患有供体主动脉瓣疾病的心脏移植受者经导管主动脉瓣置换术:文献系统综述。

IF 1.3 American journal of cardiovascular disease Pub Date : 2023-08-15 eCollection Date: 2023-01-01
Saeed Shoar, Ashok Chaudhary, Varinder Bansro, Mohammad Sadegh Asadi
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引用次数: 0

摘要

背景:尽管心脏移植(HTx)受者患主动脉瓣疾病(AVD)的手术风险很高,但经皮主动脉瓣置换术(TAVR)在该患者群体中几乎没有报道是一种可行的选择。方法:进行系统回顾,以确定报告HTx受体发生供心AVD并接受TAVR的结果的研究。如果研究提供了HTx受体的个体水平数据,这些受体在供体心脏上接受了TAVR,则研究符合条件。综述文章、社论或评论、缺乏原始数据的研究,或报道HTx受者动静脉畸形手术瓣膜置换术的研究均被排除在外。结果:共有15例病例报告,包括15名患者,描述了接受TAVR的HTx接受者的特征和结果。其中包括13名男性和2名女性,平均年龄为63.6±15岁。HTx的适应症分别为42.9%、35.7%和21.4%的患者为非缺血性扩张型心肌病、缺血性心肌病和缺血性扩张型心肌。HTx受试者主动脉瓣置换术(AVR)的主要适应症是主动脉狭窄(73.3%)。由于50%以上的患者手术风险较高,因此经皮入路优于手术AVR。TAVR前的跨瓣压力梯度和峰值主动脉压力梯度在TAVR后均下降。TAVR术后所有患者的瓣膜旁渗漏均为轻微/无至轻度。在中位随访6个月时,大多数患者在TAVR后恢复顺利,症状没有复发,超声心动图也没有变细。结论:对于发生供体主动脉瓣疾病的HTx受体,TAVR似乎是一种可行的选择。然而,对更换主动脉瓣的长期生存能力以及接受TAVR的HTx接受者的临床和超声心动图结果知之甚少。
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Transcatheter aortic valve replacement among heart transplant recipients with donor aortic valve diseases: a systematic review of the literature.

Background: Despite high surgical risk among heart transplant (HTx) recipients, who develop aortic valve diseases (AVD), transcutaneous aortic valve replacement (TAVR) has been scarcely reported as a viable option in this patient population.

Methods: A systematic review was conducted to identify studies reporting the outcomes of HTx recipients who developed AVD of the donor heart and underwent TAVR. Studies were eligible if they provided individual-level data for HTx recipients, who underwent TAVR on the donor heart. Review articles, editorials or commentaries, studies lacking original data, or those reporting surgical valve replacement for AVD in HTx recipients were excluded.

Results: A total of 15 case reports, encompassing 15 patients, describing characteristics and outcomes of HTx recipients undergoing TAVR were included. These included 13 males and 2 females with an average age of 63.6±15 years. The indications for HTx were non-ischemic dilated cardiomyopathy, ischemic cardiomyopathy and ischemic dilated cardiomyopathy in 42.9%, 35.7%, and 21.4% of the patients, respectively. The main indication for aortic valve replacement (AVR) among HTx recipients was aortic stenosis (73.3%). The transcutaneous approach was preferred over surgical AVR due to high surgical risk in > 50% of the patients. Both pre-TAVR transvalvular pressure gradient and the peak aortic pressure gradient decreased after the TAVR. Paravalvular leak was minimal/none to mild in all the patients post-TAVR. Most patients had an uneventful post-TAVR recovery with no recurrence of the symptoms or echocardiographic finings at a median follow-up of 6 months.

Conclusions: TAVR seems to be a viable option for HTx recipients who develop donor aortic valve diseases. However, there is a paucity of knowledge on the long-term survivability of the replaced aortic valves and the clinical and echocardiographic outcomes of HTx recipients undergoing TAVR.

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来源期刊
American journal of cardiovascular disease
American journal of cardiovascular disease CARDIAC & CARDIOVASCULAR SYSTEMS-
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21
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