Department of Cardiovascular Surgery, German Heart Center, Munich, Germany.
JACC Cardiovasc Interv. 2011 Jul;4(7):733-42. doi: 10.1016/j.jcin.2011.05.007.
This study sought to review the acute procedural outcomes of patients who underwent transcatheter aortic valve (TAV)-in-surgical aortic valve (SAV) implantation at the German Heart Center, Munich, and to summarize the existing literature on TAV-in-SAV implantation (n = 47).
There are several case reports and small case series describing transcatheter aortic valve implantation for a failing surgical aortic valve bioprosthesis (TAV-in-SAV implantation).
From January 2007 to March 2011, 20 out of 556 patients underwent a TAV-in-SAV implantation at the German Heart Center Munich. Baseline characteristics and clinical outcome data were prospectively entered into a dedicated database.
The mean patient age was 75 ± 13 years, and the mean logistic European System for Cardiac Operative Risk Evaluation and Society of Thoracic Surgeons' Risk Model scores were 27 ± 13% and 7 ± 4%, respectively. Of the 20 patients, 14 had stented and 6 had stentless surgical bioprostheses. Most cases (12 of 20) were performed via the transapical route using a 23-mm Edwards Sapien prosthesis (Edwards Lifesciences, Irvine, California). Successful implantation of a TAV in a SAV with the patient leaving the catheterization laboratory alive was achieved in 18 of 20 patients. The mean transaortic valve gradient was 20.0 ± 7.5 mm Hg. None-to-trivial, mild, and mild-to-moderate paravalvular aortic regurgitation was observed in 10, 6, and 2 patients, respectively. We experienced 1 intraprocedural death following pre-implant balloon aortic valvuloplasty ("stone heart") and 2 further in-hospital deaths due to myocardial infarction.
TAV-in-SAV implantation is a safe and feasible treatment for high-risk patients with failing aortic bioprosthetic valves and should be considered as part of the armamentarium in the treatment of aortic bioprosthetic valve failure.
本研究旨在回顾德国慕尼黑心脏中心接受经导管主动脉瓣（TAV）-外科主动脉瓣（SAV）植入术患者的急性手术结果，并总结现有关于 TAV- SAV 植入术（n=47）的文献。
有几例病例报告和小病例系列描述了经导管主动脉瓣置换术治疗失败的外科主动脉瓣生物瓣（TAV-SAV 植入术）。
2007 年 1 月至 2011 年 3 月，德国慕尼黑心脏中心有 20 例患者接受了 TAV-SAV 植入术。基线特征和临床结局数据被前瞻性地输入到一个专门的数据库中。
患者平均年龄为 75±13 岁，Logistic 欧洲心脏手术风险评估系统和胸外科医生风险模型的平均评分分别为 27±13%和 7±4%。20 例患者中，14 例为带支架的，6 例为无支架的外科生物瓣。大多数病例（20 例中的 12 例）采用经心尖途径，使用 23 毫米爱德华兹 Sapien 假体（爱德华兹生命科学公司，加利福尼亚州欧文）。20 例患者中有 18 例成功地将 TAV 植入 SAV，患者在离开导管室时存活。平均跨主动脉瓣梯度为 20.0±7.5mmHg。10 例、6 例和 2 例患者分别出现无至轻度、轻度至中度瓣周主动脉反流。我们在进行预植入球囊主动脉瓣成形术时（“石心”）出现 1 例术中死亡，并因心肌梗死出现另外 2 例院内死亡。
TAV-SAV 植入术是治疗高危主动脉生物瓣功能障碍患者的一种安全可行的治疗方法，应作为主动脉生物瓣功能障碍治疗手段的一部分。
