Danenberg Haim, Finkelstein Ariel, Kornowski Ran, Segev Amit, Dvir Danny, Gilon Dan, Keren Gad, Sagie Alex, Feinberg Micha, Schwammenthal Ehud, Banai Shmuel, Lotan Chaim, Guetta Victor
Department of Cardiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Isr Med Assoc J. 2010 Aug;12(8):468-71.
The prevalence of aortic stenosis increases with advancing age. Once symptoms occur the prognosis in patients with severe aortic stenosis is poor. The current and recommended treatment of choice for these patients is surgical aortic valve replacement. However, many patients, mainly the very elderly and those with major comorbidities, are considered to be at high surgical risk and are therefore denied treatment. Recently, a transcatheter alternative to surgical AVR has emerged.
To describe the first year experience and 30 day outcome of transcatheter aortic self-expandable CoreValve implantation in Israel.
Transcatheter aortic valve implantation using the CoreValve system has been performed in Israel since September 2008. In the following year 55 patients underwent CoreValve TAVI in four Israeli centers.
Patients' mean age was 81.7 +/- 7.1 years; there were 35 females and 20 males. The mean valve area by echocardiogram was 0.63 +/- 0.16 cm2. The calculated mean logistic Euroscore was 19.3 +/- 8%. Following TAVI, mean transvalvular gradient decreased from baseline levels of 51 +/- 13 to 9 +/- 3 mmHg. The rate of procedural success was 98%. One patient died on the first day post-procedure (1.8%) and all-cause 30 day mortality was 5.5% (3 of 55 patients). One patient had a significant post-procedural aortic regurgitation of > grade 2. Symptomatic improvement was evident in most patients, with reduction in functional capacity grade from 3.2 +/- 0.6 at baseline to 1.4 +/- 0.7. The most common post-procedural complication was complete heart block, which necessitated permanent pacemaker implantation in 37% of patients.
The Israeli first year experience of transcatheter aortic valve implantation using the CoreValve self-expandable system demonstrates an effective and safe procedure for the treatment of severe aortic stenosis in patients at high surgical risk.
主动脉瓣狭窄的患病率随年龄增长而增加。一旦出现症状，重度主动脉瓣狭窄患者的预后较差。目前针对这些患者推荐的治疗选择是外科主动脉瓣置换术。然而，许多患者，主要是高龄患者和患有严重合并症的患者，被认为手术风险高，因此无法接受治疗。最近，出现了一种经导管主动脉瓣置换术替代外科手术的方法。
描述以色列经导管主动脉自膨胀CoreValve瓣膜植入术的第一年经验及30天结局。
自2008年9月起，以色列开始使用CoreValve系统进行经导管主动脉瓣植入术。在接下来的一年里，55例患者在以色列的四个中心接受了CoreValve经导管主动脉瓣置换术（TAVI）。
患者的平均年龄为81.7±7.1岁；女性35例，男性20例。超声心动图测得的平均瓣口面积为0.63±0.16平方厘米。计算得出的平均逻辑欧洲心脏手术风险评估系统（Euroscore）评分为19.3±8%。经导管主动脉瓣置换术后，平均跨瓣压差从基线水平的51±13降至9±3毫米汞柱。手术成功率为98%。1例患者在术后第一天死亡（1.8%），30天全因死亡率为5.5%（55例患者中有3例）。1例患者术后出现严重的主动脉瓣反流，反流程度>2级。大多数患者症状明显改善，功能能力分级从基线时的3.2±0.6降至1.4±0.7。最常见的术后并发症是完全性心脏传导阻滞，37%的患者需要植入永久性起搏器。
以色列使用CoreValve自膨胀系统进行经导管主动脉瓣植入术的第一年经验表明，该手术对于治疗手术风险高的重度主动脉瓣狭窄患者有效且安全。
