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JUPITER注册研究:使用第二代经导管心脏瓣膜经心尖主动脉瓣植入治疗主动脉瓣关闭不全的一年结局

The JUPITER registry: One-year outcomes of transapical aortic valve implantation using a second generation transcatheter heart valve for aortic regurgitation.

作者信息

Silaschi Miriam, Conradi Lenard, Wendler Olaf, Schlingloff Friederike, Kappert Utz, Rastan Ardawan J, Baumbach Hardy, Holzhey David, Eichinger Walter, Bader Ralf, Treede Hendrik

机构信息

Department of Cardiac Surgery, University Hospital Halle (Saale), Halle, Saale, Germany.

Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.

出版信息

Catheter Cardiovasc Interv. 2018 Jun;91(7):1345-1351. doi: 10.1002/ccd.27370. Epub 2017 Nov 24.

Abstract

OBJECTIVES

We present 1-year outcomes of the post-market registry of a next-generation transcatheter heart valve used for aortic regurgitation (AR).

BACKGROUND

Transcatheter aortic valve replacement (TAVR) is routine in high-risk patients with aortic stenosis but is not recommended for AR. The JenaValve™ (JenaValve Technology GmbH, Munich, Germany) overcomes technical challenges in AR patients through a leaflet clipping mechanism.

METHODS

The JenaValve EvalUation of Long Term Performance and Safety In PaTients with SEvere Aortic Stenosis oR Aortic Insufficiency (JUPITER) Registry is a European study to evaluate safety and effectiveness of this THV. From 2012-2015, 30 patients with AR were enrolled.

RESULTS

Mean age was 74.4 ± 9.3 years. Procedural success was 96.7% (29/30). One patient was converted to open surgery. No annular rupture or coronary ostia obstruction occurred. Mortality at 30 days was 10.0% (3/30). Combined safety endpoint was met in 13.3% (4/30). Paravalvular regurgitation was not present/trivial in 84.6% (22/26) and mild in 15.4% (4/26). Rate of permanent pacemaker implantation was 3.8% (1/26). One-year Kaplan-Meier survival was 79.9%, one-year combined efficacy was 73.1% (19/30). No further strokes were observed during 1 year of follow-up.

CONCLUSIONS

The JenaValve overcomes technical challenges of TAVR in AR through a clipping mechanism. We report satisfactory outcomes of a multicenter registry using the JenaValve for predominant AR, as rate of THV embolization, residual AR and permanent pacemaker implantation was low. One-year results using the JenaValve for AR encourage its use for this indication.

摘要

目的

我们展示了用于主动脉瓣反流(AR)的下一代经导管心脏瓣膜上市后注册研究的1年结果。

背景

经导管主动脉瓣置换术(TAVR)在高危主动脉瓣狭窄患者中已成为常规手术,但不推荐用于AR。耶拿瓣膜™(JenaValve Technology GmbH,德国慕尼黑)通过瓣叶修剪机制克服了AR患者的技术挑战。

方法

耶拿瓣膜评估严重主动脉瓣狭窄或主动脉瓣关闭不全患者的长期性能和安全性(JUPITER)注册研究是一项欧洲研究,旨在评估这种经导管心脏瓣膜的安全性和有效性。2012年至2015年,纳入了30例AR患者。

结果

平均年龄为74.4±9.3岁。手术成功率为96.7%(29/30)。1例患者转为开胸手术。未发生瓣环破裂或冠状动脉开口阻塞。30天死亡率为10.0%(3/30)。13.3%(4/30)达到综合安全终点。84.6%(22/26)无瓣周反流/微量瓣周反流,15.4%(4/26)为轻度瓣周反流。永久起搏器植入率为3.8%(1/26)。1年的Kaplan-Meier生存率为79.9%,1年综合疗效为73.1%(19/30)。随访1年期间未观察到进一步的中风。

结论

耶拿瓣膜通过修剪机制克服了TAVR在AR中的技术挑战。我们报告了使用耶拿瓣膜治疗主要AR的多中心注册研究的满意结果,因为经导管心脏瓣膜栓塞、残余AR和永久起搏器植入率较低。使用耶拿瓣膜治疗AR的1年结果鼓励将其用于该适应症。

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