Objective: To explore the long-term clinical efficacy of transcatheter repair of mitral paravalvular leak (PVL) post surgical mitral valve replacement. Methods: This study is a retrospective study. Patients who completed transcatheter repair of paravalvular leak after surgical mitral valve replacement at Shanghai Chest Hospital, Shanghai Jiaotong University School of Medicine from March 2010 to December 2018 were included. Technical success was defined as the occluder being stably implanted in the paravalvular leak site without affecting the function of the mitral valve and surrounding tissues; and there were no intervention-related complications, such as new hemolysis or aggravated hemolysis, and echocardiography confirmed mitral paravalvular regurgitation reduced by more than 1 grade. Patients were followed up at 30 days, 1, and 3 years after the intervention. The main endpoints were all-cause death and re-surgery due to interventional failure or serious complications. The occurrence of occluder-mediated hemolysis and chronic renal insufficiency was recorded, and patients were monitored with echocardiography during follow up. Results: A total of 75 patients were included, aged (54.3±22.9) years old, and 38 patients were males. All patients had decreased cardiac function and/or hemolysis before intervention. Procedural success was achieved in 54 patients (72.0%). Incidence of device-mediated hemolysis was 18.7% (14/75). During the follow-up period, all-cause death occurred in 7 patients (9.3%), and 3 were cardiac deaths.The 3-year event-free survival rate was 81.3% (61/75). The need for cardiac surgery was 9.3% (7/75): 3 cases due to severe device-mediated hemolysis, 2 cases due to prosthetic valve failure and 2 cases due to moderate to severe residual regurgitation. The echocardiography follow-up results showed that the position of the occluder was stable, there was no impact on the artificial valve function and surrounding structures, and the residual regurgitation was stable without progressive increase in event-free patients. Compared with pre-intervention, the left ventricular end systolic diameter ((33.9±7.4)mm vs. (38.3±8.9) mm, P=0.036), end diastolic diameter ((53.7±8.3) mm vs. (58.4±9.1) mm, P=0.045) and left atrial diameter (59.3 (44.5, 90.7) mm vs. 64.3 (44.8, 96.6) mm, P=0.049) were significantly reduced, pulmonary artery systolic pressure was also significantly decreased ((36.5±15.8) mmHg vs. (46.3±14.9) mmHg, P=0.022, 1 mmHg=0.133 kPa). There was no significant difference between 3 years and 1 year after transcatheter repair of mitral paravalvular leak post surgical mitral valve replacement (all P>0.05). Conclusion: Transcatheter repair of mitral paravalvular leak post surgical mitral valve replacement is an effective treatment option in selective patients.
目的： 探讨经导管封堵外科二尖瓣置换术后瓣周漏的长期临床疗效。 方法： 本研究为回顾性研究。入选2010年3月至2018年12月在上海交通大学医学院附属胸科医院完成经导管介入封堵二尖瓣置换术后瓣周漏的患者。技术成功定义为封堵器稳定植入于瓣周漏部位，不影响人工二尖瓣功能以及周边组织；无介入相关并发症，如新发溶血或溶血加重等；经超声心动图证实二尖瓣瓣周反流程度减轻1级以上。于介入术后30 d，1、3年对患者进行随访，主要研究终点为全因死亡和因介入失败或严重并发症转为外科手术，并记录封堵器介导性溶血、慢性肾功能不全等发生情况，完善超声心动图检查。 结果： 共纳入75例患者，年龄（54.3±22.9）岁，男性38例。患者术前均有心功能下降和（或）溶血。技术成功率72.0%（54/75）。术后新发溶血或溶血加重者14例（18.7%）。随访期间全因死亡7例（9.3%），其中心原性死亡3例。3年无临床终点事件生存率为81.3%（61/75）。再次外科手术的比例为9.3%（7/75），原因包括封堵器介导性溶血（3例）、人工瓣膜干扰失功（2例）及中度以上残余反流（2例）。超声心动图随访结果显示，封堵器位置稳定、随访期间未发现对人工瓣功能及周边结构造成影响，残余反流稳定无进行性增加；与术前相比，术后1年患者的左心室收缩末期内径［（33.9±7.4）mm比（38.3±8.9）mm，P=0.036］、舒张末期内径［（53.7±8.3）mm比（58.4±9.1）mm，P=0.045］以及左心房内径［59.3（44.5，90.7）mm比64.3（44.8，96.6）mm，P=0.049］均缩小，肺动脉收缩压降低［（36.5±15.8）mmHg比（46.3±14.9）mmHg，P=0.022，1 mmHg=0.133 kPa］。术后3年与术后1年比较差异均无统计学意义（P均>0.05）。 结论： 经导管封堵二尖瓣瓣周漏在外科高风险且符合封堵解剖条件的患者中是有效的治疗方案。.