Deuschl Florian, Schofer Niklas, Seiffert Moritz, Hakmi Samer, Mizote Isamu, Schaefer Andreas, Schirmer Johannes, Reichenspurner Hermann, Blankenberg Stefan, Conradi Lenard, Schäfer Ulrich
Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.
Department for Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
Catheter Cardiovasc Interv. 2017 Dec 1;90(7):1167-1174. doi: 10.1002/ccd.26986. Epub 2017 Mar 15.
The aim of this study was to evaluate safety, feasibility, and efficacy of transaxillary TAVI using a novel self-expandable transcatheter heart valve (THV) via a direct percutaneous technique.
The analysis comprises 12 consecutive patients with severe aortic stenosis treated with the ACURATE Neo™ THV (Symetis) by direct percutaneous transaxillary access.
Patients presented with a mean age of 79.9 ± 6.2 years and high calculated surgical risk (logEuroSCORE I: 19.55 ± 15.00%; STS PROM score: 5.42 ± 3.25%). Transaxillary TAVI was performed in 11/12 via the left and in 1/12 via the right-sided axillary artery. Device success was achieved in all patients (12/12). Mortality rate at 30 days was 0% (0/12). No major and one minor access site complication (1/12) occurred. No major or life-threatening access site-related bleeding resulted. None of the patients suffered from postprocedural stroke/transient ischemic attack. There was no need for a permanent pacemaker. Mean effective orifice area post implantation was 2.1 ± 0.29 cm and mean aortic gradient 6.2 ± 1.5 mm Hg. In none of the patients, greater than moderate aortic regurgitation or paravalvular leakage was detected at discharge (0/12).
Our study suggests that the implantation of the second-generation self-expandable ACURATE Neo™ via a transaxillary access is technically feasible and safe and yields excellent short-term clinical results. © 2017 Wiley Periodicals, Inc.
本研究旨在评估经直接经皮技术使用新型自膨胀经导管心脏瓣膜（THV）进行经腋窝经导管主动脉瓣植入术（TAVI）的安全性、可行性和有效性。
分析连续12例严重主动脉瓣狭窄患者，通过直接经皮经腋窝途径使用ACURATE Neo™ THV（Symetis）进行治疗。
患者平均年龄为79.9±6.2岁，手术风险计算值较高（欧洲心脏手术风险评估系统I评分：19.55±15.00%；胸外科医师协会预计风险评分：5.42±3.25%）。11/12例经腋窝TAVI通过左侧腋动脉进行，1/12例通过右侧腋动脉进行。所有患者（12/12）均成功植入装置。30天死亡率为0%（0/12）。未发生重大及1例轻微穿刺部位并发症（1/12）。未发生与穿刺部位相关的重大或危及生命的出血。术后无患者发生中风/短暂性脑缺血发作。无需植入永久性起搏器。植入后平均有效瓣口面积为2.1±0.29平方厘米，平均主动脉跨瓣压差为6.2±1.5毫米汞柱。出院时，所有患者均未检测到中重度以上主动脉瓣反流或瓣周漏（0/12）。
我们的研究表明，经腋窝途径植入第二代自膨胀ACURATE Neo™在技术上是可行且安全的，并能产生优异的短期临床结果。©2017威利期刊公司。
