Transcatheter valve-in-valve implantation for degenerated stentless aortic bioroots.

Autor:	Cekmecelioglu D; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.; Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas, USA., Preventza O; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.; Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas, USA., Dougherty KG; Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas, USA., Chatterjee S; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.; Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas, USA.; Division of General Surgery, Michael E. DeBakey Department of Surgery, Baylor College Medicine, Houston, Texas, USA., Green SY; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.; Office of Surgical Research, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA., Silva GV; Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA., Díez JG; Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.; Department of Cardiology, Texas Heart Institute, Houston Texas, USA., Coselli JS; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.; Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas, USA.
Jazyk:	angličtina
Zdroj:	Annals of cardiothoracic surgery [Ann Cardiothorac Surg] 2021 Sep; Vol. 10 (5), pp. 641-650.
DOI:	10.21037/acs-2021-tviv-124
Abstrakt:	Background: Open surgical repair of a failed valve-sparing aortic root replacement (VSARR) or stentless bioroot aortic root replacement (bio-ARR) entails significant operative risks. Whether valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) is feasible in patients with a previous VSARR or stentless bio-ARR remains unclear, given lingering concerns about the ill-defined aortic annulus in these patients and the potential for coronary obstruction. We present our experience with patients who had a previous VSARR or stentless bio-ARR and underwent ViV-TAVR to repair a degenerated aortic valve with combined valvular disease, aortic insufficiency and aortic stenosis. Methods: In this retrospective data review, we identified and analyzed consecutive patients with a previous VSARR or stentless bio-ARR who underwent ViV-TAVR between December 1, 2014 and August 31, 2019. Results: ViV-TAVR was performed in twelve high-risk patients with previous VSARR or bio-ARR during the study period. Of these, seven received Medtronic Freestyle porcine stentless bioprosthetic aortic roots, three received homograft aortic roots, one underwent a Ross procedure and one underwent VSARR. ViV-TAVR restored satisfactory valve function in all patients, and technical success was 100%. No patient had more than mild regurgitation after implantation. No thirty-day mortality was seen. One patient had major bleeding after transapical access, one patient had a transient ischemic stroke, and one patient needed permanent pacemaker implantation. At a median last follow-up of 21.5 months (interquartile range, 9.0-69.0 months), all patients remained alive and had satisfactory valve function. Conclusions: In this study, ViV-TAVR was a clinically effective option for treating patients with a failed stentless bio-ARR or previous VSARR. Short-term and intermediate-term results after these procedures were favorable. These findings may have important implications for treating high-risk patients with structural aortic root deterioration and call for better transcatheter heart valves that are suitable for treating aortic insufficiency. Competing Interests: Conflicts of Interest: OP participates in clinical trials with and/or consults for Terumo Aortic and W.L. Gore & Associates. SC has participated in advisory boards for Edwards Lifesciences & La Jolla Pharmaceutical Corp. JSC participates in clinical studies with and/or consults for Terumo Aortic, Medtronic, W.L. Gore & Associates, CytoSorbents, and Abbott Laboratories and receives royalties and grant support from Terumo. The other authors have no conflicts of interest to declare. (2021 Annals of Cardiothoracic Surgery. All rights reserved.)
Databáze:	MEDLINE
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