Schneeberger Yvonne, Seiffert Moritz, Schaefer Andreas, Bhadra Oliver D, Schofer Niklas, Pecha Simon, Westermann Dirk, Blankenberg Stefan, Reichenspurner Hermann, Conradi Lenard
Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.
Front Cardiovasc Med. 2022 Jan 25;8:743579. doi: 10.3389/fcvm.2021.743579. eCollection 2021.
Transcatheter aortic valve implantation (TAVI) is routinely performed in patients with severe aortic stenosis (AS). For patients with pure non-calcified aortic regurgitation (AR) who are not suitable for open heart surgery no clear recommendations exist and use of TAVI has been largely off-label. We herein report a series of patients treated with the self-expandable AcurateNeo and Neo2 (Boston Scientific Co., Marlborough, MS, USA) transcatheter heart valve (THV) for pure AR. Between 05/2017 and 03/2021, 9 patients (88.8% female, 74.4 ± 7.1 years, logEuroSCORE II 5.5 ± 3.6%, STS PROM 6.2 ± 3.0%) received transfemoral (TF) TAVI for pure non-calcified AR following an adjusted valve sizing algorithm. Data were retrospectively analyzed according to updated Valve Academic Research Consortium (VARC-2) definitions. Device success was 100%. Early safety was 77.7% (7/10), due to two (22.2%) cases of acute kidney injury. Thirty-day mortality was 0%, in seven (77.7%) patients no or trace paravalvular leakage (PVL) was seen and mild PVL in two (22.2%) patients at 30-day follow-up. No permanent pacemaker (PPM) was required during 30-day follow-up. In this series of selected patients using the Acurate neo THV for pure non-calcified AR, safety and efficacy were demonstrated. Thirty-day mortality as well as PPM implantation and PVL rates showed excellent results in this high-risk patient cohort. These results will have to be confirmed in larger patient cohorts.
经导管主动脉瓣植入术（TAVI）常用于严重主动脉瓣狭窄（AS）患者。对于不适合进行心脏直视手术的单纯非钙化性主动脉瓣反流（AR）患者，目前尚无明确的治疗建议，TAVI的使用在很大程度上属于超适应证应用。我们在此报告一系列使用可自膨胀的AcurateNeo和Neo2（美国马萨诸塞州马尔伯勒市波士顿科学公司）经导管心脏瓣膜（THV）治疗单纯AR的患者。在2017年5月至2021年3月期间，9例患者（女性占88.8%，年龄74.4±7.1岁，欧洲心脏手术风险评估系统（EuroSCORE）II评分为5.5±3.6%，胸外科医师协会预测死亡率（STS PROM）为6.2±3.0%）在采用调整后的瓣膜尺寸算法后，经股动脉（TF）途径接受了TAVI治疗单纯非钙化性AR。根据更新后的瓣膜学术研究联盟（VARC-2）定义对数据进行回顾性分析。手术成功率为100%。早期安全性为77.7%（7/10），原因是有2例（22.2%）发生急性肾损伤。30天死亡率为0%，在7例（77.7%）患者中，30天随访时未见或仅有微量瓣周漏（PVL），2例（22.2%）患者有轻度PVL。30天随访期间无需植入永久性起搏器（PPM）。在这一系列使用Acurate neo THV治疗单纯非钙化性AR的选定患者中，安全性和有效性得到了证实。在这一高危患者队列中，30天死亡率以及PPM植入率和PVL发生率均显示出优异的结果。这些结果有待在更大规模的患者队列中得到证实。
Zotero 插件