Allen Keith B, Chhatriwalla Adnan K, Saxon John T, Huded Chetan P, Sathananthan Janarthanan, Nguyen Tom C, Whisenant Brian, Webb John G
Saint Luke's Mid America Heart Institute and University of Missouri-Kansas, City School of Medicine, Kansas City, Missouri, USA.
Centre for Cardiovascular Innovation and Centre for Heart Valve Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, Canada.
Ann Cardiothorac Surg. 2021 Sep;10(5):564-570. doi: 10.21037/acs-2021-tviv-25.
Valve-in-valve transcatheter aortic valve replacement (VIV TAVR) is currently indicated for the treatment of failed surgical tissue valves in patients determined to be at high surgical risk for re-operative surgical valve replacement. VIV TAVR, however, often results in suboptimal expansion of the transcatheter heart valve (THV) and can result in patient-prosthesis mismatch (PPM), particularly in small surgical valves. Bioprosthetic valve fracture (BVF) and bioprosthetic valve remodeling (BVR) can facilitate VIV TAVR by optimally expanding the THV and reducing the residual transvalvular gradient by utilizing a high-pressure inflation with a non-compliant balloon to either fracture or stretch the surgical valve ring, respectively. This article, along with the supplemental video, will provide patient selection, procedural planning and technical insights for performing BVF and BVR.
瓣中瓣经导管主动脉瓣置换术（VIV TAVR）目前适用于治疗那些被判定再次进行手术瓣膜置换手术风险较高的患者中手术植入的组织瓣膜功能失效的情况。然而，VIV TAVR常常导致经导管心脏瓣膜（THV）扩张不理想，并可能导致患者-人工瓣膜不匹配（PPM），尤其是在小型手术瓣膜的情况下。生物瓣膜骨折（BVF）和生物瓣膜重塑（BVR）可以通过分别使用非顺应性球囊进行高压充气来使手术瓣膜环骨折或伸展，从而最佳地扩张THV并降低残余跨瓣压差，进而促进VIV TAVR。本文以及补充视频将提供有关进行BVF和BVR的患者选择、手术规划和技术见解。
