Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Catheter Cardiovasc Interv. 2013 Oct 1;82(4):E630-6. doi: 10.1002/ccd.25037. Epub 2013 Jul 1.
Transcatheter aortic valve-in-valve (VIV) implantation in high-risk patients with degenerative surgical bioprosthetic aortic valves is a novel application of transcatheter aortic valve replacement technology. Although transcatheter aortic VIV procedure is clinically effective in most patients, it is a more demanding procedure in terms of the technical aspects of procedural planning. VIV carries a higher risk of coronary occlusion which is associated with a higher rate of in-hospital mortality. We hereby report a technique of pre-emptive left main (LM) protection, by positioning a coronary stent in the proximal left anterior descending artery prior to VIV implantation. The patient treated was considered to be at an increased risk of LM occlusion as a result of the procedure. The technique was performed in anticipation of emergent bailout stenting of the LM. As predicted, the LM occluded during the procedure and LM protection facilitated the safe and effective treatment of an otherwise life-threatening procedure.
经导管主动脉瓣中瓣（VIV）植入术在退行性外科生物瓣主动脉瓣高危患者中是经导管主动脉瓣置换术的一种新应用。虽然在大多数患者中，经导管主动脉瓣 VIV 手术在临床上是有效的，但就手术规划的技术方面而言，该手术的要求更高。VIV 导致冠状动脉闭塞的风险更高，与更高的住院死亡率相关。我们在此报告一种预防性左主干（LM）保护技术，即在 VIV 植入术之前将冠状动脉支架置于左前降支近端。该患者由于手术而被认为存在 LM 闭塞的风险增加。该技术是为了紧急救援 LM 支架置入术而进行的。正如所预测的那样，LM 在手术过程中闭塞，而 LM 保护则有助于安全有效地治疗危及生命的手术。
