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首页> 外文期刊>Structural heart : >Bioprosthetic Valve Remodeling of Trifecta Surgical Valves to Facilitate Valve-in-Valve TAVR
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Bioprosthetic Valve Remodeling of Trifecta Surgical Valves to Facilitate Valve-in-Valve TAVR

机译：很定高于生物瓣膜,重塑节节胜利外科瓣膜促进Valve-in-Valve TAVR

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Background: Valve-in-valve transcatheter aortic valve replacement (VIV TAVR) is an effective treatment for high-risk patients with failed surgical bioprosthetic valves, but may be complicated by patient-prosthesis mismatch (PPM). We describe a novel technique - bioprosthetic valve remodeling (BVR) - to distort the frame of Trifecta surgical valves with a high-pressure balloon inflation, allowing for improved expansion and hemodynamics of the transcatheter heart valve (THV). Methods: We performed bench testing of BVR by deploying Portico THVs (Abbott, Minneapolis, MN, USA) inside Trifecta GT valves both at baseline and following BVR. Fluoroscopic and video imaging was performed to assess Trifecta frame distortion, THV expansion, and leaflet motion. Hydrodynamic testing was performed to determine transvalvular gradient under baseline conditions and following BVR. We performed 6 clinical cases of VIV TAVR with Evolut R THVs (Medtronic, Minneapolis, MN), followed by BVR. Hemodynamic measurements and calculation of the effective orifice area (EOA) were performed at baseline, immediately after implantation of the THV, and after BVR. Results: BVR resulted in an increase in the post-to-post diameter in Trifecta valves, and a lower transvalvular gradient after THV implantation. VIV TAVR and BVR was successful in all cases, with no major short-term complications. The mean baseline transvalvular gradient was 47.5 ± 14.4 mmHg, which was reduced to 21.0 +- 6.2 mmHg after THV implantation, and further reduced to 11.7 ± 4.1 mmHg following BVR. Gradients were stable at 1 month follow up. Conclusion: BVR distorts the frame of Trifecta valves, improving THV expansion and procedural hemodynamics of VIV TAVR.
机译：背景:Valve-in-valve经导管主动脉瓣膜置换(韦夫TAVR)是一种有效的高危患者治疗失败外科瓣膜,但可能复杂的二尖瓣置换术(PPM)不匹配。我们描述了一个新颖的技术——bioprosthetic阀改造(BVR)——扭曲的框架给手术用高压阀门气球膨胀,改善和血液动力学的经导管扩张心脏瓣膜(THV)。测试部署的BVR门廊THVs(阿伯特,明尼阿波利斯,美国)内给GT阀门在基线和BVR之后。和视频成像进行了评估给框架变形,THV扩张传单运动。执行确定transvalvular梯度在基线条件下和BVR之后。执行6临床病例韦夫TAVRBVR紧随其后。计算有效孔面积(地址结束)后立即进行基线,BVR THV植入,和之后。post-to-post BVR导致增加直径在三连胜式阀,较低transvalvular THV植入术后梯度。薇芙TAVR BVR是成功的在所有情况下,没有主要的短期并发症。基线transvalvular梯度为47.5±14.4毫米汞柱,这是减少到21.0 + - 6.2毫米汞柱THV植入,进一步减少到11.7±BVR后4.1毫米汞柱。1个月跟进。三连胜式阀门的框架,提高THV扩张和程序的血液动力学韦夫TAVR。

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