Zahn Ralf, Schiele R, Kilkowski C, Klein B, Schwarz A K, Zeymer U, Lehmann A, Cornelius B, Horack M, Saggau W, Werling C
Abteilung für Kardiologie, Herzzentrum Ludwigshafen, Ludwigshafen.
Dtsch Med Wochenschr. 2010 Aug;135(33):1589-95. doi: 10.1055/s-0030-1262450. Epub 2010 Aug 17.
Percutaneous transcatheter aortic valve implantation (TAVI) is a new therapeutic method for patients with severe symptomatic aortic stenosis who are at very high surgical risk or in whom there are contraindications to surgical valve replacement.
Between August 2008 and December 2009, sixty such patients underwent TAVI at our hospital.
The mean age of the patients was 82 +/- 6.1 years, 25 of them were men. The mean "European system for cardiac operative risk" (EuroSCORE) was 25.8 +/- 17.0%. A very high surgical risk was the indication for TAVI in 51 patients. The mean aortic valve orifice area was 0.6 +/- 0.1cm(2) and the mean transvalvular gradient 48.2 +/- 14.4 mm Hg before the intervention. The mean duration of the intervention was 62.6 +/- 19.9 minutes and the screening time 11.8 +/- 5.1 minutes. The procedure was technically successful in all but one patient. The post-interventional mean transvalvular gradient was 2.87.0 mm Hg. Significant residual aortic regurgitation (more than grade 3) was present in six patients but was reduced by the catheter-based "snare" technique in most cases. Mean hospital stay was 15.4 +/- 18.9 days. A permanent pacemaker was implanted in 22 of the patients. Eight patients died during the hospital stay, most of them for reasons not directly related to the intervention.
TAVI is becoming a new therapeutic method for elderly patients with severe co-morbidities and severe symptomatic aortic stenosis. Complications of TAVI are not trivial and their management by catheter techniques is challenging. In consequence the selection of patients and of suitably experienced hospitals is crucial for the further development of this promising new technique.
经皮导管主动脉瓣植入术（TAVI）是一种针对外科手术风险极高或存在外科瓣膜置换禁忌证的重度症状性主动脉瓣狭窄患者的新型治疗方法。
2008年8月至2009年12月期间，我院对60例此类患者实施了TAVI。
患者的平均年龄为82±6.1岁，其中25例为男性。平均“欧洲心脏手术风险系统”（EuroSCORE）为25.8±17.0%。51例患者因手术风险极高而接受TAVI。干预前平均主动脉瓣口面积为0.6±0.1cm²，平均跨瓣压差为48.2±14.4mmHg。平均干预持续时间为62.6±19.9分钟，筛查时间为11.8±5.1分钟。除1例患者外，手术在技术上均获成功。干预后平均跨瓣压差为2.8±7.0mmHg。6例患者存在显著的残余主动脉瓣反流（超过3级），但多数情况下通过基于导管的“圈套”技术反流有所减轻。平均住院时间为15.4±18.9天。22例患者植入了永久性起搏器。8例患者在住院期间死亡，其中多数死亡原因与干预无直接关联。
TAVI正成为患有严重合并症和重度症状性主动脉瓣狭窄的老年患者的一种新型治疗方法。TAVI的并发症不容小觑，通过导管技术进行处理具有挑战性。因此，患者和具备适当经验的医院的选择对于这项有前景的新技术的进一步发展至关重要。
