球囊扩张式经导管主动脉瓣植入治疗LVAD相关自身主动脉瓣关闭不全：单中心经验
Balloon-Expandable Transcatheter Aortic Valve Implantation for LVAD-Associated Native Aortic Insufficiency: A Single-Center Experience
长期使用左心室辅助装置（LVAD，植入体内帮助心脏泵血的机械泵）可引起自身主动脉瓣关闭不全，形成血液在心脏内无效循环，加重心衰。外科换瓣风险高，经导管主动脉瓣植入（TAVI，通过导管把人工瓣膜送到位，无需开胸）是替代方案，但这类患者瓣环解剖复杂、缺少钙化锚定。本研究单中心回顾14例LVAD患者，采用按解剖定制的球囊扩张瓣膜和约15%—30%的瓣环 oversizing（选择比瓣环略大的瓣膜）策略，术中死亡为0，71.4%达到技术成功，28.6%需植入第二个瓣膜，院内死亡率21.4%，死因多为低心排和多器官衰竭而非器械失效。出院存活者无中度以上残余反流。
为什么推荐给您：TAVI用于LVAD相关主动脉瓣反流的新适应证单臂经验，样本小但技术策略有新意。
不需要生物学背景，多打比方
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摘要Abstract
BACKGROUND: Aortic insufficiency (AI) during long-term left ventricular assist device (LVAD) support creates a maladaptive recirculatory loop that impairs forward flow, increases left ventricular filling pressures, leading to progressive congestion, and accelerates right ventricular dysfunction. Surgical correction carries high risk, making transcatheter aortic valve implantation (TAVI) an alternative strategy, although outcomes are challenged by complex annular geometry and the absence of calcific anchoring.
METHODS: We performed a retrospective single-center analysis of consecutive LVAD-supported patients undergoing TAVI for native AI. Annular sizing was area-based with a predefined oversizing strategy of approximately 15-30%, adjusted to annular geometry. Balloon-expandable valves were implanted using controlled deployment under rapid pacing and temporary LVAD flow reduction. Outcomes were assessed according to VARC-3 definitions.
RESULTS: Fourteen patients underwent TAVI. The cohort demonstrated high anatomical complexity, including annular eccentricity (median 0.21 [IQR 0.19-0.23]), horizontal aorta (42.9%), and flared left ventricular outflow tract (LVOT) morphology (50%). Median annular area was 528 mm2 (IQR 487-574), with area-derived diameter 25.9 mm (IQR 24.9-27.0). Mean oversizing was 21.9% (median 20.0%; range 15.1-30.3%). Technical and VARC-3 device success were achieved in 71.4%. Second valve implantation occurred in 28.6%. Procedural mortality was 0%. In-hospital mortality (21.4%) was related to low cardiac output and multi-organ dysfunction rather than device failure. No survivor had moderate or greater residual AI at discharge.
CONCLUSIONS: In anatomically complex LVAD patients, an anatomy-driven balloon-expandable TAVI strategy achieved elimination of clinically significant AI with zero procedural mortality. In our interpretation, mortality reflected the advanced stage of heart failure at the time of intervention rather than acute device-related failure.