Department of Cardiothoracic Surgery, Princess Alexandra Hospital, Ipswich Road, Brisbane, Australia.
University of Queensland, Brisbane, Australia.
Catheter Cardiovasc Interv. 2021 Sep;98(3):E471-E474. doi: 10.1002/ccd.29465. Epub 2021 Feb 6.
Patients with a true porcelain aorta and a failed mechanical aortic valve prosthesis have limited treatment options. Using a hybrid of an open trans-ventricular approach with peripheral cardiopulmonary bypass and integration of transcatheter techniques this challenge can be overcome. Trans-ventricular mechanical valve extraction (with transcatheter endovascular occlusion and cardioplegia) followed by direct ante-grade transcatheter heart valve implantation offers a potential solution to this conundrum. The procedure described is a novel technique that allows for the effective treatment of patients with failed mechanical surgical aortic valve prostheses in the setting of an inoperable porcelain aorta. In addition, a collaborative integrated multi-disciplinary heart team environment is required for the management of these complex patients.
对于真性主动脉壁瓷化和机械主动脉瓣假体失效的患者，治疗选择有限。采用开放经心室途径与外周心肺旁路相结合，并整合经导管技术，可以克服这一挑战。经心室机械瓣取出（经导管血管内闭塞和心脏停搏液），随后直接顺行经导管心脏瓣膜植入，为这一难题提供了潜在的解决方案。所描述的手术是一种新的技术，可以有效地治疗在无法手术的真性主动脉壁瓷化情况下机械性外科主动脉瓣假体失效的患者。此外，还需要一个协作的综合多学科心脏团队环境来管理这些复杂的患者。
