Aortic valve replacement after previous TAVI

D. A. Titov, M. N. Sorkomov, D. Pursanova, M. I. Fedoseykina, S. Babenko, R. Muratov
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Abstract

Endovascular surgery for aortic valve defects has proven itself well in elderly patients with severe comorbidities competing with the underlying disease. However, the risk of dysfunction resulting from structural degeneration of bioprosthetic heart valve and prosthetic valve endocarditis remains high. Repeated surgeries are associated with complications, but open surgery is the only method of treatment in this group of patients.Objective: to describe a series of reinterventions for prosthetic valve dysfunction occurring after TAVI.Material and methods. From 2015 to 2022, at the Department of Emergency Surgery for Acquired Heart Diseases (Head, Professor R.M. Muratov), Bakulev Research Center for Cardiovascular Surgery, 6 reoperations were performed in patients who had previously undergone transcatheter aortic valve implantation (TAVI). The average age of patients at the time of TAVI and at the time of reoperation was 70.6 years (62–83) and 74.3 years (70–84), respectively. The EuroSCORE II predicted risk of mortality at the time of reintervention was 42.2% (21.7–87.6). The mean time to reoperation was 42 months. Indications for reoperation were early active prosthetic endocarditis (4 cases) and structural valve degeneration (2 cases).Results. At the hospital stage, 1 patient died of acute heart failure; the operation was performed for vital indications in conditions of extreme initial severity. In three patients, the early postoperative period was uneventful. One patient required intra-aortic balloon counterpulsation (IABP) due to heart failure, and 1 patient was implanted with permanent pacemaker. The average time of hospitalization was 14 days. Patients with active prosthetic endocarditis received a 6-week course of antibiotic therapy. The function of the implanted valves was satisfactory.Conclusions. Aortic valve replacement after previous TAVI is an emergency operation and represents the only way to treat valve dysfunction. Under active prosthetic endocarditis, timely surgery can save this patient cohort.
既往 TAVI 后的主动脉瓣置换术
主动脉瓣缺损的血管内手术在患有严重并发症的老年患者中已被证明效果良好。然而,生物人工心脏瓣膜结构退化和人工瓣膜心内膜炎导致功能障碍的风险仍然很高。重复手术与并发症有关,但开放手术是这类患者的唯一治疗方法。目的:描述TAVI术后发生的人工瓣膜功能障碍的一系列再介入治疗。2015年至2022年,巴库廖夫心血管外科研究中心后天性心脏病急诊外科(主任:R.M. Muratov教授)对曾接受过经导管主动脉瓣植入术(TAVI)的患者进行了6次再手术。患者接受经导管主动脉瓣植入术和再次手术时的平均年龄分别为 70.6 岁(62-83 岁)和 74.3 岁(70-84 岁)。再介入时的EuroSCORE II预测死亡风险为42.2%(21.7-87.6)。再次手术的平均时间为 42 个月。再次手术的指征为早期活动性人工心内膜炎(4例)和结构性瓣膜退化(2例)。在医院阶段,1名患者死于急性心力衰竭;手术是在最初病情极其严重的情况下,出于重要的适应症而进行的。三名患者的术后早期并无大碍。一名患者因心衰需要主动脉内球囊反搏器(IABP),一名患者植入了永久起搏器。平均住院时间为 14 天。活动性人工心内膜炎患者接受了为期6周的抗生素治疗。植入瓣膜的功能令人满意。主动脉瓣置换术是一种紧急手术,是治疗瓣膜功能障碍的唯一方法。在人工心内膜炎活跃的情况下,及时手术可以挽救这部分患者。
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