Division of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland.
Division of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada.
JACC Cardiovasc Interv. 2012 May;5(5):582-590. doi: 10.1016/j.jcin.2012.03.012.
This study sought to report on the pathology of transcatheter aortic valves explanted at early and late time points after transcatheter aortic valve implantation.
Information on pathological findings following transcatheter aortic valve implantation is scarce, particularly late after transcatheter aortic valve implantation.
This study included 20 patients (13 men, median age 80 years [interquartile range: 72 to 84] years) with previous transcatheter aortic valve implantation with a valve explanted at autopsy (n = 17) or surgery (n = 3) up to 30 months after implantation (10 transapical and 10 transfemoral procedures).
Structural valve degeneration was not seen, although fibrous tissue ingrowth was observed at later time points with minimal effects on cusp mobility in 1 case. Minor alterations in valve configuration or placement were observed in up to 50% of cases, but they were not accompanied by substantial changes in valve function or reliably associated with chest compressions. Vascular or myocardial injury was common, especially within 30 days of transcatheter aortic valve implantation (about 69%), with the latter associated with left coronary ostial occlusion by calcified native aortic valve tissue in 2 cases. Mild to severe myocardial amyloidosis was present in nearly 33% of cases and likely played a role in the poor outcome of 3 patients. Endocarditis, migration of the valve, and embolization during the procedure led to surgical valve removal.
Structural degeneration was not seen and minor alterations of valve configuration or placement did not affect valve function and were not reliably caused by chest compressions. Vascular or myocardial injury is very common early after transcatheter aortic valve implantation and myocardial amyloidosis represents a relatively frequent potentially significant comorbid condition.
本研究旨在报告经导管主动脉瓣置换术后早期和晚期经导管主动脉瓣置换术的病理学表现。
经导管主动脉瓣置换术后的病理学发现信息有限，尤其是在经导管主动脉瓣置换术后晚期。
本研究纳入了 20 名患者（13 名男性，中位年龄 80 岁[四分位间距：72 至 84 岁]岁），这些患者先前接受过经导管主动脉瓣置换术，在植入后 30 个月内通过尸检（n = 17）或手术（n = 3）取出了瓣膜：10 例经心尖途径，10 例经股动脉途径。
未观察到结构性瓣膜退化，但在后期观察到纤维组织向内生长，1 例可见轻微影响瓣叶活动。在多达 50%的病例中观察到瓣膜结构或位置的轻微改变，但它们没有伴随着瓣膜功能的实质性改变，也不能可靠地与胸外按压相关。血管或心肌损伤很常见，尤其是在经导管主动脉瓣置换术后 30 天内（约 69%），其中 2 例由钙化的原生主动脉瓣组织导致左冠状动脉口闭塞与后者相关。近 33%的病例存在轻度至重度心肌淀粉样变性，这可能与 3 名患者的不良预后有关。在手术过程中发生了心内膜炎、瓣膜迁移和栓塞。
未观察到结构性退化，瓣膜结构或位置的轻微改变不会影响瓣膜功能，也不能可靠地归因于胸外按压。血管或心肌损伤在经导管主动脉瓣置换术后早期非常常见，心肌淀粉样变性是一种相对常见的潜在严重合并症。
