Hinkov Hristian, Lee Chong Bin, Pitts Leonard, Lanmüller Pia, Klein Christoph, Kukucka Marian, Potapov Evgenij, Kempfert Jörg, Falk Volkmar, Dreger Henryk, Unbehaun Axel
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany.
Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Eur J Cardiothorac Surg. 2024 Mar 1;65(3). doi: 10.1093/ejcts/ezae028.
Aortic valve regurgitation (AR) frequently complicates the clinical course after left ventricular assist device (LVAD) implantation. Transcatheter aortic valve implantation (TAVI) has emerged as an alternative to surgical aortic valve replacement (SAVR) in this cohort with a mostly high surgical risk profile. The unique challenges in LVAD patients, such as presence of non-calcified aortic valves and annular dilatation, raise concerns about device migration and paravalvular leakage (PVL) leading to missing device success. This study evaluates procedural outcomes and survival rates in LVAD patients who underwent TAVI, emphasizing strategies to enhance device success.
Between January 2017 and April 2023, 27 LVAD patients with clinically significant AR underwent elective or urgent TAVI at our centre. Primary end-points were procedural success rates, without the need for a second transcatheter heart valve (THV) and postprocedural AR/PVL. Secondary outcomes included survival rates and adverse events.
Among the cohort, 14.8% received AR-dedicated TAVI devices, with none requiring a second THV. There was no intraprocedural AR, and 1 patient (25%) had AR > 'trace' at discharge. Additionally, 25.9% underwent device landing zone (DLZ) pre-stenting with a standard TAVI device, all without needing a second THV. There was no intraprocedural AR, and none to trace AR at discharge. Among the 59.3% receiving standard TAVI devices, 37.5% required a second THV. In this subgroup, intraprocedural AR > 'trace' occurred in 12.5%, decreasing to 6.25% at discharge. In-hospital mortality was 3.7%, and median follow-up survival was 388 days (interquartile range 208-1167 days).
TAVI yields promising procedural outcomes and early survival rates in LVAD patients with AR. Tailored TAVI devices and pre-stenting techniques enhance procedural success. Continued research into these strategies is essential to optimize outcomes in this complex patient cohort.
主动脉瓣反流（AR）常使左心室辅助装置（LVAD）植入后的临床病程复杂化。经导管主动脉瓣植入术（TAVI）已成为该队列中手术主动脉瓣置换术（SAVR）的替代方案，该队列患者大多手术风险较高。LVAD患者面临的独特挑战，如非钙化主动脉瓣的存在和瓣环扩张，引发了对装置移位和瓣周漏（PVL）导致装置植入失败的担忧。本研究评估接受TAVI的LVAD患者的手术结果和生存率，重点关注提高装置植入成功率的策略。
2017年1月至2023年4月期间，27例有临床显著AR的LVAD患者在我们中心接受了择期或急诊TAVI。主要终点是手术成功率，无需二次经导管心脏瓣膜（THV）以及术后AR/PVL。次要结局包括生存率和不良事件。
在该队列中，14.8%的患者接受了专门用于AR的TAVI装置，无一例需要二次THV。术中无AR发生，1例患者（25%）出院时AR > “微量”。此外，25.9%的患者使用标准TAVI装置进行了装置着陆区（DLZ）预支架置入，均无需二次THV。术中无AR发生，出院时无AR。在接受标准TAVI装置的59.3%的患者中，37.5%需要二次THV。在该亚组中，术中AR > “微量”的发生率为12.5%，出院时降至6.25%。住院死亡率为3.7%，中位随访生存期为388天（四分位间距208 - 1167天）。
TAVI在患有AR的LVAD患者中产生了有前景的手术结果和早期生存率。定制的TAVI装置和预支架置入技术提高了手术成功率。对这些策略的持续研究对于优化这一复杂患者队列的结局至关重要。
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