Department of Cardiac Surgery, Quebec Heart and Lung University Institute, Quebec City, Quebec, Canada.
Department of Pathology, Quebec Heart and Lung University Institute, Quebec City, Quebec, Canada.
J Card Surg. 2022 Oct;37(10):3178-3187. doi: 10.1111/jocs.16784. Epub 2022 Jul 23.
With the extended indications of transcatheter aortic valve (TAV) replacement (TAVR) to lower-risk patients, there is an increasing number of patients requiring surgical explantation of failed TAV. We sought to describe macroscopic and microscopic features of surgically explanted percutaneous aortic valve prostheses.
Preoperative and surgical characteristic of patients undergoing surgical explantation of TAV were retrospectively analyzed from 2007 to 2020. Surgical and pathologic features of these valves, and outcomes of the surgical valve replacement were described.
Out of 1764 patients who underwent a TAVR procedure, 21 were operated for TAV failure. Isolated or combined indications for surgery included: significant paravalvular leak (n = 15), delayed prosthesis migration (n = 5), significant increase of trans-TAV gradients (n = 6), and endocarditis (n = 3). Mean time elapsed between TAVR and explantations was 674.9 ± 803.9 days. Macroscopic lesions found on explanted percutaneous valves were severe adhesions to the aorta (n = 10), calcifications (n = 7), leaflet thrombosis (n = 4), and vegetations (n = 3). Except for patients with endocarditis, one or more pathological lesions were found in 15 patients. Pathology analyses on these valves showed fibro-calcific degenerations (n = 12), pannus formation (n = 9), and chronic inflammation (n = 3). One patient (4.8%) died after surgical explantation, and 13 (61.9%) had concomitant procedures. The survival rate at 1 year was 94.4%.
Microscopic findings of fibro-calcific leaflet degeneration, and pannus formation in addition to macroscopic calcification and thrombosis present early, (within a mean of 2 years) after TAVR. Further investigation with a higher number of patients and echocardiographic follow-up is warranted.
随着经导管主动脉瓣置换术（TAVR）适应证向低危患者扩展，越来越多的患者需要手术取出失败的 TAV。本研究旨在描述经皮主动脉瓣假体的手术取出的大体和微观特征。
回顾性分析 2007 年至 2020 年期间因 TAV 失败而行手术取出 TAV 的患者的术前和手术特征。描述这些瓣膜的手术和病理特征，以及手术瓣膜置换的结果。
在 1764 例行 TAVR 手术的患者中，有 21 例因 TAV 失败而行手术。手术的单一或联合适应证包括：严重瓣周漏（n=15）、延迟假体移位（n=5）、跨瓣 TAV 梯度显著增加（n=6）和心内膜炎（n=3）。TAVR 与手术取出之间的平均时间间隔为 674.9±803.9 天。在取出的经皮瓣膜上发现的大体病变有：主动脉严重粘连（n=10）、钙化（n=7）、瓣叶血栓形成（n=4）和赘生物（n=3）。除心内膜炎患者外，15 例患者中发现 1 种或多种病理病变。对这些瓣膜的病理学分析显示纤维-钙化变性（n=12）、肉芽组织形成（n=9）和慢性炎症（n=3）。1 例（4.8%）患者在手术取出后死亡，13 例（61.9%）患者同时行其他手术。1 年生存率为 94.4%。
TAVR 后 2 年内（平均时间），除了大体上的钙化和血栓形成外，还会出现纤维-钙化瓣叶退行性变和肉芽组织形成等微观发现。需要进一步进行研究，纳入更多患者并进行超声心动图随访。
