Kische Stephan, D'Ancona Giuseppe, Agma Hüseyin U, Gürer Hakan, Ortak Jasmin, Elsässer Albrecht, Öner Alper, Ince Hüseyin
Department of Cardiology, Vivantes Klinikum im Friedrichshain Und Am Urban, Berlin, Germany.
Department of Cardiology, Rostock University Medical Center, Rostock, Germany.
Catheter Cardiovasc Interv. 2016 Feb 15;87(3):500-7. doi: 10.1002/ccd.26039. Epub 2015 May 27.
We present our experience with an inflatable, non-metallic, fully retrievable, and repositionable transcatheter aortic valve [Direct Flow® Medical (DFM)] focusing on technical features adopted during implantation.
Implantation techniques of new generation percutaneous aortic valves are still developing and with experience implementations are described.
The "low pressure" (initial valve inflation at 4 ATM, lower than the recommended 12 ATM) and the "alternate aortic curve" techniques (initial valve pulling either from the wire running on the side of the inner or from the one on the outer aortic curve) are part of our modified protocol for DFM® implantation.
Forty-two consecutive patients underwent TAVI with DFM. The "low pressure" technique was used in all patients. In 27 (64.3%) patients the bulkiest calcifications were on the inner aortic curve side, and an inner curve technique was used to initiate valve pulling toward the annular hinge point. In the remaining 15 (35.7%) patients, an outer curve technique was used. Neither pull-through nor re-valving was reported. Valve performance showed mean gradient of 8.9 mm Hg. Mild paravalvular leak was reported in seven (16%) patients. No one experienced moderate or severe aortic insufficiency. Thirty-day mortality was 9.5% (4/42).
The "low pressure technique" and the "alternate curve technique" guarantee an anatomy and patient tailored approach to achieve controlled and finely tuned valve seating.
我们介绍了使用一种可膨胀、非金属、完全可回收且可重新定位的经导管主动脉瓣[Direct Flow® Medical（DFM）]的经验，重点关注植入过程中采用的技术特点。
新一代经皮主动脉瓣的植入技术仍在发展，随着经验的积累，相关实施方法也得到了描述。
“低压”（初始瓣膜膨胀压力为4个大气压，低于推荐的12个大气压）和“交替主动脉曲线”技术（初始瓣膜牵拉要么从内侧主动脉曲线一侧的导丝进行，要么从外侧主动脉曲线一侧的导丝进行）是我们改良的DFM®植入方案的一部分。
42例连续患者接受了DFM经导管主动脉瓣植入术（TAVI）。所有患者均采用了“低压”技术。27例（64.3%）患者最严重的钙化位于内侧主动脉曲线一侧，采用内侧曲线技术将瓣膜牵拉向瓣环铰链点。其余15例（35.7%）患者采用外侧曲线技术。未报告牵拉困难或再次瓣膜植入情况。瓣膜性能显示平均跨瓣压差为8.9毫米汞柱。7例（16%）患者报告有轻度瓣周漏。无一例出现中度或重度主动脉瓣关闭不全。30天死亡率为9.5%（4/42）。
“低压技术”和“交替曲线技术”保证了一种根据解剖结构和患者情况量身定制以实现可控且精确瓣膜定位的方法。
