Endo Yoshiki, Nakanowatari Hitoshi, Kitagawa Akinobu, Fukada Yasuhisa, Irie Yoshihito
Department of Cardiovascular Surgery, Iwaki City Medical Center, 16 Kusehara Uchigo Mimayamachi, Iwaki city, Fukushima 973-8555, Japan.
Department of Cardiovascular Surgery, Iwaki City Medical Center, 16 Kusehara Uchigo Mimayamachi, Iwaki city, Fukushima 973-8555, Japan.
Int J Surg Case Rep. 2023 Aug;109:108559. doi: 10.1016/j.ijscr.2023.108559. Epub 2023 Jul 20.
Transcatheter aortic valve implantation (TAVI) is rarely performed in patients with a pre-existing mitral valve prosthesis, which was excluded from the Placement of Aortic Transcatheter Valve trial. Cardiopulmonary bypass (CPB) can provide sufficient hemodynamic stability to facilitate safe implantation; specifically, we prefer using normothermic femoro-femoral CPB. Careful attention should be paid to determine the positional relationship between the two valves in such patients.
We present a case of transfemoral TAVI using femoro-femoral CPB in a 90-year-old female patient with a pre-existing bioprosthetic mitral valve. Baseline echocardiography revealed severe aortic valve stenosis; hence, emergency balloon valvuloplasty was performed. Three months later, elective TAVI was performed; subsequently, left ventricular ejection fraction reached 63 % without mitral valve regurgitation or stenosis.
Despite the safety of TAVI using CPB in older patients, cannula insertion into peripheral vessels carries a high risk.
As CPB can increase tissue invasion for a short duration, the safety of this procedure needs further validation.
经导管主动脉瓣植入术（TAVI）在已有二尖瓣人工瓣膜的患者中很少进行，此类患者被排除在经导管主动脉瓣置入试验之外。体外循环（CPB）可提供足够的血流动力学稳定性以利于安全植入；具体而言，我们更倾向于使用常温股-股体外循环。对于此类患者，应仔细确定两个瓣膜之间的位置关系。
我们报告一例90岁患有生物人工二尖瓣的女性患者，采用股-股体外循环行经股动脉TAVI。基线超声心动图显示严重主动脉瓣狭窄；因此，进行了急诊球囊瓣膜成形术。三个月后，进行了择期TAVI；随后，左心室射血分数达到63%，且无二尖瓣反流或狭窄。
尽管在老年患者中使用体外循环进行TAVI是安全的，但将插管插入外周血管具有高风险。
由于体外循环会在短时间内增加组织侵袭，该手术的安全性需要进一步验证。
