Yamashita Go, Hirao Shingo, Komiya Tatsuhiko
Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.
Interdiscip Cardiovasc Thorac Surg. 2024 Nov 6;39(5). doi: 10.1093/icvts/ivae177.
Transcatheter aortic valve replacement (TAVR) has become an established alternative to surgical aortic valve replacement for severe aortic stenosis. However, the long-term outcomes and need for surgical reintervention following TAVR remain uncertain. This case report describes a 76-year-old woman who underwent surgical explantation of a SAPIEN-XT valve more than a decade after initial TAVR implantation due to late valve failure. The patient presented with severe aortic insufficiency and heart failure symptoms. Surgical intervention involved concomitant ascending aortic replacement, tricuspid annuloplasty and coronary artery bypass grafting. The TAVR valve was successfully explanted using careful blunt dissection to avoid annulus damage. Postoperative recovery was uneventful, with the patient discharged after 4 weeks. This case highlights the potential need for long-term surgical management of patients after TAVR and emphasizes the importance of surgical preparedness as TAVR indications expand. It also provides valuable insights for surgeons encountering similar cases of late TAVR failure requiring explantation.
经导管主动脉瓣置换术（TAVR）已成为重度主动脉瓣狭窄患者外科主动脉瓣置换术的既定替代方案。然而，TAVR后的长期疗效以及再次接受外科手术干预的必要性仍不明确。本病例报告描述了一名76岁女性，在最初植入TAVR十多年后，因瓣膜晚期功能障碍接受了SAPIEN-XT瓣膜的外科取出术。该患者出现严重主动脉瓣关闭不全和心力衰竭症状。手术干预包括同期升主动脉置换、三尖瓣环成形术和冠状动脉旁路移植术。通过仔细钝性分离成功取出TAVR瓣膜，避免了瓣环损伤。术后恢复顺利，患者在4周后出院。本病例突出了TAVR术后患者长期外科治疗的潜在需求，并强调随着TAVR适应症的扩大，外科准备的重要性。它还为遇到类似晚期TAVR失败需要取出瓣膜病例的外科医生提供了宝贵的见解。
