Webb John G, Pasupati Sanjeevan, Humphries Karin, Thompson Christopher, Altwegg Lukas, Moss Robert, Sinhal Ajay, Carere Ronald G, Munt Brad, Ricci Donald, Ye Jian, Cheung Anson, Lichtenstein Sam V
Division of Cardiology, St Paul's Hospital and the Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
Circulation. 2007 Aug 14;116(7):755-63. doi: 10.1161/CIRCULATIONAHA.107.698258. Epub 2007 Jul 23.
Percutaneous aortic valve replacement represents an endovascular alternative to conventional open heart surgery without the need for sternotomy, aortotomy, or cardiopulmonary bypass.
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 cm2. 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.
Percutaneous valve replacement may be an alternative to conventional open heart surgery in selected high-risk patients with severe symptomatic aortic stenosis.
经皮主动脉瓣置换术是一种血管内治疗方法，可替代传统的心脏直视手术，无需进行胸骨切开、主动脉切开或体外循环。
对50例有症状的严重主动脉瓣狭窄患者尝试采用经股动脉途径经导管植入球囊扩张式支架瓣膜，这些患者一致认为传统心脏直视手术的风险非常高。86%的患者瓣膜植入成功。术中死亡率为2%。出院中位时间为5天（四分位间距，4至13天）。逻辑欧洲心脏手术风险评估系统风险评分为28%的患者30天死亡率为12%。随着经验的积累，手术成功率从前25例患者的76%提高到后25例患者的96%（P=0.10），30天死亡率从16%降至8%（P=0.67）。成功的瓣膜置换与超声心动图瓣膜面积从0.6±0.2增加到1.7±0.4 cm²相关。轻度瓣周反流常见但耐受性良好。瓣膜植入后，左心室射血分数（P<0.0001）、二尖瓣反流（P=0.01）和心功能分级（P<0.0001）有显著改善。1年时仍保持改善。中位随访359天未观察到结构性瓣膜退变。
对于选定的有症状的严重主动脉瓣狭窄高危患者，经皮瓣膜置换术可能是传统心脏直视手术的一种替代方法。
