Department of Advanced Cardiopulmonary Therapies and Transplantation, Center for Advanced Heart Failure, University of Texas Health Science Center at Houston, Houston, Texas.
Tex Heart Inst J. 2022 Sep 1;49(5). doi: 10.14503/THIJ-21-7579.
The transcatheter aortic valve replacement procedure is used in patients with aortic stenosis. Transcatheter aortic valve replacement devices are quite versatile; thus, they are increasingly being used for nonaortic applications, such as tricuspid valve-in-valve implantation. This case series describes a transcatheter aortic valve replacement procedure in 4 patients with anatomic challenges (eg, aortic tortuosity, high valvular calcium burden, highly calcified bicuspid valve, low coronary artery takeoff, left main coronary artery occlusion, and large aortic annulus) and a fifth patient who had a failed tricuspid bioprosthesis and underwent a tricuspid valve-in-valve implantation with the Edwards SAPIEN 3 transcatheter heart valve (Edwards Lifesciences). All procedures required adjustments to the standard protocol, and each procedure was successful. The critical, technical adjustments in the deployment technique and preprocedural planning of the procedures are detailed to provide a road map for other cardiologists who encounter similar challenges.
经导管主动脉瓣置换术用于治疗主动脉瓣狭窄患者。经导管主动脉瓣置换装置用途广泛，因此，其在非主动脉瓣疾病中的应用日益增多，如三尖瓣瓣中瓣植入术。本病例系列描述了 4 例解剖结构复杂（如主动脉扭曲、瓣上钙质负荷重、高度钙化的二叶瓣、冠状动脉开口较低、左主干冠状动脉闭塞、主动脉瓣环较大）患者行经导管主动脉瓣置换术，以及 1 例三尖瓣生物瓣置换术后失败患者行经导管三尖瓣瓣中瓣植入术，使用 Edwards SAPIEN 3 经导管心脏瓣膜（爱德华生命科学公司）。所有手术均需要调整标准方案，且每例手术均成功完成。详细介绍了手术展开技术和术前规划中的关键技术调整，为遇到类似挑战的其他心脏病专家提供了指导。
