Bjursten Henrik, Götberg Matthias, Harnek Jan, Nozohoor Shahab
Department of Cardiothoracic Surgery, Lund University, Lund, Sweden.
J Heart Valve Dis. 2013 May;22(3):433-5.
Increased life expectancy and improvement in clinical outcome following surgery has led to an increasing number of elderly patients with a history of prior aortic valve replacement (AVR). As a consequence, a considerable number of patients may require reintervention due to a dysfunctional bioprosthesis with structural valve deterioration (SVD). Transcatheter aortic valve implantation (TAVI) has become an established surgical alternative in patients with aortic stenosis and severe comorbidities. For those patients requiring reoperation, the 'valve-in-valve' concept has been described. Here, the case is reported of a patient with a very small Sorin Soprano 18 bioprosthesis with SVD who underwent a reintervention with the transapical valve-in-valve technique. The implantation was uneventful, with no residual paravalvular leakage and a low mean transprosthetic gradient. The valve-in-valve procedure may represent a feasible alternative for redo AVR in patients with a very small, structurally deteriorated bioprosthesis.
预期寿命的延长以及手术后临床结果的改善，导致既往有主动脉瓣置换术（AVR）史的老年患者数量不断增加。因此，相当一部分患者可能因生物假体功能障碍伴结构性瓣膜退变（SVD）而需要再次干预。经导管主动脉瓣植入术（TAVI）已成为主动脉瓣狭窄和严重合并症患者既定的手术替代方案。对于那些需要再次手术的患者，“瓣中瓣”概念已被描述。在此，报告一例使用经心尖瓣中瓣技术进行再次干预的患者，该患者植入的是非常小的索林·索普拉诺18生物假体且伴有SVD。植入过程顺利，无残余瓣周漏，平均跨瓣压差低。瓣中瓣手术可能是生物假体非常小且结构退变的患者再次行AVR的可行替代方案。
