Development of transcatheter aortic valve implantation (TAVI): A 20-year odyssey
Development of transcatheter aortic valve implantation (TAVI): A 20-year odyssey
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DOI：
10.1016/j.acvd.2012.01.005
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发表时间：
2012-03-01
影响因子：
3
通讯作者：
Cribier, Alain
中科院分区：
文献类型：
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作者：
Cribier, Alain
本课题组开展经导管主动脉瓣植入术（TAVI）已有20年的历史。1993年，尸检研究证实了钙化性主动脉瓣狭窄的瓣内支架植入术的概念。2000年，第一批球囊扩张瓣膜原型在动物模型中进行了测试。2002年在鲁昂进行了首次人体植入，随后在我们中心的同情病例中进行了两个前瞻性系列。TAVI于2004年在Edwards Lifesciences的手中飞行，在设备和方法上有重大改进。与此同时，推出了自膨胀CoreValve。数千名高手术风险患者参加了可行性研究，导致两种器械在2007年获得了欧洲认证（CE）标志。许多上市后登记研究显示，随着经验的增加和技术的改进，手术和中期结果显著改善，并发症发生率降低。美国随机PARTNER研究的结果最近证实了TAVI在不可手术和高手术风险患者中的重要地位。迄今为止，全世界已有超过50，000名患者从TAVI中受益（2011年法国33个中心的2300名患者），并且这一数字还在不断增加。最佳的多学科合作和经过正式培训的经验丰富的医生是成功的关键。在未来几年，可能会将适应症扩展到低风险患者，但应谨慎研究。在首例人体手术十年后，TAVI仍然存在，未来充满希望。(C)2012年Elsevier Masson SAS。All rights reserved.
The development of transcatheter aortic valve implantation (TAVI) by our group has been a 20-year odyssey. In 1993, postmortem studies validated the concept of intravalvular stenting in calcific aortic stenosis. The first prototypes of balloon-expandable valves were tested in an animal model in 2000. The first-in-man implantation was performed in Rouen in 2002, rapidly followed by two prospective series in compassionate cases in our centre. TAVI took flight in 2004 in the hands of Edwards Lifesciences, with major improvements in devices and approaches. At the same time, the self-expanding CoreValve was launched. Thousands of high-surgical-risk patients were enrolled in feasibility studies, leading to the Conformite Europeenne (CE) mark being granted in 2007 for the two devices. A number of postmarketing registries have shown dramatic improvements in procedural and midterm results and decreased complication rates, with more experience and improved technology. The results of the randomized PARTNER study in the USA recently confirmed the important place of TAVI in non-operable and high-surgical-risk patients. To date, more than 50,000 patients have benefited from TAVI worldwide (2300 patients in 33 centres in France in 2011) and the number is consistently increasing. An optimal multidisciplinary collaboration and formally trained experienced physicians are the keys to success. An extension of indications to lower-risk patients might be expected in the coming years but should be cautiously investigated. Ten years after the first-in-man case, TAVI is here to stay and the future is promising. (C) 2012 Elsevier Masson SAS. All rights reserved.