De Ferrari Tommaso, Ancona Marco B, Romano Vittorio, Ferri Luca, Russo Filippo, Agricola Eustachio, Esposito Antonio, Montorfano Matteo
Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy.
Cardiovascular Imaging Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy.
Eur Heart J Case Rep. 2024 Sep 24;8(10):ytae529. doi: 10.1093/ehjcr/ytae529. eCollection 2024 Oct.
Transcatheter aortic valve replacement (TAVR)-in-TAVR within index supra-annular transcatheter heart valves (THVs) and high-risk anatomy can compromise coronary perfusion and re-access.
An 80-year-old male presented with acute heart failure caused by degeneration of an Evolut R THV, leading to severe aortic regurgitation. Aortic computed tomography imaging revealed a high-risk anatomy characterized by the index THV's commissural plane being placed above the coronary ostia and a valve-to-aorta distance of less than 2 mm, resulting not eligible for redo-TAVR according to recent literature. The current case represents the first-in-human application of redo-TAVR with low SAPIEN 3 THV implantation within an Evolut R THV obtaining index leaflet overhang, preserving coronary perfusion and potential coronary re-engagement.
Following study, this case demonstrates feasibility of redo-TAVR with low SAPIEN 3 THV implantation within an Evolut R THV obtaining index leaflet overhang.
在初次使用的瓣上经导管心脏瓣膜（THV）内进行经导管主动脉瓣置换术（TAVR）-in-TAVR以及高风险解剖结构可能会影响冠状动脉灌注和再次入路。
一名80岁男性因Evolut R THV退变导致急性心力衰竭，进而引发严重主动脉瓣反流。主动脉计算机断层扫描成像显示为高风险解剖结构，其特征为初次使用的THV连合平面位于冠状动脉开口上方，瓣膜与主动脉距离小于2毫米，根据近期文献，不符合再次进行TAVR的条件。本病例是在Evolut R THV内植入低瓣架SAPIEN 3 THV进行再次TAVR并获得初次瓣叶悬垂、保留冠状动脉灌注和潜在冠状动脉再接入的首例人体应用。
经过研究，本病例证明了在Evolut R THV内植入低瓣架SAPIEN 3 THV进行再次TAVR并获得初次瓣叶悬垂的可行性。
