Percutaneous transarterial aortic valve replacement in selected high-risk patients with aortic stenosis
Percutaneous transarterial aortic valve replacement in selected high-risk patients with aortic stenosis
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DOI：
10.1161/circulationaha.107.698258
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发表时间：
2007-08-14
期刊：
影响因子：
37.8
通讯作者：
Lichtenstein, Sam V.
中科院分区：
文献类型：
--
作者：
Webb, John G.;Pasupati, Sanjeevan;Lichtenstein, Sam V.
背景-经皮主动脉瓣置换术是传统心内直视手术的血管内替代方法，不需要胸骨切开术，胸骨切开术，方法和结果-球囊的经导管植入-在50例有症状的严重主动脉瓣狭窄患者中尝试了使用股动脉入路的可扩张支架瓣膜，非常高。86%的患者成功植入瓣膜。术中死亡率为2%。出院回家的平均时间为5天（四分位数范围，4至13）。在logistic欧洲心脏手术风险评估系统风险评分为28%的患者中，30天时的死亡率为12%。随着经验的积累，手术成功率从前25例患者的76%增加到后25例患者的96%（P = 0.10），30天死亡率从16%下降到8%（P = 0.67）。成功的瓣膜置换术与超声心动图瓣膜面积从0.6 +/- 0.2增加到1.7 +/- 0.4 cm相关（2）。轻度瓣周返流很常见，但耐受性良好。瓣膜植入后，左心室射血分数（P < 0.0001）、二尖瓣反流（P = 0.01）和功能分级（P < 0.0001）均明显改善。改善维持在1年。结构性瓣膜恶化没有观察到平均随访359 day. Conclusion-Percutaneous瓣膜置换术可能是一种替代传统的心内直视手术在选定的高危患者严重症状性主动脉瓣狭窄。
Background - Percutaneous aortic valve replacement represents an endovascular alternative to conventional open heart surgery without the need for sternotomy, aortotomy, or cardiopulmonary bypass.Methods and Results - Transcatheter implantation of a balloon- expandable stent valve using a femoral arterial approach was attempted in 50 symptomatic patients with severe aortic stenosis in whom there was a consensus that the risks of conventional open heart surgery were very high. Valve implantation was successful in 86% of patients. Intraprocedural mortality was 2%. Discharge home occurred at a median of 5 days ( interquartile range, 4 to 13). Mortality at 30 days was 12% in patients in whom the logistic European System for Cardiac Operative Risk Evaluation risk score was 28%. With experience, procedural success increased from 76% in the first 25 patients to 96% in the second 25 ( P = 0.10), and 30- day mortality fell from 16% to 8% ( P = 0.67). Successful valve replacement was associated with an increase in echocardiographic valve area from 0.6 +/- 0.2 to 1.7 +/- 0.4 cm(2). Mild paravalvular regurgitation was common but was well tolerated. After valve insertion, there was a significant improvement in left ventricular ejection fraction ( P < 0.0001), mitral regurgitation ( P = 0.01), and functional class ( P < 0.0001). Improvement was maintained at 1 year. Structural valve deterioration was not observed with a median follow- up of 359 days.Conclusion - Percutaneous valve replacement may be an alternative to conventional open heart surgery in selected high- risk patients with severe symptomatic aortic stenosis.