Department of Cardiovascular Surgery, German Heart Center Munich, Technical University Munich, Lazarettstr. 36, 80636, Munich, Germany.
Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center, Technical University Munich, Munich, Germany.
Heart Vessels. 2022 Dec;37(12):2083-2092. doi: 10.1007/s00380-022-02119-7. Epub 2022 Jul 8.
Given the recent surge in transcatheter heart valve replacement (THVR), cardiac surgeons will surely face the challenge of eventual explantation. The aim of this study was to determine indications for reoperation, while exploring pertinent technical aspects and survival after THV explantation in a cohort originally deemed high risk or even inoperable. Between February 2008 and March 2019, 31 patients with failed transcatheter aortic valve replacement (TAVR) underwent surgical explantations at our facility. Data were prospectively collected for retrospective analysis of procedural indications, technical issues, and postoperative survival. The major reason for TAVR removal was bioprosthetic valve failure (BVF) due to infective endocarditis (IE: 16/31 [51.6%]), non-structural (NSVD: 14/31 [45.2%]) and structural (SVD: 1/31 [3.2%]) valve deterioration accounting for the rest. Mean age at THV explantation was 76.3 ± 8.3 years, and median time from TAVR to explantation was 153 days (0 days-56.6 months). Median ICU and hospital stay were 6 days (1-44 days) and 23 days (8-62 days), respectively. Thirty-day and 1-year survival rates were 74.2% and 67.2%, respectively. Median follow-up interval after explantation was 364 days (3 days-80 months). Mean cardiopulmonary bypass time was 124.6 ± 46.8 min, and mean aortic cross-clamp time was 84.3 ± 32.9 min. There was no need for unplanned aortic root repair owing to tissue damage during dissection of the TAVR from surrounding tissue. The most common reason for THV explantation was (a) BVF for IE and (b) BVF secondary to NSVD. Although 30-day and 1-year mortality rates in this multimorbid cohort were predictably high, no procedural mortalities occurred.
鉴于经导管心脏瓣膜置换术（THVR）的近期激增，心脏外科医生肯定将面临最终瓣膜取出的挑战。本研究的目的是确定再次手术的适应证，同时探讨在最初被认为是高危甚至无法手术的患者队列中，经 THV 取出后的相关技术问题和生存情况。在 2008 年 2 月至 2019 年 3 月期间，我院有 31 例经导管主动脉瓣置换术（TAVR）失败的患者接受了手术瓣膜取出。前瞻性收集数据，用于回顾性分析手术适应证、技术问题和术后生存情况。TAVR 取出的主要原因是生物瓣功能障碍（BVF），其中感染性心内膜炎（IE）占 16/31 [51.6%]，非结构性（NSVD）和结构性（SVD）瓣叶退化分别占 14/31 [45.2%]和 1/31 [3.2%]。THV 取出时的平均年龄为 76.3±8.3 岁，从 TAVR 到取出的中位时间为 153 天（0 天-56.6 个月）。ICU 和住院的中位时间分别为 6 天（1-44 天）和 23 天（8-62 天）。30 天和 1 年生存率分别为 74.2%和 67.2%。瓣膜取出后中位随访时间为 364 天（3 天-80 个月）。体外循环时间的平均为 124.6±46.8 分钟，主动脉阻断时间的平均为 84.3±32.9 分钟。由于在从周围组织解剖 TAVR 过程中对组织造成损伤，因此无需计划修复主动脉根部。THV 取出的最常见原因是（a）IE 导致的 BVF 和（b）NSVD 导致的 BVF。尽管该多合并症队列的 30 天和 1 年死亡率预计较高，但无手术相关死亡。
