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.
ObjectiveTo summarize and analyze the risk factors and management of artificial valve slippage in transcatheter aortic valve implantation (TAVI).MethodsWe retrospectively analyzed the clinical data of 131 patients undergoing TAVI surgery in our center from September 2017 to May 2019, including 62 patients through transapical approach and 69 patients through transfemoral artery approach.ResultsA total of 131 patients received TAVI surgery, among whom 4 patients had slipped during the operation, 2 patients via transfemoral artery approach, and another 2 patients via transapical. The average age was 77±9 years with one female (25%). Preoperative evaluation, higher position and poor coaxial were main risk factors for valve slip in TAVI.ConclusionValve slippage is also a serious complication in TAVI surgery. Reasonable and effective treatment can avoid thoracotomy.
ObjectiveTo analyze the characteristics of platelet changes and their influencing factors during postoperative hospitalization in patients who underwent transcatheter aortic valve implantation (TAVI). MethodsThe patients who underwent TAVI at Beijing Anzhen Hospital Valve Surgery Center between March 2017 and October 2021 were retrospectively selected. The patients were divided into a self-limiting group and a non-self-limiting group according to the characteristics of postoperative platelet decline. In addition, the general preoperative data, preoperative and postoperative ultrasound data, intraoperative data, and the use of anticoagulant drugs during the postoperative stay in the hospital were compared between the two groups. ResultsA total of 249 patients were enrolled in this study. There were 175 (70.3%) patients in the self-limiting group, including 100 males and 75 females, and there were 74 (29.7%) patients in the non-self-limiting group, including 43 males and 31 females, with no statistical difference between the two groups (P=0.863). The mean age of patients was 73.11±8.88 years in the self-limiting group and 71.54±10.39 years in the non-self-limiting group (P=0.231). The decline of platelets in the self-limiting group generally occurred on the postoperative day 2 and reached the lowest count on the postoperative day 4, and returned to the baseline level on the postoperative day 5-7, while the platelets in the non-self-limiting group changed by simple rise, fall or irregular fluctuation. Patients in the self-limiting group had severer preoperative aortic stenosis (P<0.001) and used more extracorporeal circulation assistance during surgery (P<0.001). Postoperatively, patients in the self-limiting group were more likely to have periaortic valve leakage than those in the non-self-limiting group (P=0.013). ConclusionPlatelet changes in most patients after TAVI show a self-limiting decline, which may be related to the severity of patients’ preoperative aortic stenosis, intraoperative extracorporeal circulation device use, and postoperative perivalvular leakage.