经股动脉vs经心尖部主动脉瓣置换术-那种创伤更小.ppt

;声明;;主动脉狭窄和PVD;Corevalve;;REVIVEandREVIVALII

可行性研究;REVIVALII包括

备选入路:经心尖;;经股动脉AVR汇总分析

REVIVEREVIVALII(n=161);经心尖部AVR

REVIVALII(n=40);*OnepatientonCVVHDpriortovalveimplantation;经心尖入路;血管并发症;;绝对不能发生血管入路的并发症;使入路更简便:

髂动脉导管;基本假设;无法穿过-3;;;;;;SlidecourtesyofJohnWebb;;TRAVERCE:换瓣成功率:93%;TRAVERCE:中转:7%;TA学习曲线(n=175)

TRAVERCE;;PARTNEREUTF

并发症;SAPIEN?THV商业经验

SOURCE注册

;34心脏介入中心

598植入

15%的患者签署代理协议;THV学习曲线

植入成功的百分数;比较;不是!;腋动脉导管

避免跨越主动脉弓;下一代设备;结论;;;TransfemoralVsTransapicalValves–WhichisLessInvasive?;Disclosure;PercutaneousAorticValves;AorticStenosisandPVD;Corevalve;;REVIVEandREVIVALII

FeasibilityStudies;REVIVALIIincluded

AlternateAccess:Transapical;12/2006-2/2008

Inclusioncriteria:

PVDprecludingTFapproach

STS≥15%,orinoperable

AoVarea≤0.7cm2

70yrsofage

NYHA≥II

;PooledTransfemoralAVR

REVIVEREVIVALII(n=161);TransapicalAVR

REVIVALII(n=40);*OnepatientonCVVHDpriortovalveimplantation;TransapicalAccess;VascularComplications;;ZeroToleranceforVascularAccessComplications;FacilitatedAccess:

Iliacconduit;FundamentalAssumption;Unabletocross-3;;REVIVALIITransapical

TechnicalSuccess;OtherIntra-ProceduralEventsRelatedtoPositioning;Intra-operativeManagement;Intra-operativeManagement;SlidecourtesyofJohnWebb;TransapicalProceduralsuccess(n=58);TRAVERCE:ImplantSuccess:93%;TRAVERCE:Conversion:7%;TALearningCurve(n=175)

TRAVERCE;;PARTNEREUTF

Complications;SAPIEN?THVCommercialExperience

TheSOURCERegistry

;34cardiacinterventioncenters

598implants

15%ofcasesproctored;THVLearningCurve

PercentSuccessfulImplant;Comparison;NO!;AxillaryConduit

AvoidsArchTransit;NextGenerationDevices;Conclusion;