Kakizaki Ryota, Meguro Kentaro, Kitamura Tadashi, Hashimoto Takuya, Ako Junya
Department of Cardiovascular Medicine, Kitasato University School of Medicine.
Department of Cardiovascular Surgery, Kitasato University School of Medicine.
Int Heart J. 2019 Jul 27;60(4):990-993. doi: 10.1536/ihj.18-591. Epub 2019 Jun 14.
A 92-year-old man with acute heart failure due to severe aortic stenosis underwent transcatheter aortic valve implantation (TAVI). Computed tomography demonstrated severe stenosis of the right common iliac artery, occlusion of the left external iliac artery, and stenosis of the left subclavian artery. Severe calcification was observed in the sinotubular junction, which was considered a risk factor for aortic dissection with transapical TAVI using a balloon-expanding bioprosthetic valve. Therefore, transaortic (TAo) access was the only option for this high-risk surgical patient. As the maximum distance from the aortic valve annulus to the sheath insertion point was less than 60 mm, TAVI was performed transaortically using a vascular graft that extended this distance, in order to avoid sheath dislocation. Our experience demonstrates that vascular graft application is a viable option in patients with an inadequate distance between the aortic valve annulus and the puncture site in TAo-TAVI.
一名因严重主动脉瓣狭窄导致急性心力衰竭的92岁男性接受了经导管主动脉瓣植入术（TAVI）。计算机断层扫描显示右髂总动脉严重狭窄、左髂外动脉闭塞以及左锁骨下动脉狭窄。在窦管交界处观察到严重钙化，这被认为是使用球囊扩张生物人工瓣膜经心尖TAVI发生主动脉夹层的危险因素。因此，对于这位高风险手术患者，经主动脉（TAo）入路是唯一选择。由于从主动脉瓣环到鞘管插入点的最大距离小于60毫米，为避免鞘管移位，使用延长该距离的血管移植物经主动脉进行了TAVI。我们的经验表明，在TAo-TAVI中，当主动脉瓣环与穿刺部位之间距离不足时，应用血管移植物是一种可行的选择。
