Seshiah Puvi, Choo Joseph, Garcia Santiago, Kereiakes Dean J
The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio.
The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio.
J Soc Cardiovasc Angiogr Interv. 2023 Oct 24;2(6Part A):101111. doi: 10.1016/j.jscai.2023.101111. eCollection 2023 Nov-Dec.
Severe calcific aortic stenosis (AS) can be successfully treated with transcatheter aortic valve replacement (TAVR) using both balloon-expandable valves (BEV) and self-expanding valves. Challenges remain for treatment of AS with TAVR in relation to the severity of calcification involving valve leaflets, aortic annulus, and/or left ventricular outflow tract. Severe calcification presents challenges to TAVR with respect to aortic root/annular rupture and risk for peri-valve leak (PVL).
Three separate patients with symptomatic severe AS and severely calcified valves underwent TAVR with BEV. Case 1 underwent TAVR without preceding intravascular lithotripsy (IVL) of the native valve and developed annular rupture requiring surgical rescue. Following this experience, TAVR in 2 subsequent cases was preceded by Shockwave IVL using a novel 12-mm × 30-mm L6 balloon placed across the native valve prior to BEV implantation.
Following IVL, cases 2 and 3 had uncomplicated TAVR with excellent valve frame expansion, and no significant residual gradient or PVL.
Severely calcified aortic valves increase the risk of aortic annular rupture and PVL following TAVR. IVL prior to TAVR may enhance leaflet/ annular compliance with the potential to improve the safety and effectiveness of TAVR.
严重钙化性主动脉瓣狭窄（AS）可通过使用球囊扩张瓣膜（BEV）和自膨胀瓣膜的经导管主动脉瓣置换术（TAVR）成功治疗。在涉及瓣叶、主动脉瓣环和/或左心室流出道钙化严重程度方面，TAVR治疗AS仍存在挑战。严重钙化在主动脉根部/瓣环破裂和瓣周漏（PVL）风险方面给TAVR带来挑战。
3例有症状的严重AS且瓣膜严重钙化的患者接受了BEV TAVR治疗。病例1在未先行对自身瓣膜进行血管内碎石术（IVL）的情况下接受了TAVR，并发瓣环破裂，需要手术挽救。基于这一经验，随后的2例病例在BEV植入前，先使用新型12毫米×30毫米L6球囊对自身瓣膜进行Shockwave IVL，然后进行TAVR。
IVL后，病例2和病例3的TAVR过程顺利，瓣膜框架扩张良好，无明显残余梯度或PVL。
严重钙化的主动脉瓣会增加TAVR后主动脉瓣环破裂和PVL的风险。TAVR前进行IVL可能会提高瓣叶/瓣环顺应性，有可能提高TAVR的安全性和有效性。
