Sakata Yoshihito, Syed Zubair, Salinger Michael H, Feldman Ted
Evanston Northwestern Healthcare, Evanston, Illinois, USA.
Catheter Cardiovasc Interv. 2005 Mar;64(3):314-21. doi: 10.1002/ccd.20300.
Percutaneous balloon aortic valvuloplasty (BAV) has been limited predominantly to a palliative treatment for poor surgical candidates with critical aortic stenosis and multiple high-risk or comorbid conditions. The most commonly used technique for BAV is the retrograde approach, in which the balloon is passed via the femoral artery using 12-14 Fr sheaths. We compared an antegrade transseptal approach using the Inoue balloon vs. the retrograde transarterial approach using conventional balloons. The antegrade group had an improved acute hemodynamic outcome, including 20% additional increase of aortic valve area and 20% greater reduction of transaortic valve gradient compared to the retrograde approach. Preclosure with the Perclose device was used for the 14 Fr venous access sites, resulting in immediate hemostasis, minimizing the need for transfusion, and diminishing the period of bed rest. The improved acute efficacy and relative ease of venous access for the antegrade approach facilitate BAV by eliminating the need for large-caliber arterial access sheaths. The antegrade approach also incorporates technical elements necessary for percutaneous aortic valve replacement and may have expanded applications as an adjunct to this developing therapy. The impact of improved acute results on the long-term clinical outcome for this patient group will require further study.
经皮球囊主动脉瓣成形术（BAV）主要局限于作为患有严重主动脉瓣狭窄且有多种高风险或合并症的手术不佳候选者的姑息治疗。BAV最常用的技术是逆行法，即使用12-14F鞘管经股动脉送入球囊。我们比较了使用Inoue球囊的顺行经房间隔法与使用传统球囊的逆行经动脉法。与逆行法相比，顺行组的急性血流动力学结果有所改善，包括主动脉瓣面积额外增加20%以及跨主动脉瓣压差降低20%。对于14F静脉入路部位，使用Perclose装置进行预闭合，可实现即时止血，减少输血需求，并缩短卧床休息时间。顺行法改善的急性疗效和相对容易的静脉入路通过消除对大口径动脉入路鞘管的需求而便于进行BAV。顺行法还纳入了经皮主动脉瓣置换所需的技术要素，并且作为这种正在发展的治疗方法的辅助手段可能有更广泛的应用。改善的急性结果对该患者群体长期临床结局的影响需要进一步研究。
