Heart & Vascular Institute, Cleveland Clinic.
Catheter Cardiovasc Interv. 2018 Sep 1;92(3):550-554. doi: 10.1002/ccd.27415. Epub 2017 Dec 11.
To demonstrate the feasibility of achieving good hemodynamic results with valve-in-valve transcatheter aortic valve replacement (ViV TAVR) for degenerated 19 mm surgical bioprosthetic valves.
Considerable controversy exists regarding ViV TAVR within 19mm surgical prostheses due to concerns of elevated valve gradients and mortality.
Among all patient undergoing ViV TAVR between 7/2016 and 4/2017 for symptomatic severe bioprosthetic aortic stenosis (AS), five had a 19 mm surgical valve in place and were included in this publication. None of the patients had patient-prosthesis mismatch. Aggressive post-dilation was performed in four out of five cases using a special technique we describe below.
In all cases, mean aortic valve (AV) gradients significantly improved post-ViV TAVR, particularly after post-dilation. Interestingly, high pressure post-dilation of the ViV resulted in an increase in the diameter of surgical valve stent frame dimensions in nearly all patients who underwent post-dilation.
Good hemodynamic outcome is possible with aggressive post-dilation in patients with 19 mm failed surgical bioprostheses. High-risk patients with 19 mm failed surgical prostheses who do not otherwise have viable surgical options should be considered for ViV TAVR.
证明经导管主动脉瓣置换术（ViV TAVR）治疗退行性 19mm 外科生物瓣的可行性，以获得良好的血流动力学结果。
由于担心瓣上梯度升高和死亡率，对于 19mm 外科假体中的 ViV TAVR 存在相当大的争议。
在 2016 年 7 月至 2017 年 4 月期间因症状性严重生物瓣主动脉瓣狭窄（AS）而行 ViV TAVR 的所有患者中，有 5 例患者植入了 19mm 外科瓣膜，本研究纳入了这 5 例患者。所有患者均无患者-假体不匹配。在 5 例患者中的 4 例中采用了我们下面描述的特殊技术进行了积极的后扩张。
在所有患者中，主动脉瓣（AV）平均梯度在 ViV TAVR 后明显改善，尤其是在后扩张后。有趣的是，ViV 的高压后扩张导致几乎所有接受后扩张的患者的外科瓣支架框架尺寸增加。
对于 19mm 失败的外科生物瓣患者，积极的后扩张可获得良好的血流动力学结果。对于没有其他可行手术选择的 19mm 失败外科假体的高危患者，应考虑行 ViV TAVR。
