Department of Cardiovascular Medicine, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106 USA.
J Invasive Cardiol. 2020 May;32(5):186-193. doi: 10.25270/jic/19.00331. Epub 2020 Mar 11.
We share our center's experience with the use of transcatheter valvular therapies in the setting of failed bioprostheses.
As medicine continues to advance, the lifespan of individuals continues to increase, and current surgical valvular therapies begin to degrade prior to a person's end of life. It is important to evaluate the efficacy and durability of transcatheter valves within failed surgical bioprostheses.
Baseline characteristics, periprocedural complications, and long-term outcomes were collected and assessed in patients who received transcatheter valves for failing surgical aortic valve bioprostheses and mitral valve and ring bioprostheses from March 2011 to July 2018.
From our cohort of 1048 patients, we identified 45 individuals (4.3%) who underwent transcatheter replacement of a failed bioprosthetic valve or ring. Mean age at presentation was 80.8 ± 10.7 years and 75.5 ± 9.3 years, mean STS score was 9.3 ± 5.1 and 13.3 ± 8.7, and mean time to failure was 12.0 ± 5.2 years and 7.3 ± 4.5 years for aortic and mitral positions, respectively. At 1 year, time to event analysis suggested a 16.4% mortality rate for aortic replacement and 12.8% mortality rate for mitral replacement.
We demonstrate outcomes from one of the largest single-center United States based cohorts of transcatheter replacements of failed surgical bioprostheses. Our center has demonstrated that it is feasible to pursue the replacement of failed surgical bioprostheses in the aortic and mitral positions with transcatheter valves given appropriate patient selection.
我们分享中心在失败的生物瓣假体情况下使用经导管瓣膜治疗的经验。
随着医学的不断进步，人们的寿命不断延长，而目前的瓣膜手术治疗在患者生命结束之前开始恶化。评估经导管瓣膜在失败的外科生物瓣假体中的疗效和耐久性非常重要。
从 2011 年 3 月至 2018 年 7 月，我们收集并评估了因外科主动脉瓣生物瓣和二尖瓣及瓣环生物瓣失败而接受经导管瓣膜治疗的患者的基线特征、围手术期并发症和长期结果。
在我们的 1048 例患者队列中，我们确定了 45 名（4.3%）接受失败的生物瓣假体或瓣环经导管置换的患者。就诊时的平均年龄为 80.8 ± 10.7 岁和 75.5 ± 9.3 岁，平均 STS 评分分别为 9.3 ± 5.1 和 13.3 ± 8.7，平均失败时间分别为 12.0 ± 5.2 年和 7.3 ± 4.5 年，用于主动脉瓣和二尖瓣位置。在 1 年时，时间事件分析表明主动脉瓣置换的死亡率为 16.4%，二尖瓣置换的死亡率为 12.8%。
我们展示了美国一个最大的单中心基于经导管置换失败的外科生物瓣假体队列之一的结果。我们中心已经证明，在适当的患者选择下，在主动脉瓣和二尖瓣位置使用经导管瓣膜置换失败的外科生物瓣假体是可行的。
