Chatfield Andrew G, Cheung Anson, Akodad Mariama, Chuang Anthony, Besola Laura, Sellers Stephanie, Wood David A, Sathananthan Janarthanan, Webb John
Centre for Heart Valve Innovation, Centre for Cardiovascular Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
Ann Cardiothorac Surg. 2021 Sep;10(5):571-584. doi: 10.21037/acs-2021-tviv-85.
As transcatheter aortic valve replacement (TAVR) expands into a younger and lower risk cohort of patients, many important clinical questions are raised, including the one of overall valve durability. Bioprosthetic valve dysfunction (BVD) is a complex clinical issue, of which structural valve deterioration (SVD) is a subcategory. Similar to surgical bioprosthesis, transcatheter heart valves (THVs) can fail over the years however, data on long-term THVs durability is lacking, especially in the lower risk cohort. Surgical explant with open aortic surgery or a second THV, described as redo-TAVR, are feasible options when the first THV fails. However long-term data in these patients is even more limited. Important clinical considerations such as the mechanism(s) of THV dysfunction, the type and timing of the second procedure must be carefully considered. There are also inherently important clinical concerns regarding redo-TAVR, such as coronary access and higher post procedure gradients. In the present keynote lecture, we review the diagnosis of THV dysfunction and transcatheter options available when SVD occurs.
随着经导管主动脉瓣置换术（TAVR）应用于更年轻、风险更低的患者群体，引发了许多重要的临床问题，包括瓣膜整体耐久性问题。生物瓣膜功能障碍（BVD）是一个复杂的临床问题，其中结构性瓣膜退变（SVD）是一个子类别。与外科生物瓣膜类似，经导管心脏瓣膜（THV）多年后可能会失效，然而，缺乏关于THV长期耐久性的数据，尤其是在低风险患者群体中。当第一个THV失效时，采用开放式主动脉手术取出或植入第二个THV（即再次TAVR）是可行的选择。然而，这些患者的长期数据更为有限。必须仔细考虑诸如THV功能障碍的机制、二次手术的类型和时机等重要临床因素。再次TAVR还存在一些本质上重要的临床问题，如冠状动脉通路和术后更高的压力阶差。在本次主题演讲中，我们将回顾THV功能障碍的诊断以及SVD发生时可用的经导管治疗选择。
