ObjectiveTo summarize the results and clinical experience of transcatheter valve-in-valve implantation using domestic self-expanding valve in patients with aortic degenerated bio-prosthesis. MethodsFrom January 2019 to April 2023, the patients who underwent transcatheter valve-in-valve surgery in the Department of Cardiac Surgery of Tianjin Chest Hospital due to surgical bio-prosthesis failure were included. Characteristics of valves, perioperative complications, and hemodynamic manifestations during the early postoperative and follow-up period were analyzed. ResultsA total of 24 patients were enrolled, including 14 males and 10 females with an average age of 68.17±7.72 years, and the average interval between the two operations was 10.48±4.09 years. All patients were successfully discharged without complications such as coronary artery obstruction and pacemaker implantation, and the average transvalvular pressure gradient was 16.39±6.52 mm Hg before discharge. During the median follow-up time of 16 months, the left ventricular diastolic inner diameter and ejection fraction were continuously improved. ConclusionTranscatheter valve-in-valve using domestic self-expanding valves is safe and feasible to treat aortic bioprosthetic valve failure. Sound patient selection and surgical strategies are critical to achieve good hemodynamics.
Objective To preliminarily investigate the feasibility and clinical outcomes of percutaneous pulmonary valve implantation (PPVI) using a domestic self-expanding valve. Methods Patients with right ventricle outflow tract (RVOT) dysfunction after surgery for congenital heart disease who presented to Beijing Anzhen Hospital from March 2019 to July 2024 and were assessed to be suitable for PPVI via self-expanding valves were retrospectively analyzed. The patients underwent PPVI with either the PT-Valve or the Venus-P. Baseline, surgical, and imaging data were recorded and the patients were followed up. Results A total of 13 patients, including 4 males and 9 females, aged 14 to 55 years, were included. Initial congenital heart disease included tetralogy of Fallot (9 patients), right ventricular double outlet (1 patient), simple pulmonary stenosis (2 patients), and pulmonary atresia (1 patient). All patients underwent RVOT reconstruction with transannular patching. Indications for PPVI intervention included severe pulmonary stenosis with mild regurgitation (1 patient), severe regurgitation of the pulmonary valve (12 patients). PT-Valve was used in 9 patients, and Venus-P was used in 4. Valve implantation was successful in 13 patients, with no psevere erioperative complications. One patient with pulmonary stenosis was implanted with an overlay Cheatham-Platinum stent followed by PT-Valve valve implantation, and the postoperative result was satisfactory. Postoperative pulmonary and perivalvular regurgitation were mild or less, and the median peak flow velocity of the pulmonary valve was 1.32 m/s. At 3-month follow-up, the patient's NYHA classification improved significantly compared with the preoperative period, and the QRS wave width shortened compared with that of the preoperative period, the difference was statistically significant [(159.0±27.6) ms vs. (144.3±33.8) ms, P=0.005]. Ejection fraction and tricuspid annular plane systolic excursion increased, but the difference did not reach statistical significance. The patients had an increased postoperative left ventricular end-diastolic diameter, and the difference was statistically significant [(41.00±3.63) versus (44.77±5.12) mm, P=0.023]. Patients had a reduction in moderate or greater mitral regurgitation postoperatively, the difference was statistically significant. The difference in moderate or greater tricuspid regurgitation was not statistically significant. The follow-up time was (27.7±20.5) months, and no stent fracture or infective endocarditis occurred during the follow-up period; mild valve displacement occurred in one patient, and the remaining patients had good valve position. The patients' NYHA classification was class Ⅰ. Conclusion Domestic self-expanding valves for PPVI are feasible for the treatment of patients with RVOT dysfunction after surgery for congenital heart disease, and their safety and efficacy need to be further verified by studies with longer periods of time and larger sample sizes.