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经导管瓣中瓣植入术治疗退行性生物瓣主动脉瓣和二尖瓣 - 适应证、技术及临床结果的更新。

Transcatheter valve-in-valve implantation for degenerated bioprosthetic aortic and mitral valves - an update on indications, techniques, and clinical results.

机构信息

Cardiovascular Surgery, Cardiocentro Ticino Institute, Lugano, Switzerland.

Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco PROCAPE, University of Pernambuco-UPE, Recife, Brazil.

出版信息

Expert Rev Med Devices. 2021 Jul;18(7):597-608. doi: 10.1080/17434440.2021.1939009. Epub 2021 Jun 15.

Abstract

: Aortic and mitral bioprosthesis are the gold standard treatment to replace a pathological native valve. However, bioprostheses are prone to structural valve degeneration, resulting in limited long-term durability. During the past decade, the implantation of transcatheter stent-valves within degenerated aortic and mitral bioprostheses, (the so-called 'valve-in-valve' procedure), represents a valid alternative to redo surgery in patients with high-risk surgical profiles.: We reviewed the clinical outcomes and the procedural details of transcatheter aortic and mitral valve-in-valve series according to current published literature and include a practical guide for valve sizing and stent-valve positioning and strategies to prevent complications.: In both aortic and mitral positions meticulous planning is fundamental in these procedures to avoid serious complications including patient prosthesis mismatch, coronary obstruction and left ventricular outflow tract obstruction.

摘要

: 主动脉瓣和二尖瓣生物瓣是置换病理性原生瓣膜的金标准治疗方法。然而,生物瓣易发生结构性瓣膜退化,导致长期耐久性有限。在过去十年中,在退行性主动脉瓣和二尖瓣生物瓣内植入经导管支架瓣膜(所谓的“瓣中瓣”手术),对于高手术风险患者来说,是 redo 手术的一种有效替代方法。

: 我们根据当前已发表的文献综述了经导管主动脉瓣和二尖瓣瓣中瓣系列的临床结果和手术细节,并提供了瓣膜尺寸选择和支架瓣膜定位的实用指南以及预防并发症的策略。

: 在这两种情况下,在这些手术中,仔细的规划是至关重要的,以避免严重的并发症,包括患者-假体不匹配、冠状动脉阻塞和左心室流出道阻塞。

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