Murashita Takashi, Joyce David L, Pochettino Alberto, Stulak John M, Joyce Lyle D
From the Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN USA.
Innovations (Phila). 2017 Mar/Apr;12(2):147-149. doi: 10.1097/IMI.0000000000000360.
Redo aortic valve replacement (AVR) performed simultaneously with left ventricular assist device (LVAD) implantation carries potential for increased mortality rates. Although transcatheter AVR has been used for patients with previous LVAD placement, no literature reports concomitant valve-in-valve transcatheter AVR and LVAD implantation. Our patient had severe aortic prosthetic valve deterioration and advanced heart failure. Given the risks associated with reoperative aortic valve surgery, we chose transcatheter AVR at the time of LVAD implantation. Transthoracic echocardiography results showed severe aortic prosthetic valve deterioration with moderate aortic regurgitation as well as severe left ventricular dysfunction (ejection fraction, 11%). After redosternotomy, we performed transcatheter AVR via the ascending aorta and subsequent LVAD implantation. The postoperative course was uneventful. Generally, patients with structural deterioration of a bioprosthetic valve who report for LVAD therapy present considerable challenges to the surgeon. Concomitant transcatheter AVR offers a less-invasive alternative to surgical AVR that minimizes ischemic injury to myocardium.
在植入左心室辅助装置（LVAD）的同时进行再次主动脉瓣置换术（AVR）可能会增加死亡率。尽管经导管主动脉瓣置换术已用于曾植入LVAD的患者，但尚无文献报道同期进行瓣中瓣经导管主动脉瓣置换术和LVAD植入。我们的患者存在严重的人工主动脉瓣退化和晚期心力衰竭。鉴于再次进行主动脉瓣手术相关的风险，我们在植入LVAD时选择了经导管主动脉瓣置换术。经胸超声心动图结果显示严重的人工主动脉瓣退化伴中度主动脉瓣反流以及严重的左心室功能障碍（射血分数为11%）。再次开胸后，我们经升主动脉进行了经导管主动脉瓣置换术，随后植入了LVAD。术后过程顺利。一般来说，因生物人工瓣膜结构退化而前来接受LVAD治疗的患者给外科医生带来了相当大的挑战。同期经导管主动脉瓣置换术为外科主动脉瓣置换术提供了一种侵入性较小的替代方法，可将对心肌的缺血性损伤降至最低。
