Universität Leipzig, Herzzentrum, Klinik für Herzchirurgie, Leipzig, Germany.
Ann Thorac Surg. 2010 Jun;89(6):1934-41. doi: 10.1016/j.athoracsur.2010.02.061.
The reoperative risk for degenerated aortic valve xenografts may be increased in elderly patients with comorbidities. We evaluated the off-pump beating heart concept of transapical aortic valve implantation using the valve-in-valve (VinV) concept.
Since March 2007, 11 patients with degenerated xenografts received transapical aortic valve implantation using the Edwards Sapien transcatheter heart valve (Edwards Lifesciences, Irvine, CA). After informed consent, all procedures were performed as an off-label use. Mean patient age was 78 +/- 6 years (range, 72 to 89), mean logistic European System for Cardiac Operative Risk Evaluation was 32% +/- 16% (range, 16% to 62%) and mean Society for Thoracic Surgeons score was 7% +/- 3% (range, 3% to 10%).
All patients were treated off pump. The transapical aortic valve implantation was successful in all patients, and apical access was uncomplicated in all of them. Total operating room time was 71 +/- 14 minutes. On postoperative echocardiography, there was no paravalvular incompetence in any and mild (first degree) central incompetence in 2 of 11 patients. Sufficient flaring of the inflow and outflow parts of the Sapien prosthesis was observed in all patients, suggesting a stable position and an almost absent risk of late embolization. Maximal transvalvular pressure gradients were 21 +/- 8 mm Hg, and mean echocardiographic pressure gradients were 11 +/- 4 mm Hg. Follow-up extends to 330 +/- 293 days (range, 15 to 1,007), and all patients are well and alive.
Valve-in-valve implantation is a truly minimally invasive procedure for redo treatment of failed aortic valve xenografts in high-risk elderly patients. The Edwards Sapien valve is well suited for VinV implantation, and this technique may become a routine procedure to treat degenerated xenografts in the future.
对于合并症的老年患者，退行性异种主动脉瓣再次手术的风险可能会增加。我们评估了经心尖主动脉瓣植入术的非体外循环跳动心脏概念，使用了瓣中瓣（VinV）概念。
自 2007 年 3 月以来，11 例退行性异种移植物患者接受了经心尖主动脉瓣植入术，使用 Edwards Sapien 经导管心脏瓣膜（爱德华生命科学公司，加利福尼亚州欧文）。在获得知情同意后，所有程序均作为标签外使用进行。患者平均年龄为 78 +/- 6 岁（范围，72 至 89），平均逻辑欧洲心脏手术风险评估系统为 32% +/- 16%（范围，16%至 62%），平均胸外科医师协会评分为 7% +/- 3%（范围，3%至 10%）。
所有患者均非体外循环下进行治疗。所有患者均成功进行了经心尖主动脉瓣植入术，并且所有患者的心尖入路均无并发症。总手术室时间为 71 +/- 14 分钟。术后超声心动图检查显示，11 例患者中无瓣周漏，2 例患者轻度（一级）中心瓣关闭不全。所有患者均观察到 Sapien 假体的流入和流出部分充分张开，表明其位置稳定，几乎不存在晚期栓塞的风险。最大跨瓣压力梯度为 21 +/- 8mmHg，平均超声心动图压力梯度为 11 +/- 4mmHg。随访时间延长至 330 +/- 293 天（范围，15 至 1007），所有患者均状况良好且存活。
对于高危老年患者再次治疗失败的异种主动脉瓣，瓣中瓣植入术是一种真正微创的方法。Edwards Sapien 瓣膜非常适合 VinV 植入，该技术将来可能成为治疗退行性异种移植物的常规方法。
