Nagasaka Takashi, Patel Vivek, Koren Ofir, Shechter Alon, Chakravarty Tarun, Cheng Wen, Ishii Hideki, Jilaihawi Hasan, Nakamura Mamoo, Makkar Raj R
Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States.
Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan.
Front Cardiovasc Med. 2024 Mar 19;11:1374078. doi: 10.3389/fcvm.2024.1374078. eCollection 2024.
Paravalvular leak (PVL) is a severe complication of transcatheter aortic valve replacement (TAVR) that can lead to poor outcomes. TAVR-in-TAVR is a promising treatment for PVL; however, reports on its safety or efficacy are limited. In this study, we aimed to investigate the clinical outcomes of TAVR-in-TAVR using balloon-expandable prostheses for PVLs after TAVR.
We retrospectively analyzed data from patients who underwent TAVR-in-TAVR using balloon-expandable Sapien prostheses for PVL after an initial TAVR at our institution. The procedural success, in-hospital complications, all-cause mortality, and echocardiographic data for up to 2 years post-surgery were evaluated.
In total, 31 patients with a mean age of 81.1 ± 7.9 years and mean Society of Thoracic Surgeons score of 8.8 ± 5.4% were identified. The procedural success rate of TAVR-in-TAVR was 96.8% (30/31). No in-hospital deaths, cardiac tamponade, or conversion to sternotomy occurred. Re-intervention was performed in only one patient (3.2%) during hospitalization. The all-cause mortality rates at 30 days and 2 years were 0% and 16.1%, respectively. A significant reduction in the PVL rate was observed at 30 days compared with that at baseline ( < 0.01).
Our findings suggest that TAVR-in-TAVR using balloon-expandable prostheses is safe and effective for PVL after TAVR with low complication rates and acceptable long-term outcomes. Further studies with larger sample sizes are needed to confirm our findings.
瓣周漏（PVL）是经导管主动脉瓣置换术（TAVR）的一种严重并发症，可导致不良预后。TAVR-in-TAVR是治疗PVL的一种有前景的方法；然而，关于其安全性或有效性的报道有限。在本研究中，我们旨在调查使用球囊扩张式假体进行TAVR-in-TAVR治疗TAVR术后PVL的临床结局。
我们回顾性分析了在我们机构初次接受TAVR术后使用球囊扩张式Sapien假体进行TAVR-in-TAVR治疗的患者的数据。评估了手术成功率、院内并发症、全因死亡率以及术后长达2年的超声心动图数据。
共纳入31例患者，平均年龄81.1±7.9岁，平均胸外科医师协会评分8.8±5.4%。TAVR-in-TAVR的手术成功率为96.8%（30/31）。未发生院内死亡、心脏压塞或转为开胸手术。住院期间仅1例患者（3.2%）进行了再次干预。30天和2年时的全因死亡率分别为0%和16.1%。与基线相比，30天时PVL率显著降低（<0.01）。
我们的研究结果表明，使用球囊扩张式假体进行TAVR-in-TAVR治疗TAVR术后PVL是安全有效的，并发症发生率低，长期结局可接受。需要进一步开展更大样本量的研究来证实我们的研究结果。
