Berry Colin, Asgar Anita, Lamarche Yoan, Marcheix Bertrand, Couture Pierre, Basmadjian Arsène, Ducharme Anique, Laborde Jean-Claude, Cartier Raymond, Bonan Raoul
Department of Cardiology, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.
Catheter Cardiovasc Interv. 2007 Oct 1;70(4):610-6. doi: 10.1002/ccd.21282.
Percutaneous aortic valve replacement (PAVR) is an emerging therapy for nonsurgical patients with severe aortic stenosis (AS). We investigated whether novel therapeutic approaches may facilitate AVR outcomes for high-risk patients.
Eleven patients [n = 6 (54%) men] aged 82 +/- 10 years underwent PAVR after being refused for open surgery. The mean+/-SD AV area and left ventricular ejection fraction (LVEF) of these patients was 0.56 +/- 0.19 cm(2) and 49 +/- 17%, respectively, with severe functional limitation (NYHA class III (n = 8) and IV (n = 3)). One patient underwent PAVR combined with simultaneous percutaneous coronary intervention (PCI). Two male patients needed left iliac artery angioplasty. A percutaneous ventricular assist device (PVAD) was used in the most recent case. Compared with pre-PAVR, mean AV area (1.3 +/- 0.4 cm(2); P < 0.001) and LVEF (56 +/- 11%; P < 0.001) increased. One man had a peri-procedural stroke and died 5 days post-PAVR. Four other patients died within 4 months of hospital discharge. The median duration of survival of the survivors was 305 (range 249-431) days.
Novel percutaneous techniques facilitate CoreValve PAVR (21 Fr.). Future lower profile devices (e.g. 18 Fr. Generation III CoreValve) should permit inclusion of a broader spectrum of high-risk patients. PAVR may evolve toward a full percutaneous approach.
经皮主动脉瓣置换术（PAVR）是一种针对严重主动脉瓣狭窄（AS）非手术患者的新兴治疗方法。我们研究了新的治疗方法是否能改善高危患者的主动脉瓣置换术预后。
11例患者（6例（54%）男性），年龄82±10岁，在被拒绝接受开放手术后接受了PAVR。这些患者的平均±标准差主动脉瓣面积和左心室射血分数（LVEF）分别为0.56±0.19 cm²和49±17%，功能严重受限（纽约心脏协会III级（8例）和IV级（3例））。1例患者接受了PAVR联合同期经皮冠状动脉介入治疗（PCI）。2例男性患者需要进行左髂动脉血管成形术。最近1例使用了经皮心室辅助装置（PVAD）。与PAVR前相比，平均主动脉瓣面积（1.3±0.4 cm²；P<0.001）和LVEF（56±11%；P<0.001）增加。1例男性患者发生围手术期卒中，在PAVR后5天死亡。另外4例患者在出院后4个月内死亡。幸存者的中位生存时间为305天（范围249 - 431天）。
新的经皮技术有助于CoreValve PAVR（21 Fr.）。未来更小尺寸的装置（如18 Fr.第三代CoreValve）应能纳入更广泛的高危患者群体。PAVR可能会朝着完全经皮的方法发展。
