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主动脉瓣置换术后瓣周漏的处理。

The management of paravalvular leaks post aortic valve replacement.

机构信息

Dnipro Medical Institute of Traditional and Non-Traditional Medicine, Dnipro, Ukraine.

Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, UK.

出版信息

J Card Surg. 2022 Sep;37(9):2786-2798. doi: 10.1111/jocs.16672. Epub 2022 Jun 13.

Abstract

BACKGROUND

Paravalvular leak (PVL) is uncommon but can lead to severe complications after surgical or transcatheter aortic valve implantation. Conditions associated with PVLs such as heart failure, hemolysis, and infective endocarditis can lead to catastrophic results if not treated promptly; the therapeutic goals differ according to the presentation. It is vital that PVLs are diagnosed early using various imaging modalities. Different approaches have been studied in managing PVLs; there is an increased interest in the transcatheter aortic valve closure procedure as it is minimally invasive and decreases the occurrence of further reinterventions.

AIM

To discuss the classification of PVLs, diagnostic approaches, and available management options.

METHOD

A literature review was performed using 28 studies.

RESULTS

This review evaluated the relationship between the time of diagnosis, management of PVL and the resulting outcomes.

DISCUSSION

Patients with PVL should be assessed through a multidisciplinary team approach and a patient-selective plan should be in place.

CONCLUSION

Open surgical intervention is reserved for complex cases where minimally invasive techniques cannot be utilized.

摘要

背景

瓣周漏(PVL)虽不常见,但可导致经导管主动脉瓣置换术或外科主动脉瓣置换术后严重并发症。如果不及时治疗,与瓣周漏相关的心力衰竭、溶血性贫血和感染性心内膜炎等病症可能导致灾难性后果;治疗目标因临床表现而异。使用各种影像学方法尽早诊断瓣周漏至关重要。已经研究了不同的方法来治疗瓣周漏;经导管主动脉瓣关闭术作为一种微创方法,可减少进一步再次介入的发生,因此受到越来越多的关注。

目的

讨论瓣周漏的分类、诊断方法和现有的治疗选择。

方法

使用 28 项研究进行了文献复习。

结果

本综述评估了诊断时间、瓣周漏处理与结果之间的关系。

讨论

应通过多学科团队方法评估患有瓣周漏的患者,并制定患者选择性方案。

结论

开放性手术干预保留用于无法使用微创技术的复杂病例。

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