所属 医学部 医学科（東京女子医科大学病院） 職種 講師
|発表タイトル||Relay implantation of biological prostheses in the aortic position|
|会議名||The 119th Annual Congress of Japan Surgical Society|
|主催者||Japan Surgical Society|
|発表者・共同発表者||◎NIINAMI Hiroshi, DOMOTO Satoru, ISOMURA Shogo, KOMAGAMINE Masahide, HATTORI Kaoru, NAKAMAE Kosuke|
Due to advancement in TAVI devices, the only remaining Achille's heel of TAVI over SAVR is probably durability. Since it is inevitable that the indication of TAVI in elderly patients will continue to grow over the next several years, it is essential to design a valve in valve (VIV) treatment strategy in order for SVAR to survive. The durability of the currently available bioprosthetic valves when SAVR is performed in patients in their early 60s is about 15 years. Given the current life expectancy of Japanese patients it is very likely that these younger patients will require more than one VIV procedure. However, the EOA after VIV becomes smaller than that of the initial bioprosthetic valve, and the EOA after a second VIV will be even smaller. Since the selected size of the bioprosthetic valves used for SAVR in Japan is often at least one size smaller than that of western countries, performing VIV twice is not an ideal treatment in terms of PPM. AT the same, redo SAVR in relatively younger patients can still be safely performed. Therefore, it should be possible care for patients into their 90s by using a relay implantation strategy for bioprosthetic valves where the initial SAVR is performed with MICS, then next redo SAVR is then done through median sternotomy, and then finally a VIV. This strategy should make it possible to treat patients their entire life using only bioprosthetic valves thereby minimizing perioperative complications and reducing the concern of PPM in Japan.