interventional cardiology：介入性心脏病学.pdfVIP

Interventional Cardiology Percutaneous Pulmonary Valve Implantation Impact of Evolving Technology and Learning Curve on Clinical Outcome Philipp Lurz, BSc; Louise Coats, MRCP; Sachin Khambadkone, MD, MRCP; Johannes Nordmeyer, MD; Younes Boudjemline, MD; Silvia Schievano, MEng; Vivek Muthurangu, MRCP; Twin Yen Lee, RN; Giovanni Parenzan, MA; Graham Derrick, MRCP; Seamus Cullen, MRCPI; Fiona Walker, MRCP; Victor Tsang, MD, FRCS; John Deanfield, FRCP; Andrew M. Taylor, MD, MRCP, FRCR; Philipp Bonhoeffer, MD Background—Percutaneous pulmonary valve implantation was introduced in the year 2000 as a nonsurgical treatment for patients with right ventricular outflow tract dysfunction. Methods and Results—Between September 2000 and February 2007, 155 patients with stenosis and/or regurgitation underwent percutaneous pulmonary valve implantation. This led to significant reduction in right ventricular systolic pressure (from 63 18 to 4513 mm Hg, P 0.001) and right ventricular outflow tract gradient (from 37 20 to 1710 mm Hg, P 0.001). Follow-up ranged from 0 to 83.7 months (median 28.4 months). Freedom from reoperation was 93% ( 2%), 86% ( 3%), 84% (4%), and 70% ( 13%) at 10, 30, 50, and 70 months, respectively. Freedom from transcatheter reintervention was 95% ( 2%), 87% ( 3%), 73% (6%), and 73% ( 6%) at 10, 30, 50, and 70 months, respectively. Survival at 83 months was 96.9%. On time-dependent analysis, the first series of 50 patients (log-rank test P 0.001) and patients with a residual gradient 25 mm Hg (log-rank test P 0.01) were associated with a higher risk of reoperations. Conclusions—Percutaneous pulmonary valve implantation resulted in the ability to avoid surgical right ventricular outflow tract revision in the majority of cases. This procedure