Transcatheter Valve-In-Valve Implantation for Failed Balloon-Expandable Transcatheter Aortic Valves

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• 作者：Stefan Toggweiler ; MD^鈦?/sup> ; David A. Wood ; MD^鈦?/sup> ; Josep Rodé ; s-Cabau ; MD^&dagger ; ; Samir Kapadia ; MD^&Dagger ; ; Alexander B. Willson ; MBBS ; MPH^鈦?/sup> ; Jian Ye ; MD^鈦?/sup> ; Anson Cheung ; MD^鈦?/sup> ; Jonathon Leipsic ; MD^鈦?/sup> ; Ronald K. Binder ; MD^鈦?/sup> ; Ronen Gurvitch ; MBBS^鈦?/sup> ; Melanie Freeman ; MBBS^鈦?/sup> ; Christopher R. Thompson ; MD^鈦?/sup> ; Lars G. Svensson ; MD^&Dagger ; ; Eric Dumont ; MD^&dagger ; ; E. Murat Tuzcu ; MD^&Dagger ; ; John G. Webb ; MD^鈦?/sup> ; ^{john.webb@vch.ca}
• 关键词：aortic stenosis ; aortic valve regurgitation ; transcatheter aortic valve implantation ; transcatheter aortic valve replacement
• 刊名：JACC ; Cardiovascular Interventions
• 出版年：2012
• 期刊代码：pca198_19368798
• 类别：med
• 出版时间：May, 2012
• 卷：5
• 期：5
• 页码：571-577
• 文件大小：1506 K

摘要

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lass="h4">Objectives

This study sought to evaluate outcomes after implantation of a second transcatheter heart valve (THV-in-THV) for acute THV failure.

lass="h4">Background

Aortic regurgitation after transcatheter aortic valve replacement (TAVR) may be valvular due to prosthetic leaflet dysfunction or paravalvular due to poor annular sealing.

lass="h4">Methods

Patients undergoing aortic balloon-expandable TAVR at 3 centers were prospectively evaluated at baseline, intraprocedurally, at hospital discharge, and annually.

lass="h4">Results

Of 760 patients undergoing TAVR, 21 (2.8%) received a THV-in-THV implant due to acute, severe regurgitation. Aortic regurgitation was paravalvular in 18 patients and transvalvular in the remaining 3 patients. THV-in-THV implantation was technically successful in 19 patients (90%) and unsuccessful in 2 patients (10%), who subsequently underwent open heart surgery. Mortality at 30 days and 1 year was 14.3%and 24%, respectively. After successful THV-in-THV, mean aortic valve gradient fell from 37 卤 12 mm Hg to 13 卤 5 mm Hg (p < 0.01); aortic valve area increased from 0.64 卤 0.14 cm² to 1.55 卤 0.27 cm² (p < 0.01); and paravalvular aortic regurgitation was none in 4 patients, mild in 13 patients, and moderate in 2 patients. At 1-year follow-up, 1 patient had moderate and the others had mild or no paravalvular leaks. The mean transvalvular gradient was 15 卤 4 mm Hg, which was higher than in patients undergoing conventional TAVR (11 卤 4 mm Hg, p = 0.02).

lass="h4">Conclusions

THV-in-THV implantation is feasible and results in satisfactory short- and mid-term outcomes.