Innovative use of a self-expanding valve for valve-in-valve transcatheter mitral valve replacement: experience from a four-year single-center study

作者全名："Li, Yuehuan; Lei, Ruobing; Zhou, Jiawei; Wu, Kaisheng; Shen, Jinglun; Zhu, Zhihui; Wang, Jiangang; Zhang, Haibo"

作者地址："[Li, Yuehuan; Zhou, Jiawei; Wu, Kaisheng; Shen, Jinglun; Wang, Jiangang; Zhang, Haibo] Capital Med Univ, Beijing Anzhen Hosp, Dept Cardiac Surg, Beijing, Peoples R China; [Lei, Ruobing] Chongqing Med Univ, Dept Pediat Res Inst, Chevidence Lab Child & Adolescent Hlth, Childrens Hosp, Chongqing, Peoples R China; [Zhu, Zhihui] Ludwig Maximilian Univ Munich, LMU Univ Hosp, Dept Medicine4, Munich, Germany"

通信作者："Wang, JA; Zhang, HB (通讯作者)，Capital Med Univ, Beijing Anzhen Hosp, Dept Cardiac Surg, Beijing, Peoples R China."

来源：FRONTIERS IN CARDIOVASCULAR MEDICINE

ESI学科分类：　

WOS号：WOS:001012941100001

JCR分区：Q2

影响因子：2.8

年份：2023

卷号：10

期号：　

开始页：　

结束页：　

文献类型：Article

关键词：valve-in-valve transcatheter mitral valve replacement; failed mitral bioprosthetic valves; transapical approach; health-related quality of life outcomes; Kansas city cardiomyopathy questionnaire-12

摘要："BackgroundValve-in-valve transcatheter mitral valve replacement (ViV-TMVR) is a minimally invasive option for patients with bioprosthetic mitral valve failure. Since January 2019, our center has been using a new innovative option, J-Valve, to treat patients with bioprosthetic mitral valve failure who were at high risk for open heart surgery. The aim of this study is to explore the effectiveness and safety of J-Valve and report the results from the four-year follow-up period of the innovative application of the transcatheter valve.MethodsPatients who underwent the ViV-TMVR procedure between January 2019 and September 2022 in our center were included in the study. J-Valve & TRADE; system (JC Medical Inc., Suzhou, China) with three U-shape grippers was used for ViV-TMVR via transapical approach. Data on survival, complications, transthoracic echocardiographic results, New York Heart Association functional class in heart failure, and patient-reported health-related quality of life according to the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) were collected during the four-year follow up.ResultsThirty-three patients (mean age 70.1 & PLUSMN; 1.1 years, 13 men) were included and received ViV-TMVR. The surgery success rate was 97%: only one patient was converted to open-heart surgery due to intraoperative valve embolization to the left ventricle. During the first 30 days all-cause mortality was 0%, risk of stroke 2.5% and risk of mild paravalvular leak 15.2%; mitral valve hemodynamics improved (179.7 & PLUSMN; 8.9 at 30 days vs. 269 & PLUSMN; 49 cm/s at baseline, p < 0.0001). Median time from operation to discharge was six days, and there were no readmissions within 30 days from operation. The median and maximum follow-up durations were 28 and 47 months, respectively; during the entire follow-up, all-cause mortality was 6.1%, and the risk of cerebral infarction 6.1%. Cox regression analysis did not identify any variables significantly associated with survival. The New York Heart Association functional class and the KCCQ-12 score improved significantly compared with their preoperative values.ConclusionThe use of J-Valve for ViV-TMVR is safe and effective with a high success rate, low mortality and very few associated complications, representing an alternative surgical strategy for the elderly, high-risk patients with bioprosthetic mitral valve failure."

基金机构：National Key Ramp;D Program of China [2020YFC2008105]

基金资助正文：Funding This study was funded by the National Key R&D Program of China (2020YFC2008105).