Prevention and Management of Transcatheter Balloon-Expandable Aortic Valve Malposition
Prevention and Management of Transcatheter Balloon-Expandable Aortic Valve Malposition
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DOI：
10.1002/ccd.21667
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发表时间：
2008-10-01
影响因子：
2.3
通讯作者：
Webb, John G.
中科院分区：
文献类型：
--
作者：
Al Ali, Abdullah M.;Altwegg, Lukas;Webb, John G.
目标。选择高危患者进行导管主动脉瓣置换术（AVR）的早期临床结果与常规手术AVR比较有利。提高对经导管AVR成功和失败机制的理解可能会进一步改善结果。为此，我们回顾了我们在经导管AVR发展阶段的经验，并描述了人工瓣膜错位的原因和处理。方法。在两个中心的170例患者中进行了经导管球囊扩张AVR。错位被定义为假体瓣膜植入在非原瓣膜内的位置。作为正在进行的数据库的一部分，对患者进行前瞻性识别和随访。结果。170例患者中有9例发生瓣膜错位（5.3%）。9例中有8例为瓣上位。在所有病例中，升主动脉栓塞发生在部署后的几个心动周期内。重要的是，没有观察到晚期栓塞。在大多数情况下，假体被平稳地重新定位在远端主动脉。1例患者（0.6%）定位于瓣膜下，导致严重返流并残留原生瓣膜狭窄。6例患者尝试了第二个经导管瓣膜的植入，所有患者都成功了。2例患者行常规AVR， 1例早期死亡。在随访后期（平均412天），9名患者中有7名（78%）仍然存活，假体功能正常，主动脉狭窄缓解。结论。当前球囊扩张主动脉瓣的错位在很大程度上是可预防的并发症。加深对手术程序的了解，可能会减少这种可能性，并减轻发生错位时的后果。(C) 2008 Wiley-Liss, Inc。
Objectives. Early clinical outcomes in selected high-risk patients undergoing catheter-based aortic valve replacement (AVR) compare favorably with conventional surgical AVR. Improved understanding of the mechanisms of success and failure of transcatheter AVR will likely improve outcomes further. To this end, we examined our experience during the developmental phases of transcatheter AVR and describe the causes and management of prosthetic valve malposition. Methods. Transcatheter balloon-expandable AVR was performed in 170 patients at two centers. Malposition was defined as prosthetic valve implantation in a location other than within the native valve. Patients were prospectively identified and followed as part of an ongoing database. Results. Valve malposition occurred in 9 of 170 patients (5.3%). Final position was supravalvular in eight of nine cases. In all cases, embolization to the ascending aorta occurred within a few cardiac cycles following deployment. Importantly, late embolization was not observed. In most cases, the prosthesis was uneventfully repositioned in the more distal aorta. Positioning was subvalvular in one patient (0.6%), resulting in a severe regurgitation with residual native valve stenosis. Implantation of a second transcatheter valve was attempted in six patients and was successful in all. Conventional AVR was performed in two patients, with early mortality in one. At late follow-up (mean 412 days), seven of nine patients remain alive (78%) with a functioning prosthesis and relief of aortic stenosis. Conclusions. Malposition of current balloon-expandable aortic valves is a largely preventable complication. An improved understanding of the procedure will likely minimize this possibility and mitigate the consequences should malposition occur. (C) 2008 Wiley-Liss, Inc.