Barr Peter, Ormiston John, Stewart Jim, Nand Parma, Ramanathan Tharumenthiran, Webster Mark
Green Lane Cardiovascular Service (Cardiology), Auckland Hospital, Auckland, New Zealand.
Green Lane Cardiovascular Service (Cardiology), Auckland Hospital, Auckland, New Zealand.
Heart Lung Circ. 2018 Mar;27(3):e11-e14. doi: 10.1016/j.hlc.2017.08.025. Epub 2017 Sep 28.
As the indications for transcatheter aortic valve implantation (TAVI) have expanded, so to have the demands on interventionists to allow as many patients to access this technology as possible.
We retrospectively reviewed our TAVI database for patients who had received a 29mm SAPIEN 3 valve despite having an annular area greater than the manufacturer-recommended upper limit of 683mm, as determined by multi-detector computed tomography (MDCT). Procedural and inpatient outcome data were collected.
The study population was 5 of 121 patients receiving a SAPIEN 3 valve since it became available in March 2015. Their annular area ranged from 691 to 800mm. Valve deployment was successful in all patients. The deployment balloon volume was nominal, except for an additional 1ml in one patient. No patient had a new indication for permanent pacing, and no significant valvular or paravalvular regurgitation (PVR) was identified on post-procedure transthoracic echocardiography. All patients survived to hospital discharge.
In this select group of patients we have demonstrated that it is safe and feasible to use the 29mm SAPIEN 3 in patients with annular dimensions greater than those recommended, with minimal balloon overfilling.
随着经导管主动脉瓣植入术（TAVI）适应症的扩大，对介入医生的要求也在增加，以便让尽可能多的患者能够使用这项技术。
我们回顾性分析了TAVI数据库中接受29mm SAPIEN 3瓣膜植入的患者，这些患者经多排螺旋计算机断层扫描（MDCT）测定，瓣环面积大于制造商推荐的683mm上限。收集了手术和住院结局数据。
自2015年3月SAPIEN 3瓣膜可用以来，研究人群为121例接受该瓣膜植入患者中的5例。他们的瓣环面积在691至800mm之间。所有患者瓣膜植入均成功。除1例患者额外增加1ml外，植入球囊体积均为标称值。术后经胸超声心动图检查未发现患者有永久性起搏的新适应症，也未发现明显的瓣膜或瓣周反流（PVR）。所有患者均存活至出院。
在这组特定患者中，我们证明了对于瓣环尺寸大于推荐值的患者，使用29mm SAPIEN 3瓣膜并尽量减少球囊过度充盈是安全可行的。
