Koifman Edward, Patel Nirav, Weissman Gaby, Kiramijyan Sarkis, Didier Romain, Torguson Rebecca, Kumar Sandeep, Tavil-Shatelyan Arpi, Ben-Dor Itsik, Satler Lowell F, Pichard Augusto D, Waksman Ron
Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
Catheter Cardiovasc Interv. 2017 Oct 1;90(4):673-679. doi: 10.1002/ccd.26960. Epub 2017 Mar 15.
Residual aortic regurgitation (AR) following transcatheter aortic valve replacement (TAVR) is associated with adverse outcome. We sought to evaluate the efficacy and safety of second CoreValve (CV) implantation to treat residual AR following the initial CV deployment.
TAVR patients treated with a second CV due to moderate and above residual AR were compared to single device implantation. Valvular function parameters were compared at baseline, post procedure, and 30 days. Among 172 CV TAVR patients, 11 required a second device (6%) due to significant residual AR. The main differences between the groups were higher rates of low ejection fraction in patients with 2 CV implanted and higher annular diameter (27 [29-25] vs. 25 [26-24] mm, P = 0.03), requiring a larger device. Although two patients in the two CV group had high initial implantation, low implantation was similar between the groups. A second CV achieved adequate reduction in residual AR in six patients (55%), while an additional four patients had moderate residual AR. Only one remained with moderate to severe AR after 30 days follow-up. There were no cases of peri-procedural stroke or mortality.
Second implantation of self-expanding valve can successfully reduce residual significant AR following initial CV implantation and should be considered as therapeutic option for this population. © 2017 Wiley Periodicals, Inc.
经导管主动脉瓣置换术（TAVR）后残留主动脉瓣反流（AR）与不良预后相关。我们旨在评估二次植入CoreValve（CV）治疗初次植入CV后残留AR的疗效和安全性。
将因中度及以上残留AR而接受二次CV植入的TAVR患者与单次装置植入患者进行比较。在基线、术后和30天时比较瓣膜功能参数。在172例CV TAVR患者中，11例（6%）因显著残留AR需要二次装置。两组之间的主要差异在于，植入2个CV的患者中低射血分数发生率较高，且瓣环直径较大（27[29 - 25]mm对25[26 - 24]mm，P = 0.03），需要更大的装置。虽然两组中有2例患者初始植入高度较高，但两组间低植入情况相似。二次植入CV使6例患者（55%）的残留AR得到充分降低，另有4例患者有中度残留AR。30天随访后仅1例仍有中度至重度AR。围手术期无卒中或死亡病例。
自膨胀瓣膜的二次植入可成功降低初次植入CV后残留的显著AR，应被视为该人群的治疗选择。©2017威利期刊公司。
