Ranney David N, Williams Judson B, Wang Andrew, Gaca Jeffrey G
Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
J Card Surg. 2016 May;31(5):282-8. doi: 10.1111/jocs.12745. Epub 2016 Apr 5.
Transcatheter valve-in-valve (VIV) procedures are an alternative to standard surgical valve replacement in high risk patients.
Cases in which a commercially approved transcatheter aortic valve replacement (TAVR) device was used for a nonaortic VIV procedure between November 2013 and September 2015 are reviewed. Clinical, echocardiographic, and procedural details, patient survival, and symptom severity by NYHA class at follow-up were assessed.
All patients were heart-team determined high risk for conventional redo surgery (mean STS PROM = 6.8 ± 2.2%). Five patients underwent VIV replacement in the nonaortic position, four for bioprosthetic mitral valve dysfunction, and one for bioprosthetic tricuspid valve dysfunction. Bioprosthetic failure was due to stenosis in three patients and regurgitation in two others. A balloon-expandable device was used for all patients (Edwards Lifesciences, Irvine, CA, USA). Transcatheter VIV replacement was accomplished by the transapical (mitral) and transfemoral venous (tricuspid) approaches. Median postoperative length of stay was five days (range 3-12). No deaths occurred at a mean follow-up of 21 months. NYHA class at follow-up decreased from class IV at baseline to class I or II for all patients. No paravalvular leaks greater than trivial were encountered. Median mean gradient following mitral replacement was 6.5 mmHg (range 6-13 mmHg), and following tricuspid replacement was 4 mmHg. Postoperative complications included hematuria, epistaxis, acute kidney injury, and atrial fibrillation.
Transcatheter VIV implantation in the nonaortic position for dysfunctional bioprostheses can be performed safely with favorable clinical outcomes using a balloon expandable TAVR device. doi: 10.1111/jocs.12745 (J Card Surg 2016;31:282-288).
经导管瓣中瓣（VIV）手术是高危患者标准外科瓣膜置换术的替代方案。
回顾2013年11月至2015年9月间使用商业批准的经导管主动脉瓣置换术（TAVR）装置进行非主动脉VIV手术的病例。评估临床、超声心动图和手术细节、患者生存率以及随访时纽约心脏协会（NYHA）分级的症状严重程度。
所有患者经心脏团队评估均为传统再次手术的高危患者（平均胸外科医师协会预计风险[STS PROM] = 6.8 ± 2.2%）。5例患者在非主动脉位置接受VIV置换，4例因生物瓣二尖瓣功能障碍，1例因生物瓣三尖瓣功能障碍。生物瓣功能障碍3例因狭窄，2例因反流。所有患者均使用球囊扩张装置（美国加利福尼亚州尔湾市爱德华兹生命科学公司）。经导管VIV置换通过经心尖（二尖瓣）和经股静脉（三尖瓣）途径完成。术后中位住院时间为5天（范围3 - 12天）。平均随访21个月无死亡病例。所有患者随访时NYHA分级从基线时的IV级降至I级或II级。未发现大于轻微程度的瓣周漏。二尖瓣置换术后平均跨瓣压差中位数为6.5 mmHg（范围6 - 13 mmHg），三尖瓣置换术后为4 mmHg。术后并发症包括血尿、鼻出血、急性肾损伤和心房颤动。
使用球囊扩张型TAVR装置，在非主动脉位置对功能失调的生物瓣进行经导管VIV植入术可安全进行，并取得良好的临床效果。doi: 10.1111/jocs.12745（《心脏外科杂志》2016年；31:282 - 288）
