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预装干心包维也纳自膨式经导管主动脉瓣系统的早期安全性和性能:首例人体 VIVA 可行性研究的 30 天结果。

Early Safety and Performance of the Premounted Dry-Pericardium Vienna Self-Expandable Transcatheter Aortic Valve System: 30-Day Outcomes of the First-in-Human VIVA Feasibility Study.

机构信息

Departments of Cardiology.

Departments of Cardiology.

出版信息

Am J Cardiol. 2023 Oct 1;204:302-311. doi: 10.1016/j.amjcard.2023.07.109. Epub 2023 Aug 9.

Abstract

The purpose of this first-in-human (FIH) study was to determine the safety and feasibility of the transfemoral premounted dry-pericardium Vienna Self-Expandable Supra-Annular Aortic Valve System. This novel system is repositionable and retrievable and comes already premounted on the delivery system, eliminating the need for assembly and crimping of the device before valve implantation. This is a prospective, nonrandomized, single-arm, single-center, first-stage FIH feasibility study, which will be followed by a second-stage pivotal, multicenter, multinational study in symptomatic patients with severe aortic stenosis. The first-stage FIH study evaluated the safety and feasibility of the device in 10 patients with severe aortic stenosis based on recommendations by the Valve Academic Research Consortium-2 for transcatheter aortic valve implantations. The mean patient age was 79 ± 5 years, 60% were male, and all patients were in New York Heart Association functional class II to III. The primary safety end point was successful when all patients were alive at 30-day follow-up. Device and technical success were observed in all patients. Two patients had a stroke, 1 of which occurred 5 days after the procedure. New permanent pacemakers were implanted in 2 patients (22.2%), of which only 1 was because of complete heart block. Only 1 patient (10%) had moderate paravalvular leak at 30 days. After the procedure, the mean aortic valve gradient decreased from 48.7 ± 10.8 mm Hg to 8.8 ± 4.3 mm Hg. In conclusion, this FIH feasibility study demonstrates successful procedural feasibility, with no 30-day mortality and favorable valve hemodynamic performance, leading to an improvement in quality of life. ClinicalTrials.gov identifier NCT04861805.

摘要

这项首次人体(FIH)研究的目的是确定经股 premounted 干心包维也纳自膨式 supra-annular 主动脉瓣系统的安全性和可行性。这个新型系统是可重新定位和可回收的,已经预装在输送系统上,消除了在植入瓣膜之前对设备进行组装和卷曲的需要。这是一项前瞻性、非随机、单臂、单中心、第一阶段 FIH 可行性研究,随后将在有严重主动脉瓣狭窄症状的患者中进行第二阶段的关键、多中心、多国研究。第一阶段 FIH 研究根据经导管主动脉瓣植入术的瓣膜学术研究联盟-2 的建议,在 10 名严重主动脉瓣狭窄患者中评估了该设备的安全性和可行性。患者的平均年龄为 79±5 岁,60%为男性,所有患者均为纽约心脏协会功能 II 至 III 级。主要安全性终点是所有患者在 30 天随访时存活。所有患者均观察到设备和技术成功。两名患者发生中风,其中 1 例发生在手术后 5 天。两名患者(22.2%)植入了新的永久性起搏器,其中只有 1 例是因为完全性心脏传导阻滞。仅 1 例患者(10%)在 30 天时存在中度瓣周漏。手术后,主动脉瓣梯度从 48.7±10.8mmHg 降至 8.8±4.3mmHg。总之,这项 FIH 可行性研究表明手术具有可行性,无 30 天死亡率和良好的瓣膜血流动力学性能,从而提高了生活质量。ClinicalTrials.gov 标识符 NCT04861805。

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