Deutsches Herzzentrum Berlin, Berlin, Germany.
J Thorac Cardiovasc Surg. 2011 Aug;142(2):270-7. doi: 10.1016/j.jtcvs.2010.09.049. Epub 2010 Nov 18.
The "valve-in-valve" concept may be applied in patients with previously implanted biological aortic valve prostheses. There are few reports of individual cases and as yet no clinical proof of safety and feasibility in a larger group of patients. We report the single-center outcome of transapical implantation of aortic valves into degenerated biological aortic valve prostheses ("valve-in-valve") in very high-risk patients.
Since October 2008, 14 patients were treated by transapical valve implantation into degenerated biological aortic valve prostheses. Edwards SAPIEN (Edwards Lifesciences, Irvine, Calif) transcatheter heart valves were used in all patients. Mean (± standard deviation) patient age was 73.3 ± 13.1 years. Mean (± standard deviation) Society of Thoracic Surgeons score was 21.9% ± 10.9% (range, 4.2%-42.2%), and logistic euroSCORE was 45.3% ± 22.2%. Preoperatively, all patients were in New York Heart Association functional class III or IV.
The procedural success was 100%. Preoperative transthoracic echocardiography mean transvalvular gradient was reduced from 37.1 ± 25.7 mm Hg to 13.1 ± 6.4 mm Hg, and mean aortic valve area increased from 0.68 ± 0.23 cm(2) to 1.35 ± 0.48 cm(2). There was no postoperative valve insufficiency. The postoperative course was short and uneventful in all but 1 patient. One patient underwent reoperation 3 months later because of endocarditis. Up to 20 months postoperatively, the patients were in New York Heart Association functional class I or II.
Transapical aortic valve implantation after previous aortic valve replacement was feasible and safe in our patients. The results are excellent with improvements in hemodynamics, but longer follow-up with more patients is needed.
“瓣中瓣”技术可应用于先前植入生物瓣的患者。目前仅有少数个案报道，尚无临床证据表明该技术在更大患者群体中的安全性和可行性。我们报告了在极高危患者中行经心尖途径植入生物瓣中瓣治疗退行性病变生物瓣的单中心结果。
自 2008 年 10 月以来，14 例患者接受了经心尖途径植入退行性病变生物瓣的治疗。所有患者均使用 Edwards SAPIEN（爱德华生命科学公司，加利福尼亚州欧文市）经导管心脏瓣膜。患者平均（±标准差）年龄为 73.3±13.1 岁。平均（±标准差）胸外科医师协会评分（STS）为 21.9%±10.9%（范围 4.2%-42.2%），逻辑 EuroSCORE 为 45.3%±22.2%。术前，所有患者均为纽约心脏协会（NYHA）心功能 III 级或 IV 级。
手术成功率为 100%。术前经胸超声心动图显示跨瓣压差从 37.1±25.7mmHg 降低至 13.1±6.4mmHg，主动脉瓣面积从 0.68±0.23cm2 增加至 1.35±0.48cm2。术后无瓣膜关闭不全。除 1 例患者外，其余患者术后恢复顺利，无并发症。1 例患者因感染性心内膜炎在术后 3 个月再次手术。术后 20 个月，患者 NYHA 心功能分级均为 I 级或 II 级。
在我们的患者中，先前行主动脉瓣置换术后行经心尖主动脉瓣植入是可行且安全的。该技术的结果非常理想，可改善血液动力学，但需要更长时间的随访和更多患者的研究。
