Neragi-Miandoab Siyamek, Skripochnik Edvard, Michler Robert E
Montefiore Medical Center, 3400 Bainbridge Ave, MAP 5, Department of Cardiovascular and Thoracic Surgery, Albert Einstein College of Medicine, New York, NY 10467, USA.
Recent Pat Cardiovasc Drug Discov. 2012 Dec;7(3):196-205. doi: 10.2174/157489012803832810.
Aortic stenosis (AS) is a serious condition in the aging US and European populations. Management of a stenotic valve is crucial as it can become symptomatic quickly leading to ventricular deterioration and overall poor quality of life. Considering that AS is a disease of the elderly patient population, surgical intervention may not be well tolerated by some patients. Transcatheter aortic valve implantation (TAVI) has emerged as an alternative approach for patients who are unsuitable surgical candidates. Since the first balloon-expandable Edwards SAPIEN valve (Edwards Lifesciences, Irvine, CA) was implanted by Dr. Cribier, many other valves have been introduced into clinical practice. Self-expanding valves such as the CoreValve ReValving system (Medtronic, Minneapolis, MN) for retrograde implantation and Symetis TX for antegrade and transapical implantation are the most frequently used self-expanding valves. The SAPIEN valve, on the other hand can be implanted both antegrade as well as retrograde. Overall, the most widely used valves are the Edwards SAPIEN and the CoreValve, which have been implanted in more than 40,000 patients worldwide. The Symetis valve has shown promising results in small series in Europe and may be introduced to the US market in the near future. This manuscript will review these 3 recently patented valves and discuss some of the clinical results that are available.
主动脉瓣狭窄(AS)在美国和欧洲的老年人群中是一种严重的病症。狭窄瓣膜的管理至关重要,因为它可能很快出现症状,导致心室功能恶化和整体生活质量较差。鉴于AS是老年患者群体的一种疾病,一些患者可能无法很好地耐受手术干预。经导管主动脉瓣植入术(TAVI)已成为不适宜进行手术的患者的一种替代方法。自从克里比埃医生植入首个球囊扩张式爱德华兹SAPIEN瓣膜(爱德华兹生命科学公司,加利福尼亚州欧文市)以来,许多其他瓣膜已被引入临床实践。自膨胀瓣膜,如用于逆行植入的CoreValve ReValving系统(美敦力公司,明尼苏达州明尼阿波利斯市)和用于顺行及经心尖植入的Symetis TX,是最常用的自膨胀瓣膜。另一方面,SAPIEN瓣膜既可以顺行植入也可以逆行植入。总体而言,使用最广泛的瓣膜是爱德华兹SAPIEN瓣膜和CoreValve瓣膜,全球已有超过40000名患者植入了这两种瓣膜。Symetis瓣膜在欧洲的小规模研究中已显示出有前景的结果,可能在不久的将来被引入美国市场。本文将回顾这三种最近获得专利的瓣膜,并讨论一些现有的临床结果。