Mizutani Kazuki, Ueno Masafumi, Sakaguchi Genichi, Nakazawa Gaku
Division of Cardiology, Department of Medicine, Kindai University Faculty of Medicine, Ohno-Higashi, Osakasayama, Osaka 589-8511, Japan.
Department of Cardiovascular Surgery, Kindai University Faculty of Medicine, Osaka, Japan.
Eur Heart J Case Rep. 2024 Mar 11;8(3):ytae126. doi: 10.1093/ehjcr/ytae126. eCollection 2024 Mar.
There are a few case reports regarding transcatheter aortic valve implantation (TAVI) for deteriorated surgical homograft.
We present a case of severe structural valve deterioration (SVD) of homograft surgical aortic valve presenting severe aortic regurgitation in an 84-year-old man with decompensated heart failure. We performed TAVI in homograft valve using 23 mm SAPIEN3 Ultra RESILIA. The resulting grade of paravalvular regurgitation was trace, the post-operative effective orifice area (EOA) was 1.66 cm (index EOA: 1.19 cm/m), and device success was achieved.
Stented bioprosthetic valves are more commonly implanted than mechanical and stentless bioprosthetic valves. In the 1980s and the early 1990s, homografts became particularly popular as alternatives to stented valves. There are several reports of TAVI for homograft SVD, but the paravalvular leakage grade is worse than that of redo-surgical aortic valve replacement, although the mortality rate is lower. However, the valves used in these reports were from older valves such as SAPIEN XT or SAPIEN3. There are no reports using SAPIEN3 Ultra RESILIA with a significant reduction in paravalvular leak due to an external textured polyethylene terephthalate skirt extending 40% higher above the valve inflow than the classical SAPIEN3, which is now available. Transcatheter aortic valve implantation using SAPIEN3 Ultra RESILIA showed good therapeutic efficacy.
关于经导管主动脉瓣植入术（TAVI）用于退化的外科同种异体移植物的病例报告较少。
我们报告一例84岁患有失代偿性心力衰竭的男性，其外科主动脉同种异体瓣膜出现严重结构瓣膜退化（SVD）并伴有严重主动脉瓣反流。我们使用23毫米SAPIEN3 Ultra RESILIA对同种异体瓣膜进行了TAVI。术后瓣周反流分级为微量，术后有效瓣口面积（EOA）为1.66平方厘米（指数EOA：1.19平方厘米/平方米），手术成功。
带支架生物瓣膜比机械瓣膜和无支架生物瓣膜更常被植入。在20世纪80年代和90年代初，同种异体移植物作为带支架瓣膜的替代物变得特别流行。有几篇关于TAVI治疗同种异体瓣膜SVD的报道，尽管死亡率较低，但瓣周漏分级比再次手术主动脉瓣置换术更差。然而，这些报道中使用的瓣膜是较旧的瓣膜，如SAPIEN XT或SAPIEN3。目前尚无使用SAPIEN3 Ultra RESILIA的报道，其外部有纹理的聚对苯二甲酸乙二醇酯裙边比经典的SAPIEN3在瓣膜流入上方高出40%，可显著减少瓣周漏。使用SAPIEN Ultra RESILIA进行经导管主动脉瓣植入术显示出良好的治疗效果。
