更多经皮瓣膜介入治疗循环支持演示文稿.ppt

Disclosure Medtronic Consultant Edwards Investigator Direct Flow Medical Consultant Balloon Valvuloplasty Rapid Ventricular Pacing Valve Deployment Unable to cross - 3 161 Patients Enrolled Unsuccessful Deploymentn = 19 Failed access - 9 Implant Success 88.2% 23 mm Valve (55) Cardiac Perforation* - 3 26mm Valve (87) 61.3% 38.7% Malplaced/Embolized - 2 Anesthesia Complication - 2 Transfemoral REVIVE and REVIVAL II Procedural Results Successful Deploymentn = 142 23 mm Valve (55) Successful Deploymentn = 142 Slide courtesy of Susheel Kodali REVIVAL II TransapicalTechnical Success 87.5% Migration / Embolization 12.5% Failure to cross 0 Mean deployment time 11.7 min Mean procedure time 87.1 min THV Learning Curve Percent Successful Implant % Slide courtesy of T. Lefèvre b a c e d Accurate Deployment is Critical REVIVE REVIVAL IIIntra-Procedural Events Valve-in-valve due to incompetent valve – 1 (0.6%) Coronary Occlusion – 2 (1.2%)** Valve Malplacement – 1 (0.6%)* Valve Embolization – 1 (0.6%) * Valve placed too low resulting in severe AR and cardiac arrest; valve migrated into LV during CPR ** One patient treated with left main stent, one patient managed medically TRAVERCE: TA Feasibility study (n=168) Implant Success 92.8 % 30-day Survival 85 % 6-month Survival 70 % Freedom from Stroke @ 6 mo. 95 % Freedom from MI @ 6 mo. 98 % off-pump 77 % Sternotomy (conversion) 7.1% (n=12) Slide courtesy of T. Walther TRAVERCE: Conversion: 7 % Malposition Low High 4 2 2 Valve migration Distal Ventricular 3 2 1 Aortic Insufficiency Central regurgitation 3+ Paravavlular leak 2+ due to annular tear Paravalvular central regurgitation 6 2 2 2 Ascending aorta dissection 1 Mitral chordae entanglement 1 15 events in 12 patients Slide modified from Thomas Walther Lessons Learned Reoperation is not an independent predictor of mortality in conventional cardiac surgery RESCUE What is the role of circulatory support in transcatheter AVR? RE