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Transcatheter Aortic Valve-in-Valve Replacement for Degenerated Stentless Bioprosthetic Aortic Valves: Results of a Multicenter Retrospective Analysis.
JACC: Cardiovascular Interventions ( IF 11.7 ) Pub Date : 2019-07-08 , DOI: 10.1016/j.jcin.2019.05.022 Matthew Miller 1 , Mandy Snyder 2 , Benjamin D Horne 3 , James R Harkness 4 , John R Doty 4 , Edward C Miner 4 , Kent W Jones 4 , Kelly R O'Neal 4 , Bruce B Reid 4 , William T Caine 4 , Stephen E Clayson 4 , Eric Lindley 5 , Blake Gardner 6 , Rafe C Connors 5 , B Jason Bowles 6 , Brian K Whisenant 4
JACC: Cardiovascular Interventions ( IF 11.7 ) Pub Date : 2019-07-08 , DOI: 10.1016/j.jcin.2019.05.022 Matthew Miller 1 , Mandy Snyder 2 , Benjamin D Horne 3 , James R Harkness 4 , John R Doty 4 , Edward C Miner 4 , Kent W Jones 4 , Kelly R O'Neal 4 , Bruce B Reid 4 , William T Caine 4 , Stephen E Clayson 4 , Eric Lindley 5 , Blake Gardner 6 , Rafe C Connors 5 , B Jason Bowles 6 , Brian K Whisenant 4
Affiliation
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OBJECTIVES
The purpose of this study was to evaluate the safety and efficacy of valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) for stentless bioprosthetic aortic valves (SBAVs) and to identify predictors of adverse events.
BACKGROUND
ViV TAVR in SBAVs is associated with unique technical challenges and risks.
METHODS
Clinical records and computer tomographic scans were retrospectively reviewed for procedural complications, predictors of coronary obstruction, mortality, and echocardiographic results.
RESULTS
Among 66 SBAV patients undergoing ViV TAVR, mortality was 2 of 66 patients (3.0%) at 30 days and 5 of 52 patients (9.6%) at 1 year. At 1 year, left ventricular end-systolic dimension was decreased versus baseline (median [interquartile range (IQR)]: 3.0 [2.6 to 3.6] cm vs. 3.7 [3.2 to 4.4] cm; p < 0.001). Coronary occlusion in 6 of 66 procedures (9.1%) resulted in myocardial infarction in 2 of 66 procedures (3.0%). Predictors of coronary occlusion included subcoronary implant technique compared with full root replacement (6 of 31, 19.4% vs. 0 of 28, 0%; p = 0.01), short simulated radial valve-to-coronary distance (median [IQR]: 3.4 [0.0 to 4.6] mm vs. 4.6 [3.2 to 6.2] mm; p = 0.016), and low coronary height (7.8 [5.8 to 10.0] mm vs. 11.6 [8.7 to 13.9] mm; p = 0.003). Coronary arteries originated <10 mm above the valve leaflets in 34 of 97 unobstructed coronary arteries (35.1%).
CONCLUSIONS
TAVR in SBAVs is frequently associated with high-risk coronary anatomy but can be performed with a low risk of death and myocardial infarction, resulting in favorable ventricular remodeling. A subcoronary surgical approach is associated with an increased risk of coronary obstruction.
中文翻译：
退化性无支架生物假体主动脉瓣的经导管主动脉瓣膜置换术：多中心回顾性分析的结果。
目的本研究的目的是评估无瓣膜生物人工主动脉瓣（SBAV）的瓣膜内瓣膜置换术（TAV）的安全性和有效性，并确定不良事件的预测因素。背景技术SBAV中的ViV TAVR与独特的技术挑战和风险相关联。方法回顾性分析临床记录和计算机断层扫描，以检查程序并发症，冠状动脉阻塞的预测因子，死亡率和超声心动图检查结果。结果在接受ViV TAVR的66例SBAV患者中，在30天时死亡率为66例患者中的2例（3.0％），在1年时死亡率为52例患者中的5例（9.6％）。在1年时，左室收缩末期尺寸相对于基线降低（中位[四分位间距（IQR）]：3.0 [2.6至3.6] cm与3.7 [3.2至4.4] cm； p <0.001）。66例手术中有6例（9.1％）的冠状动脉阻塞导致了66例手术中的2例（3.0％）的心肌梗塞。冠状动脉闭塞的预测因素包括全冠状动脉置换术与全根置换术（6/31，19.4％vs. 0 / 28，0％； p = 0.01），模拟的径向瓣膜冠状动脉到冠状动脉距离短（中位值[IQR]：3.4） [0.0至4.6] mm与4.6 [3.2至6.2] mm； p = 0.016）和低冠状动脉高度（7.8 [5.8至10.0] mm与11.6 [8.7至13.9] mm； p = 0.003）。97个通畅的冠状动脉中的34个（35.1％）中，冠状动脉起源于瓣叶上方<10 mm。结论SBAVs中的TAVR通常与高危冠状动脉解剖相关，但可以在低死亡和心肌梗塞风险的情况下进行，从而有利于心室重构。
更新日期：2019-07-01
中文翻译：
退化性无支架生物假体主动脉瓣的经导管主动脉瓣膜置换术：多中心回顾性分析的结果。
目的本研究的目的是评估无瓣膜生物人工主动脉瓣（SBAV）的瓣膜内瓣膜置换术（TAV）的安全性和有效性，并确定不良事件的预测因素。背景技术SBAV中的ViV TAVR与独特的技术挑战和风险相关联。方法回顾性分析临床记录和计算机断层扫描，以检查程序并发症，冠状动脉阻塞的预测因子，死亡率和超声心动图检查结果。结果在接受ViV TAVR的66例SBAV患者中，在30天时死亡率为66例患者中的2例（3.0％），在1年时死亡率为52例患者中的5例（9.6％）。在1年时，左室收缩末期尺寸相对于基线降低（中位[四分位间距（IQR）]：3.0 [2.6至3.6] cm与3.7 [3.2至4.4] cm； p <0.001）。66例手术中有6例（9.1％）的冠状动脉阻塞导致了66例手术中的2例（3.0％）的心肌梗塞。冠状动脉闭塞的预测因素包括全冠状动脉置换术与全根置换术（6/31，19.4％vs. 0 / 28，0％； p = 0.01），模拟的径向瓣膜冠状动脉到冠状动脉距离短（中位值[IQR]：3.4） [0.0至4.6] mm与4.6 [3.2至6.2] mm； p = 0.016）和低冠状动脉高度（7.8 [5.8至10.0] mm与11.6 [8.7至13.9] mm； p = 0.003）。97个通畅的冠状动脉中的34个（35.1％）中，冠状动脉起源于瓣叶上方<10 mm。结论SBAVs中的TAVR通常与高危冠状动脉解剖相关，但可以在低死亡和心肌梗塞风险的情况下进行，从而有利于心室重构。
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