ObjectiveTo evaluate mid-term outcomes of pulmonary valve replacement surgery after repair of tetralogy of Fallot.MethodsA total of 73 patients with repaired tetralogy of Fallot who underwent pulmonary valve replacement surgery in our hospital from January 2010 to January 2020 were enrolled, including 42 males and 31 females. The median age was 3.9 (0.2-42.8) years at initial repair and 20.0 (2.0-50.0) years at pulmonary valve replacement. The clinical data of the patients were recorded and analyzed.ResultsThere was no death in postoperative 30 d. The average follow-up time was 35.6±28.5 months, and no death occurred during the follow-up. One patient underwent a second reintervention after initial pulmonary valve replacement. The 1- and 5-year survival rates were both 100.0%, the 1- and 5-year reintervention-free rates were both 100.0%, and the 1- and 5-year valve failure-free rates were 100.0% and 67.1%. There was no significant difference in valve failure-free rates between different age groups (P=0.49) and different type of valve groups (P=0.74). The right (P=0.006) and left (P=0.002) ventricular ejection fractions were significantly improved, and the QRS duration was shortened after pulmonary valve replacement (P=0.006).ConclusionMid-term outcomes of surgical pulmonary valve replacement were satisfactory in patients with repaired tetralogy of Fallot, while the long-term effects should be further emphasized in clinical practice.
Objective To summarize the short-term results of valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) in the treatment of bioprosthetic valve failure after aortic valve replacement. Methods We reviewed the clinical data of patients who underwent ViV-TAVI from 2021 to 2022 in the First Affiliated Hospital of Zhengzhou University. The valve function was evaluated by echocardiography before operation, immediately after operation and 3 months after operation. The all-cause death and main complications during hospitalization were analyzed. Results A total of 13 patients were enrolled, including 8 males and 5 females with a mean age of 65.9±8.5 years, and the interval time between aortic valve replacement and ViV-TAVI was 8.5±3.4 years. The Society of Thoracic Surgeons mortality risk score was 10.3%±3.2%. None of the 13 patients had abnormal valve function after operation. The mean transvalvular differential pressure of aortic valve was decreased (P<0.001), the peak flow velocity of aortic valve was decreased (P<0.001), the left ventricular ejection fraction was not changed significantly (P=0.480). There were slight perivalvular leakage in 2 patient and slight valve regurgitation in 3 patients. Three months after operation, the mean transvalvular pressure difference and peak flow velocity of aortic valve in 12 patients were significantly different from those before operation (P≤0.001). Conclusion This study demonstrates that ViV-TAVI for the treatment of bioprosthetic valve failure after aortic valve replacement is associated with sustained clinical and functional cardiovascular benefits, the short-term results are satisfactory.
[Abstract]A 70-year-old woman who was admitted to the hospital for post-cardiac surgery panic attack for 4 months. Eight months ago, she was admitted to a local hospital with 7 years of post-activity panic, which worsened for 2 months, and underwent mitral valve replacement+aortic valve replacement+tricuspid valvuloplasty+modified maze procedure+left auriculotomy. Four months after the operation, mitral valve damage appeared, and transcatheter mitral valve replacement was performed in our hospital by apical approach. A case report on the treatment of this patient is presented.
Surgical bioprosthetic valve in the mitral position typically degenerates in 10-15 years, when intervention is required again. In the past, redo surgical mitral valve replacement has been the only treatment choice for such patients suffering from bioprosthetic valve failure, despite the even higher risk associated with redo open-heart surgery. In recent years, transcatheter valve-in-valve implantation in the mitral position has evolved as an reasonable alternative to redo surgery for the treatment of surgical mitral bioprosthetic valve failure. Here we report an 81-year-old female patient with surgical mitral bioprosthetic valve failure, who successfully underwent valve-in-valve transcatheter mitral valve replacement via the transfemoral-transseptal approach. The procedure was successful owing to comprehensive CT imaging work-up, despite the technical challenges associated with bilateral giant atria and small left ventricle.