Outcomes and Safety of Percutaneous Aortic Valve Replacement
Outcomes and Safety of Percutaneous Aortic Valve Replacement
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DOI：
10.1016/j.jacc.2008.11.059
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发表时间：
2009-05-19
影响因子：
24
通讯作者：
Cribier, Alain G.
中科院分区：
文献类型：
--
作者：
Zajarias, Alan;Cribier, Alain G.
经导管主动脉瓣置换术的概念是为了给严重症状性主动脉瓣狭窄的患者提供一种治疗方案，这些患者不被认为是手术瓣膜置换术的好候选人。最初的尝试由于血管通路问题和缺乏合适的工具而变得复杂。随着时间和经验的积累，我们解决了早期的问题，并明确了瓣膜尺寸、瓣膜定位和患者选择的概念。技术进步允许使用更小的动脉鞘来减少血管创伤，特殊的导管来促进瓣膜的输送，以及对瓣膜假体的治疗，以确保更长的耐用性。5年后，经导管主动脉瓣置换术的数量显著增加，随着这项技术的日益普及，这种情况可能会继续下去。目前，有两种瓣膜型号，Edwards SAPIEN瓣膜（Edwards Lifescience, Irvine, California）和CoreValve ReValving系统（CoreValve Inc., Irvine, California），在全球范围内用于治疗症状性主动脉狭窄的病例超过4000例。中期随访未发现再狭窄或人工瓣膜功能障碍的证据。可根据血管通道的质量和所使用的假体类型选择经股动脉和经根尖输送途径。目前正在进行的随机试验将确认程序安全性，并指导这项技术的适用性。[J]中华医学会心脏科杂志2009；53:1829- 1836](C) 2009
The concept of transcatheter aortic valve replacement was developed with the goal of offering a therapeutic solution to patients with severe symptomatic aortic stenosis who are not considered good candidates for surgical valve replacement. Initial attempts were complicated by vascular access problems and lack of appropriate tools. With time and experience, early problems were solved and the concepts of valve sizing, valve positioning, and patient selection were defined. Technological improvements allowed the use of smaller arterial sheaths to decrease vascular trauma, special catheters to facilitate valve delivery, and treatments on the valve prostheses that would ensure longer durability. After 5 years, the number of transcatheter aortic valve replacements has grown significantly, and will likely continue as this technology becomes increasingly available. Currently, 2 valve models, the Edwards SAPIEN valve (Edwards Lifescience, Irvine, California) and the CoreValve ReValving system (CoreValve Inc., Irvine, California), have used in over 4,000 cases worldwide for the treatment of symptomatic aortic stenosis. Midterm follow-up shows no evidence of restenosis or prosthetic valve dysfunction. Transfemoral and transapical delivery routes can be selected depending on the quality of vascular access and the type of prosthesis used. Randomized trials that are currently underway will confirm procedural safety and guide the applicability of this technology. (J Am Coll Cardiol 2009; 53: 1829-36) (C) 2009 by the American College of Cardiology Foundation