马雨晨,魏来,潘文志

• 1:复旦大学附属中山医院心内科
• 2:复旦大学附属中山医院心外科

摘要(Abstract)：

随着经导管主动脉瓣置换术（TAVR）术后生物瓣膜的衰败及其相关并发症等不良结局（如心内膜炎、结构性瓣膜退化、传导阻滞、瓣周漏、局部血管并发症、冠状动脉阻塞、血栓、死亡及脑卒中等）的发生，其生物瓣膜衰败后再次手术处理逐渐引发关注。TAVR术后生物瓣膜衰败再次手术处理的方法：（1）常见的方法是再次TAVR(redo-TAVR);(2)经导管主动脉瓣置换外科取出术（TAVR-EXPLANT），即TAVR失败或生物瓣膜衰败后接受外科瓣膜移除手术并置入新瓣膜或修复。本研究重点对TAVR-EXPLANT的适应证、手术特点、风险结局进行综述，并对上述两种方法进行比较，以提供更具有医学实践价值的临床证据。

关键词(KeyWords)： 生物瓣膜衰败;再次经导管主动脉瓣置换术;经导管主动脉瓣置换外科取出术

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金项目（62531004）

作者(Author): 马雨晨,魏来,潘文志

参考文献(References)：

• [1]苏州工业园区东方华夏心血管健康研究院国家放射与治疗临床医学研究中心心脏瓣膜病介入中心专家组.心脏瓣膜病介入中心年度报告(2024)[J].中国介入心脏病学杂志,2025,33(11):614-619. DOI:10.3969/j.issn.1004-8812.2025.11.002.
• [2] Yakubov SJ,Van Mieghem NM,Oh JK,et al.Impact of transcatheter or surgical aortic valve performance on 5-year outcomes in patients at≥intermediate risk[J].J Am Coll Cardiol,2025,85(13):1419-1430. DOI:10.1016/j.jacc.2025.02.009.
• [3] Leon MB,Mack MJ,Pibarot P,et al.Transcatheter or surgical aorticvalve replacement in low-risk patients at 7 years[J].N Engl J Med,2026,394(8):773-783. DOI:10.1056/NEJMoa2509766.
• [4] Sathananthan J,Lauck S,Polderman J,et al.Ten year followup of high-risk patients treated during the early experience with transcatheter aortic valve replacement[J].Catheter Cardiovasc Interv,2021,97(3):E431-E437. DOI:10.1002/ccd.29124.
• [5] Ferrarotto L,ImmèS,Tamburino C,et al.Ten years of transcatheter aortic valve implantation in the NOTION study:the good and the bad[J].Eur Heart J Suppl,2025,27(Suppl 3):iii153-iii155.DOI:10.1093/eurheartjsupp/suaf039.
• [6] Jia Y,Maznyczka A,Boiago M,et al.Long-term durability of transcatheter aortic valves in patients with bicuspid aortic stenosis[J].Catheter Cardiovasc Interv,2025,106(3):1746-1757.DOI:10.1002/ccd.31742.
• [7] Zaid S,Bapat VN,Sathananthan J,et al.Challenges and future directions in redo aortic valve reintervention after transcatheter aortic valve replacement failure[J].Circ Cardiovasc Interv,2023,16(11):e012966.DOI:10.1161/CIRCINTERVENTIONS.123.012966.
• [8]医疗辅助技术(介入治疗)国家临床医学研究中心,苏州工业园区东方华夏心血管健康研究院.再次经导管主动脉瓣置换(RedoTAVR)中国专家共识[J].中国介入心脏病学杂志,2026,34(8):421-431. DOI:10.3969/j.issn.1004-8812.2026.08.001.
• [9] Lee GS,Tang G,Zaid S,et al.The current state of redo transcatheter aortic valve replacement(TAVR)and limitations:why TAVR explant is important as the valve reintervention strategy[J].Ann Cardiothorac Surg,2025,14(2):98-111. DOI:10.21037/acs-2024-etavr-0149.
• [10] Brescia AA,Kachroo P,Kaneko T.Transcatheter aortic valve replacement explant various techniques[J].Ann Cardiothorac Surg,2025,14(2):157-164. DOI:10.21037/acs-2024-etavr-12.
• [11] Jabagi H,Alemany VS,Jones E,et al.Early TAVR explantation due to a large mobile leaflet mass and severe prosthetic valve stenosis[J].JACC Case Rep,2025,30(18):103885. DOI:10.1016/j.jaccas.2025.103885.
• [12] Bapat VN,Zaid S,Fukuhara S,et al.Surgical explantation after TAVR failure:mid-term outcomes from the EXPLANT-TAVR international registry[J].JACC Cardiovasc Interv,2021,14(18):1978-1991. DOI:10.1016/j.jcin.2021.07.015.
• [13] Fukuhara S,Brescia AA,Shiomi S,et al.Surgical explantation of transcatheter aortic bioprostheses:results and clinical implications[J].J Thorac Cardiovasc Surg,2021,162(2):539-547.e1. DOI:10.1016/j.jtcvs.2019.11.139.
• [14] Hawkins RB,Hamilton BCS,Sukul D,et al.Increased risk of surgical aortic valve replacement after prior transcatheter vs. surgical aortic valve replacement with concomitant valve disease[J].Ann Thorac Surg,2025,120(4):722-728. DOI:10.1016/j.athoracsur.2025.01.005.
• [15] The Society of Thoracic Surgeons.The Society of Thoracic Surgeons launches new valve surgery risk calculators[EB/OL].The Society of Thoracic Surgeons.(2024-4-26)[2026-10-22].https://www.sts.org/press-releases/society-thoracic-surgeons-launches-new-valvesurgery-risk-calculators.
• [16] Marthy A,Liu J,Danduch E,et al.Surgical explantation for embolized transcatheter aortic valve replacement valve at distal aortic arch[J].Ann Thorac Surg Short Rep,2024,3(2):438-441.DOI:10.1016/j.atssr.2024.11.006.
• [17] Fukuhara S.Safe late explantation of transcatheter aortic bioprosthesis[J].Ann Thorac Surg,2020,110(6):e555-e558. DOI:10.1016/j.athoracsur.2020.04.089.
• [18] Yin K,Titsworth M,Yokoyama Y,et al.Y-incision aortic annular enlargement after surgical explantation of transcatheter aortic valve bioprosthesis[J].Ann Cardiothorac Surg,2025,14(2):173-175. DOI:10.21037/acs-2024-etavr-0152.
• [19] Inoue S,Hayatsu Y,Nomura H,et al.Minimally invasive TAVR explantation and aortic valve replacement in a patient with a retrosternal conduit[J].JACC Case Rep,2026,31(40):108895.DOI:10.1016/j.jaccas.2026.108895.
• [20] Fukuhara S,Kim KM,Yang B,et al.Reoperation following transcatheter aortic valve replacement:insights from 10 years'experience[J].J Thorac Cardiovasc Surg,2024,168(2):488-497.e3.DOI:10.1016/j.jtcvs.2023.04.029.
• [21] Zaid S,Kleiman NS,Goel SS,et al.Impact of transcatheter heart valve type on outcomes of surgical explantation after failed transcatheter aortic valve replacement:the EXPLANT-TAVR international registry[J].EuroIntervention,2024,20(2):e146-e157.DOI:10.4244/EIJ-D-23-00722.
• [22] Fukuhara S,Nguyen CTN,Yang B,et al.Surgical explantation of transcatheter aortic bioprostheses:balloon vs. self-expandable devices[J].Ann Thorac Surg,2022,113(1):138-145. DOI:10.1016/j.athoracsur.2021.01.041.
• [23] Bowdish ME,Habib RH,Kaneko T,et al.Cardiac surgery after transcatheter aortic valve replacement:trends and outcomes[J].Ann Thorac Surg,2024,118(1):155-162. DOI:10.1016/j.athoracsur.2024.03.024.
• [24] Hawkins RB,Deeb GM,Sukul D,et al.Redo surgical aortic valve replacement after prior transcatheter versus surgical aortic valve replacement[J].JACC Cardiovasc Interv,2023,16(8):942-953.DOI:10.1016/j.jcin.2023.03.015.
• [25] Fukuhara S,Suzuki T,Deeb GM,et al.Clinical outcomes of TAVR explant stratifi ed by original risk profi le:insights from 110TAVR explants[J].Ann Cardiothorac Surg,2025,14(2):122-130.DOI:10.21037/acs-2024-etavr-0104.
• [26] Durand E,Eltchaninoff H,Tchetche D,et al.Predictors of outcomes of reintervention after transcatheter aortic valve replacement:FRANCE 2 and FRANCE TAVI registries[J].J Am Coll Cardiol,2025,85(9):896-907. DOI:10.1016/j.jacc.2024.11.048.
• [27] Brescia AA,Deeb GM,Sang SLW,et al.Surgical explantation of transcatheter aortic valve bioprostheses:a statewide experience[J].Circ Cardiovasc Interv,2021,14(4):e009927. DOI:10.1161/CIRCINTERVENTIONS.120.009927.
• [28] Bjursten H,Rasmussen M,Nozohoor S, et al. Infective endocarditis after transcatheter aortic valve implantation:a nationwide study[J].Eur Heart J,2019,40(39):3263-3269. DOI:10.1093/eurheartj/ehz588.
• [29] Regueiro A,Linke A,Latib A,et al.Infective endocarditis following transcatheter aortic valve replacement:comparison of balloon-versus self-expandable valves[J].Circ Cardiovasc Interv,2019,12(11):e007938.DOI:10.1161/CIRCINTERVENTIONS.119.007938.
• [30] Malvindi PG,Luthra S,Sarvananthan S,et al.Surgical treatment of transcatheter aortic valve infective endocarditis[J].Neth Heart J,2021,29(2):71-77. DOI:10.1007/s12471-020-01494-y.
• [31] Still SA,Xie R,Vardas PN,et al.Explantation of transcatheter aortic bioprostheses in a very high risk population[J].Ann Thorac Surg,2026,121(1):120-126. DOI:10.1016/j.athoracsur.2025.04.025.
• [32] Reiter A,Schreyer J,Burri M,et al.Infective endocarditis after TAVR-surgical challenges and outcomes[J].J Clin Med,2025,14(21):7859. DOI:10.3390/jcm14217859.
• [33] Percy ED,Harloff MT,Hirji S,et al.Nationally representative repeat transcatheter aortic valve replacement outcomes:report from the centers for medicare and medicaid services[J].JACC Cardiovasc Interv,2021,14(15):1717-1726. DOI:10.1016/j.jcin.2021.06.011.
• [34] Tang GHL,Zaid S,Kleiman NS,et al.Explant vs. redoTAV R after transcatheter valve failure:mid-term outcomes from the EXPLANTORREDO-TAVR international registry[J]. JACC Cardiovasc Interv,2023,16(8):927-941. DOI:10.1016/j.jcin.2023.01.376.
• [35] Lupu L,Reddy P,Haberman D,et al.Decision-making in valve reintervention:redo-transcatheter aortic valve replacement vs. explant surgery[J].Cardiovasc Revasc Med,2026,85:28-32. DOI:10.1016/j.carrev.2025.08.018.
• [36] Fukuhara S,Tanaka D,Brescia AA,et al.Aortic valve reintervention in patients with failing transcatheter aortic bioprostheses:a statewide experience[J].J Thorac Cardiovasc Surg,2023,165(6):2011-2020.e5.DOI:10.1016/j.jtcvs.2021.08.057.
• [37] Mendez-Hirata G,Schmidt CW,Answini GA,et al.Repeat interventions after transcatheter aortic valve replacement:clinical characteristics and outcomes of redo transcatheter aortic valve replacement and surgical explants[J].Struct Heart,2025,9(5):100393. DOI:10.1016/j.shj.2024.100393.
• [38] Tarantini G,Tang GHL,Pilgrim T,et al.Clinical characteristics and outcomes of patients undergoing 3 aortic valve interventions:the THIRD multicenter registry[J]. JACC Cardiovasc Interv,2025,18(1):103-115. DOI:10.1016/j.jcin.2024.10.037.