PMID- 34034380 OWN - NLM STAT- MEDLINE DCOM- 20210527 LR - 20210527 IS - 0253-3758 (Print) IS - 0253-3758 (Linking) VI - 49 IP - 5 DP - 2021 May 24 TI - [Feasibility, efficacy and safety of transbrachial access for interventional therapy on paravalvular leak post surgical valve replacement]. PG - 467-473 LID - 10.3760/cma.j.cn112148-20210329-00278 [doi] AB - Objective: To investigate the feasibility, efficacy and safety of transbrachial access for interventional therapy on prosthetic paravalvular leak (PVL) post surgical valve replacement. Methods: This is a retrospective study. Patients with PVL after surgical valve replacement who underwent interventional therapy via the brachial artery approach in Structural heart disease center of Fuwai hospital between August 2017 and October 2019, were included. All patients underwent puncture of the brachial artery under local anesthesia, angiography and transcatheter closure procedure were performed. The procedure was performed under transthoracic echocardiography (TTE) guidance. Baseline data, operation data and pre-and post-operative TTE examination results were collected and analyzed. Postoperative complications were recorded and operational adverse events were obtained during follow up in the outpatient department after discharge. The operation success rate was calculated, which was defined as the degree of perivalvular regurgitation decrease by 1 grade and above according to TTE without interfering the valve movement and coronary artery blood flow within 30 days after occluder placement. Results: A total of 10 patients were enrolled in this study, the mean age was (57.5+/-14.6) years, and 6 patients were males. There were 7 cases with aortic PVL, and 3 cases with mitral PVL. Except for one patient who was converted to the femoral vein-transseptal approach, the other 9 patients were successfully implanted with the devices via the brachial artery approach. The operation time was (103.3+/-34.0) minutes, and there was no need for rigorous bed rest after the operation. The median hospital stay was 7.5 (3.0, 9.8) days. The operation success rate was 9/10 via the brachial artery approach. The differences in the degree of perivalvular regurgitation, New York Heart Association (NYHA) classification, left ventricular end diastolic diameter and left atrial diameter before and after operation were statistically significant (all P<0.05). One case developed new hemolysis with renal insufficiency on the second day after procedure and discharged after successful dialysis. Another case experienced complication of brachial artery pseudoaneurysm after procedure and discharged after successful treatment with thrombin injection. The mean follow-up time was (14.3+/-7.9) months. During the follow-up, NYHA classification remained as Ⅰ/Ⅱ in 9 patients, no operational adverse events were observed. Conclusions: Transbrachial access for interventional therapy on PVL post surgical valve replacement is a feasible, effective, and safe procedure. It has the advantages of simplifying the operation process and reducing postoperative bed rest time. FAU - Zhang, H AU - Zhang H AD - Structural Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China. FAU - Hu, H B AU - Hu HB AD - Structural Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China. FAU - Lyu, J H AU - Lyu JH AD - Structural Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China. FAU - Xie, R G AU - Xie RG AD - Department of Radiology, Zhengzhou University People's Hospital, Central China Fuwai Hospital, Zhengzhou 450003, China. FAU - Pang, K J AU - Pang KJ AD - Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China. FAU - Liu, Y AU - Liu Y AD - Structural Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China. FAU - Xu, L AU - Xu L AD - Structural Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China. FAU - Pan, X B AU - Pan XB AD - Structural Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China. LA - chi GR - 2020-I2M-C&T-B-062/Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences/ GR - Z201100005520075/Translational Medicine Research Found for Characteristic Clinical Diagnosis and Treatment Technology Supported by Beijing Municipal Commission of Science and Technology/ PT - Journal Article PL - China TA - Zhonghua Xin Xue Guan Bing Za Zhi JT - Zhonghua xin xue guan bing za zhi JID - 7910682 SB - IM MH - Adult MH - Aged MH - Aortic Valve/surgery MH - Cardiac Catheterization MH - Feasibility Studies MH - Female MH - *Heart Valve Prosthesis MH - *Heart Valve Prosthesis Implantation/adverse effects MH - Humans MH - Male MH - Middle Aged MH - Retrospective Studies MH - Surgical Instruments MH - Treatment Outcome EDAT- 2021/05/26 06:00 MHDA- 2021/05/28 06:00 CRDT- 2021/05/25 22:33 PHST- 2021/05/25 22:33 [entrez] PHST- 2021/05/26 06:00 [pubmed] PHST- 2021/05/28 06:00 [medline] AID - 10.3760/cma.j.cn112148-20210329-00278 [doi] PST - ppublish SO - Zhonghua Xin Xue Guan Bing Za Zhi. 2021 May 24;49(5):467-473. doi: 10.3760/cma.j.cn112148-20210329-00278.