外巻き弁植込み後早期の人工弁機能不全に対する再手術の1例

Early Structural Valve Deterioration of Trifecta Aortic Bioprosthesis：Report of a Case

はじめに　いわゆる外巻き弁であるTrifecta弁（St. Jude Medical社）は薄いチタン製のステントを1枚のウシ心膜で被覆した生体弁であり，術後早期の良好な弁機能が報告されている1）．しかし一方で，この人工弁を使用した大動脈弁置換術（AVR）後早期の構造的人工弁破壊（SVD）に対する再手術の報告も散見される2）．Trifecta植込み後7年目の弁尖亀裂によるSVDに対する再弁置換術を経験したので報告する．

Trifecta, an externally mounted bovine pericardial bioprosthetic aortic valve, provides excellent hemodynamic performance；however, early structural deterioration of this valve has been reported. A 60-year-old man with progressive dyspnea was admitted to the emergency unit of our institution. Seven years prior, he underwent aortic valve replacement with 23-mm Trifecta valve. Severe aortic valve regurgitation and stenosis due to structural valve deterioration was diagnosed and redo aortic valve replacement using an Inspiris valve was performed. Intraoperative findings revealed a large laceration in the left coronary cusp adjacent to the non coronary-left coronary commissure and leaflet calcification. Further, circumferential fibrous pannus ingrowth at the inflow portion was also noted. To avoid anticoagulation therapy and repeat surgery, mitral valve plasty and left atrial appendage clipping were performed simultaneously. Postoperative course was uneventful, and he was transferred to a rehabilitation facility on 36th postoperative day.