Nakamae Kosuke, Niinami Hiroshi, Domoto Satoru, Shinkawa Takeshi, Morita Kozo
Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan.
Ann Thorac Surg Short Rep. 2024 Apr 27;2(4):799-803. doi: 10.1016/j.atssr.2024.04.011. eCollection 2024 Dec.
In the valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) era, implanting a larger-sized valve during the initial aortic valve replacement is important. For smaller aortic annuli, combining aortic annular and left ventricular outflow tract (LVOT) enlargement is essential. The Y-incision procedure helps achieve implantation of a 2-size larger valve. However, it can lead to size discrepancies between the valve and the LVOT, thus resulting in a residual pressure gradient, and the risk of coronary obstruction after ViV-TAVR remains because the initial surgical valve is implanted tilted inward. To resolve these concerns, we combined the Y-incision and Nicks procedures.
在经导管主动脉瓣置换术（ViV-TAVR）的瓣中瓣时代，在初次主动脉瓣置换时植入更大尺寸的瓣膜很重要。对于较小的主动脉瓣环，联合扩大主动脉瓣环和左心室流出道（LVOT）至关重要。Y形切口手术有助于植入大两号的瓣膜。然而，它可能导致瓣膜与LVOT之间出现尺寸差异，从而产生残余压力梯度，并且由于最初植入的手术瓣膜向内倾斜，ViV-TAVR术后仍存在冠状动脉阻塞的风险。为了解决这些问题，我们将Y形切口和尼克手术相结合。
