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用于原发性主动脉瓣狭窄和退化生物假体的新型自膨胀ALLEGRA经导管主动脉瓣

Novel self-expanding ALLEGRA transcatheter aortic valve for native aortic stenosis and degenerated bioprosthesis.

作者信息

Neuser Jonas, Kempf Tibor, Bauersachs Johann, Widder Julian D

机构信息

Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.

出版信息

Catheter Cardiovasc Interv. 2022 Mar;99(4):1234-1242. doi: 10.1002/ccd.30003. Epub 2021 Nov 17.

Abstract

OBJECTIVES

To investigate the safety and efficacy of the ALLEGRA valve in routine use.

BACKGROUND

The ALLEGRA aortic valve is a self-expanding transcatheter heart valve (THV) with bovine pericardial tissue and was CE approved in March 2017. Its unique design was developed to provide low prosthesis gradients.

METHODS

We analyzed patients receiving an ALLEGRA THV between May 2017 and March 2021 at our center for treatment of aortic valve stenosis or degenerated valve prosthesis. Hemodynamic results and clinical outcome according to the Valve Academic Research Consortium-2 consensus criteria were evaluated at discharge and three months post transcatheter aortic valve replacement (TAVR) procedure. 93 patients with a mean age of 82.5 ± 4.8 years and a median EuroScore II of 4.7 ± 3.4 were treated, 15 of them were valve-in-valve procedures.

RESULTS

Implantation was successful in 97.8% (91/93) and VARC-2 defined device success was achieved in 94.6% (88/93). In-hospital all-cause mortality was 2.2% (2/93). Life-threatening bleeding, major vascular complications and strokes were 3.2% (3/93), 2.2% (2/93) and 3.2% (3/93), respectively. Paravalvular leakage was none to trace in 60.4%, mild in 38.5% and moderate in 1.1%. Permanent pacemaker implantation in pacemaker naive patients was necessary in 9.5% (8/84). Mean gradient at discharge was 8.2 ± 4.3 mmHg for all patients; 7.1 ± 2.6 mmHg in patients treated for stenosis of the native aortic valve and 13.8 ± 6.3 mmHg in patients treated valve-in-valve.

CONCLUSIONS

The ALLEGRA THV provides excellent hemodynamic results and a good safety profile with a low complication rate.

摘要

目的

研究ALLEGRA瓣膜在常规使用中的安全性和有效性。

背景

ALLEGRA主动脉瓣是一种带有牛心包组织的自膨胀经导管心脏瓣膜(THV),于2017年3月获得CE认证。其独特设计旨在提供较低的人工瓣膜梯度。

方法

我们分析了2017年5月至2021年3月在我们中心接受ALLEGRA THV治疗主动脉瓣狭窄或退化瓣膜假体的患者。根据瓣膜学术研究联盟-2共识标准,在出院时和经导管主动脉瓣置换术(TAVR)后三个月评估血流动力学结果和临床结局。治疗了93例患者,平均年龄为82.5±4.8岁,欧洲心脏手术风险评估系统II中位数为4.7±3.4,其中15例为瓣中瓣手术。

结果

植入成功率为97.8%(91/93),VARC-2定义的器械成功率为94.6%(88/93)。院内全因死亡率为2.2%(2/93)。危及生命的出血、主要血管并发症和中风发生率分别为3.2%(3/93)、2.2%(2/93)和3.2%(3/93)。60.4%的患者无瓣周漏,38.5%为轻度,1.1%为中度。在既往未植入起搏器的患者中,9.5%(8/84)需要植入永久性起搏器。所有患者出院时的平均梯度为8.2±4.3 mmHg;治疗原发性主动脉瓣狭窄的患者为7.1±2.6 mmHg,瓣中瓣治疗的患者为13.8±6.3 mmHg。

结论

ALLEGRA THV提供了优异的血流动力学结果和良好的安全性,并发症发生率低。

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