Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
Department of Clinical and Molecular Medicine, School of Medicine and Psychology, University of Rome "Sapienza", Rome, Italy.
Catheter Cardiovasc Interv. 2021 Jul 1;98(1):E145-E152. doi: 10.1002/ccd.29353. Epub 2020 Nov 6.
This study sought to investigate the procedural and mid-term outcomes of transcatheter aortic valve implantation for failed surgical bioprostheses (TAVI-ViV) with Portico device.
Limited evidence coming from early experience on Portico system does not allow to fully assess safety and efficacy of this device in this ViV patients.
From January 2016 up to June 2019, 56 consecutive patients undergoing TAVI-ViV with Portico were prospectively included in our institutional TAVI database.
The prevalent mechanism of failure was stenosis (58.9%); true internal diameter (ID) was <21 mm in 71.4% of cases. Device success rate were 69.6% with 14 (25%) patients showing a residual gradient ≥20 mmHg, 2 (3.6%) a PVL ≥ moderate and 1 (1.8%) required a second THV implantation due to device embolization. At 1-year follow-up 5 patients (8.9%) died whereas moderate SVD was reported in 2 (3.6%). Patients with a post-procedural mean gradient ≥20 mmHg showed a significantly higher rate of CV hospitalization (21.4% vs. 2.4%, p = .02) whereas no differences in procedural and 1-year outcomes were noticed according to true ID diameter or degeneration mode. Chimney stenting (ChT) was performed in 23 (41%) patients without significant differences in procedural and 1-year outcomes compared to non-ChT group.
TAVI-ViV with Portico valve was associated with good procedural and 1-year outcomes, even in patients with features of high procedural and anatomical complexity.
本研究旨在探讨使用 Portico 瓣膜行经导管主动脉瓣置换术（TAVI-ViV）治疗外科生物瓣衰败（TAVI-ViV）的手术操作过程和中期结果。
Portico 系统早期经验提供的有限证据尚不能全面评估该器械在 ViV 患者中的安全性和疗效。
自 2016 年 1 月至 2019 年 6 月，56 例连续患者前瞻性地被纳入我们的 TAVI 数据库，行 TAVI-ViV 并使用 Portico 瓣膜。
瓣膜衰败的主要原因为狭窄（58.9%）；71.4%的病例瓣环真内径（ID）<21mm。器械成功率为 69.6%，14 例（25%）患者残余跨瓣压差≥20mmHg，2 例（3.6%）患者中度以上瓣周漏，1 例（1.8%）因器械栓塞需再次行 THV 植入。1 年随访时，5 例（8.9%）患者死亡，2 例（3.6%）患者发生中度以上 SVD。术后平均跨瓣压差≥20mmHg 的患者因心血管住院的风险显著增加（21.4% vs. 2.4%，p=0.02），但根据真 ID 直径或瓣膜衰败模式，手术操作过程和 1 年结果并无差异。23 例（41%）患者进行了烟囱支架（ChT），与非 ChT 组相比，手术操作过程和 1 年结果无显著差异。
Portico 瓣膜 TAVI-ViV 具有良好的手术操作过程和 1 年结果，即使在手术操作过程和解剖结构复杂的患者中也是如此。
