Gallo Michele, Dvir Danny, Demertzis Stefanos, Pedrazzini Giovanni, Berdajs Denis, Ferrari Enrico
a Cardiac Surgery Unit , Cardiocentro Ticino Foundation , Lugano , Switzerland.
b Cardiology Unit , St Paul's Hospital , Vancouver , Canada.
Expert Rev Med Devices. 2016 Aug;13(8):749-58. doi: 10.1080/17434440.2016.1207521. Epub 2016 Jul 8.
Redo surgery still is the treatment of choice for degenerated bioprosthesis. However, as far as elderly patients with concomitant comorbidities are concerned, the standard reoperation carries additional operative risks and, therefore, minimally invasive procedures must be prioritized.
During the last ten years, transcatheter procedures in native valves have become a standard technique in several centers with excellent procedural and mid-term results. Similarly, implantation of transcatheter stent-valves within degenerated aortic and mitral bioprosthesis, the 'valve-in-valve' procedure (V-in-V), represents a valid alternative to redo surgery in patients with high-risk surgical profiles. New challenges for V-in-V are the transcatheter stent-valve deployment in hostile targets (stented bioprosthesis with externally mounted leaflets, stentless valves, small bioprostheses), and avoid complications as delayed atrial embolization of mitral implantation and V-in-V thrombosis. Moreover a continuous ameliorated design of the devices on the market and new transcatheter stent-valves are recently developed in order to improve the outcome and safety of V-in-V treatment. Expert commentary: We reviewed the clinical outcomes and the procedural details of published transcatheter aortic and mitral valve-in-valve series focusing, in particular, on data from the Valve-in-Valve International Data registry (VIVID), and we provide a practical guide for valve sizing and stent-valve positioning.
再次手术仍是退化生物瓣膜的首选治疗方法。然而，对于伴有合并症的老年患者而言，标准的再次手术会带来额外的手术风险，因此，必须优先考虑微创手术。
在过去十年中，经导管介入治疗天然瓣膜疾病在多个中心已成为一项标准技术，手术效果和中期结果都非常出色。同样，在退化的主动脉和二尖瓣生物瓣膜内植入经导管支架瓣膜，即“瓣中瓣”手术（V-in-V），对于手术风险高的患者来说，是再次手术的有效替代方案。V-in-V面临的新挑战包括在复杂目标（带有外部安装瓣叶的带支架生物瓣膜、无支架瓣膜、小型生物瓣膜）中部署经导管支架瓣膜，以及避免并发症，如二尖瓣植入术后延迟性心房栓塞和V-in-V血栓形成。此外，为了提高V-in-V治疗的效果和安全性，市场上不断改进设备设计，最近还研发了新型经导管支架瓣膜。专家评论：我们回顾了已发表的经导管主动脉和二尖瓣瓣中瓣系列的临床结果和手术细节，特别关注了瓣中瓣国际数据注册中心（VIVID）的数据，并提供了瓣膜尺寸选择和支架瓣膜定位的实用指南。
