Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA.
Division of Cardiology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA.
Catheter Cardiovasc Interv. 2023 Aug;102(2):328-338. doi: 10.1002/ccd.30755. Epub 2023 Jul 2.
Valve-in-valve (VIV) transcatheter aortic valve implantation (TAVI) is a less invasive therapeutic option compared with redo surgical valve replacement for high-risk patients. Relative to procedures within stented surgical valves, VIV-TAVI within stentless valves is associated with a higher complication rate due to challenging underlying anatomy and absence of fluoroscopic landmarks.
We share a single-center experience with VIV-TAVI in stentless valves, discussing our procedural insights and associated outcomes.
Our institutional database was queried, and 25 patients who had undergone VIV-TAVI within a stentless bioprosthesis, homograft, or valve-sparing aortic root replacement between 2013 and 2022 were found. Outcome endpoints were based on the Valve Academic Research Consortium-3 criteria.
The mean age of the cohort was 69.5 ± 13.6 years. VIV implantation was performed within a homograft in 11 patients, a stentless bioprothesis in 10 patients, and a valve-sparing aortic root replacement in 4 patients. Nineteen (76%) balloon-expandable valves, 5 (20%) self-expanding valves, and one mechanically-expandable (4%) valve were implanted with 100% procedural success, with no instances of significant paravalvular leak, coronary occlusion, or device embolization. There was one (4%) in-hospitality mortality after an emergency procedure; one (4%) patient experienced a transient ischemic attack; and two (8%) patients required permanent pacemaker implantation. The median length of hospital stay was 2 days. After a median follow-up time of 16.5 months, valve function was acceptable in all patients with available data.
VIV-TAVI within stentless valves can be safely performed with methodical procedural technique and can provide clinical benefit in patients at high reoperation risk.
与高危患者再次进行外科瓣膜置换相比，经导管主动脉瓣置换术（TAVI）中的经瓣中瓣（VIV）技术是一种侵袭性更小的治疗选择。与带支架的外科瓣膜内的程序相比，由于解剖结构复杂且缺乏荧光透视标志，支架瓣内的 VIV-TAVI 与更高的并发症发生率相关。
我们分享了支架瓣内 VIV-TAVI 的单中心经验，讨论了我们的手术见解和相关结果。
我们查询了机构数据库，发现 2013 年至 2022 年间，共有 25 例患者在支架瓣、同种异体瓣或保留瓣膜的主动脉根部置换术中接受了 VIV-TAVI。结果终点基于瓣膜学术研究联盟-3 标准。
该队列的平均年龄为 69.5±13.6 岁。11 例患者在同种异体瓣内、10 例患者在支架瓣生物瓣内、4 例患者在保留瓣膜的主动脉根部置换术中进行了 VIV 植入。植入的瓣膜包括 19 个（76%）球囊扩张瓣、5 个（20%）自扩张瓣和 1 个（4%）机械扩张瓣，均获得了 100%的手术成功率，无明显瓣周漏、冠状动脉阻塞或器械栓塞的情况。1 例（4%）患者在急诊手术后死亡，1 例（4%）患者发生短暂性脑缺血发作，2 例（8%）患者需要植入永久性起搏器。中位住院时间为 2 天。在中位随访时间 16.5 个月后，所有有数据的患者的瓣膜功能均尚可。
在有经验的手术技术下，支架瓣内 VIV-TAVI 可以安全进行，并可为高再次手术风险的患者提供临床获益。
