Chmielak Zbigniew, Dąbrowski Maciej, Tyczyński Paweł, Kukuła Krzysztof, Michałowska Ilona, Szudejko Emilia, Skowroński Jarosław, Kuśmierczyk Mariusz, Witkowski Adam
Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
Postepy Kardiol Interwencyjnej. 2020 Jun;16(2):177-183. doi: 10.5114/aic.2020.96061. Epub 2020 Jun 23.
Severe aortic stenosis (AS) is an ever-growing healthcare problem in ageing populations. Transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of AS. However, TAVI in patients who have undergone mitral valve replacement (MVR) is associated with increased risk of mitral valve damage. Limited data exist on TAVI in patients with AS who underwent MVR in the past.
To retrospectively assess the clinical characteristics, detailed echocardiographic and computed tomography measurements, procedural and in-hospital outcome as well as any valve intervention or major adverse cardiovascular events according to VARC-2 criteria at follow-up of patients with a history of MVR, who underwent TAVI.
Seventeen patients with a history of mitral valve operation, in whom TAVI was performed between 2010 and 2018, were identified. Of these, 15 underwent previous MVR.
Overall, TAVI resulted in a decrease of mean transaortic gradient by 38.3 ±14 mm Hg ( < 0.001) and a decrease of maximal transaortic gradient by 58.6 ±27.6 mm Hg ( < 0.001). A successful immediate result was obtained in 14 (93.3%) patients. One tamponade occurred during TAVI, which was successfully treated with pericardiocentesis. Post-procedurally, no significant changes in transmitral gradients or mitral regurgitations were observed. Two patients died after hospital discharge, one due to possible internal bleeding and the other due to infection.
TAVI in patients after MVR is feasible. Meticulous preinterventional echocardiographic and computed tomography planning is essential. Although recommended in previous reports, TEE guidance may not necessarily be obligatory during the procedure.
在老龄化人群中，重度主动脉瓣狭窄（AS）是一个日益严重的医疗问题。经导管主动脉瓣植入术（TAVI）彻底改变了AS的治疗方式。然而，在接受过二尖瓣置换术（MVR）的患者中进行TAVI与二尖瓣损伤风险增加相关。既往接受过MVR的AS患者接受TAVI的数据有限。
回顾性评估有MVR病史且接受TAVI患者的临床特征、详细的超声心动图和计算机断层扫描测量结果、手术及住院结局，以及根据VARC-2标准在随访时的任何瓣膜干预或主要不良心血管事件。
确定了17例有二尖瓣手术史且在2010年至2018年间接受TAVI的患者。其中，15例曾接受MVR。
总体而言，TAVI使平均跨主动脉压差降低了38.3±14 mmHg（<0.001），最大跨主动脉压差降低了58.6±27.6 mmHg（<0.001）。14例（93.3%）患者获得了成功的即刻结果。TAVI期间发生1例心包填塞，经心包穿刺成功治疗。术后，未观察到二尖瓣压差或二尖瓣反流有显著变化。2例患者出院后死亡，1例可能因内出血，另1例因感染。
MVR术后患者进行TAVI是可行的。细致的介入前超声心动图和计算机断层扫描规划至关重要。尽管既往报告中推荐，但术中不一定必须采用经食管超声心动图（TEE）引导。
