Milutinovic Stefan, Karpinska-Leydier Katarzyna, Chazal Richard A
Florida State University College of Medicine Internal Medicine Residency Program at Lee Health, Cape Coral, Florida, USA.
Lee Health Heart Institute, Fort Myers, Florida, USA.
JACC Case Rep. 2025 Sep 3;30(26):104874. doi: 10.1016/j.jaccas.2025.104874.
Transcatheter aortic valve replacement (TAVR) is a preferred treatment option for many patients with severe aortic stenosis, but concerns exist regarding safety in patients with nickel allergy due to metallic valve frames. We report a series of 7 patients with a history of nickel allergy who underwent TAVR. Preprocedural allergy evaluation varied, including patch testing or direct skin contact with valve fragments. None of the patients experienced severe allergic reactions, and all remained free of significant nickel allergy-related symptoms during follow-up. A review of the literature identified only 1 prior case of severe nickel hypersensitivity requiring TAVR valve explantation. Importantly, no consistent correlation was observed between patch test results and clinical outcomes. These findings suggest that TAVR can likely be safely performed in patients with nickel allergy and that routine preprocedural patch testing has questionable utility. Further research is needed to clarify long-term outcomes in this population.
经导管主动脉瓣置换术（TAVR）是许多重度主动脉瓣狭窄患者的首选治疗方案，但由于金属瓣膜框架，镍过敏患者的安全性令人担忧。我们报告了7例有镍过敏史并接受TAVR的患者。术前过敏评估各不相同，包括斑贴试验或直接皮肤接触瓣膜碎片。所有患者均未发生严重过敏反应，且在随访期间均未出现与镍过敏相关的明显症状。文献回顾仅发现1例既往有严重镍过敏反应而需要取出TAVR瓣膜的病例。重要的是，未观察到斑贴试验结果与临床结局之间存在一致的相关性。这些发现表明，镍过敏患者可能可以安全地进行TAVR，并且术前常规斑贴试验的效用存疑。需要进一步研究以阐明该人群的长期结局。
