurs, 2015,30(3):242-247.
- [2] Timothy A. Mackram F, Allison K, et al. Long-term outcomes of melody valve-in-valve implantation for bioprosthetic mitral valve dysfunction. Catheter Cardiovasc Interv, 2019,93(6):1087-1094.
- [3]张海波,孟旭,王胜洵,等.经导管二尖瓣生物瓣损毁的瓣中瓣治疗技术.中华心血管外科杂志,2019,35(6):331-333.
- [4] Raptis DA, Beal MA, Kraft DC, et al. Transcatheter aortic valve replacement:alternative access beyond the femoral arterial approach.Radiographics, 2019,39(1):30-43.
- [5] Galatas C, Afi lalo J. Transcatheter aortic valve replacement over age 90:Risks vs benefi ts. Clin Cardiol, 2020,43(2):156-162.
- [6]中国医师协会心血管内科医师分会结构性心脏病专业委员会,中华医学会心血管病学分会结构性心脏病学组.经导管主动脉瓣置换术中国专家共识.中国介入心脏病学杂志,2015,23(12):661-667.
- [7] Shivaraju A, Michel J, Frangieh AH, et al. Transcatheter aortic and mitral valve-in-valve implantation using the edwards sapien 3 heart valve. J Am Heart Assoc, 2018,7(14):e007767.
- [8] Werner N, Kilkowski C, Sutor D, et al. Transcatheter mitral valve implantation(TMVI)using Edwards Sapien 3 prostheses in patients at very high or prohibitive surgical risk:a single-center experience. J Interv Cardiol, 2020,2020:9485247.
- [9] O’Gara PT,Grayburn PA,Badhwar V, et al. 2017 ACC Expert consensus decision pathway on the management of mitral regurgitation:a report of the American College of Cardiology task force on expert consensus decision pathways. J Am Coll Cardiol,2017,70(19):2421-2449.
- [10] Goldstone AB, Chiu P, Baiocchi M, et al. Mechanical or biologic prostheses for aortic-valve and mitral-valve replacement. N Engl J Med,2017,377:1847-1857.
- [11] Cheung A, Webb JG, Wong DR, et al. Transapical transcatheter mitral valve-in-valve implantation in a human. Ann Thorac Surg, 2009, 87(3):e18-e20.
- [12] Mylotte D, Piazza N. Transcatheter mitral valve implantation:a brief reveiew. EuroIntervention, 2015,11(Suppl W):W67-W70.
- [13]潘文志,周达新,葛均波.经导管二尖瓣置换术的应用现状与展望.上海医学,2017,38(3):11-15.
- [14] Tham JLM, Adams H, Paleri S, et al. Clinical outcomes of selfexpandable vs. balloon-expandable TAVI for severe aortic stenosis. Acta Cardiol, 2020,75(3):218-225.
- [15] Li YM, Tsauo JY, Liao YB,et al. Comparison of third generation balloon-expandable Edwards Sapien 3 versus self-expandable Evolut R in transcatheter aortic valve implantation:a meta-analysis. Ann Palliat Med, 2020,9(3):700-708.
- [16] Whisenant B, Kapadia S, Eleid M, et al. One-year outcomes of mitral valve-in-valve using the Sapien 3 transcatheter heart valve. Arch Cardiovasc Dis, 2020,5(11):1245-1252.