経皮性大動脈弁のインプラントは,股関節動脈から逆行する
John G Webb1, Mann Chandavimol, Christopher R Thompson
1Division of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada. webb@providencehealth.bc.ca
Circulation
|February 8, 2006
まとめ
股関節動脈経由のトランスキャテーター大動脈弁の埋め込みは,高リスク患者にとって実行可能な手順です. この逆行的なアプローチは,成功したインプランテーションと改善された大動脈弁の領域を示し,短期生存率も良好でした.
科学分野:
- 心血管外科手術についてです.
- 介入性心臓病学 介入性心臓病学
- バイオメディカルエンジニアリング
背景:
- 静脈経大動脈弁のアンテグラデインプラントは問題がある.
- 股関節動脈経由の逆行性義肢大動脈弁の埋め込みは,潜在的な利点を提供しています.
- この研究は,動脈のアプローチによる皮膚経由の義肢大動脈弁の埋め込みに関する最初の経験を報告しています.
研究 の 目的:
- 経皮トランス動脈性大動脈弁インプラントの技術について説明します.
- この新しい手順の初期臨床経験と結果を報告する.
- 高リスク患者におけるこのアプローチの可行性と安全性を評価する.
主な方法:
- ステントがステンレス鋼で作られ,馬の心臓弁が付いている義肢が使用されました.
- 股関節動脈から大動脈に22Fまたは24Fのシートが進んだ.
- 義肢は,方向付け可能なキャセターを使用して操作され,急速な心室ペースと風船膨張を使用して展開されました.
主要な成果:
- 皮膚経由の大動脈義肢弁の埋め込みは,高リスクの18人の患者 (平均年齢81歳) で試みられました.
- 14人の患者でインプラントが成功しました.
- 大動脈弁の面積が有意に増加した (0.6〜1.6cm2),75日経過後の生存率は89%であった. イリアック動脈の損傷は,最初の症例の後に効果的に管理されました.
結論:
- 皮膚によるトランス動脈性大動脈弁の埋め込みは,選択された高リスク患者では実現可能である.
- この手順は短期的には満足のいく結果を示した.
- このアプローチは,手術による弁置換術に不適した患者にとって,実行可能な代替案です.
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