经皮穿刺治疗心脏瓣膜置换术后瓣周漏-英文课件.ppt
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1、Transcatheter Aortic Valve Implantation: Recent Clinical Data,Hasan Jilaihawi, MD Cedars-Sinai Medical Center, Los Angeles,Objectives,To understand the devices and approaches available to treat aortic stenosis by transcatheter approach To be understand the clinical outcomes that are important after
2、Transcatheter Aortic Valve Implantation (TAVI) To be aware of recent clinical data pertaining to the above outcomes To appreciate the outstanding questions to be answered in future studies,First TAVI- Dr Anderson 1992,First Successful Transcatheter Aortic Valve Implant Antegrade Cribier-Edwards,Firs
3、t UK case 2007: Retrograde Corevalve 90 y old lady,TAVI: Designs,Edwards-Cribier / Edwards-Sapien COREVALVE Panaguia 3F SORIN CORAZONE SADRA Medical ValveXchange Direct Flow Lutter,TAVI: Post CE mark devices,Medtronic-CoreValve self expandable Porcine pericardium Retrograde Transaxillary 18 Fr No ra
4、pid pacing 10, 000+ patients,Edwards-Sapien Balloon expandable Bovine pericardium Retrograde (ante.) Transapical 22/24 Fr (soon 18/19Fr) Rapid pacing 10,000+ patients,Rapid evolution of the Corevalve device,Ongoing evolution of the Edwards design,Edwards-Sapien: Approaches,Medtronic Corevalve: Appro
5、aches,Transaxillary,Transfemoral,(Direct aortic),Corevalve or Edwards? A complementary approach to TAVI for optimal outcome,Jilaihawi et al, JACC Interventions, In press,TAVI Outcomes: What clinical results are important?,Procedural success Mortality Stroke, disabling stroke Myocardial infarction Va
6、scular complication Hemodynamic function Functional status Permanent pacemaker Quality of Life,TAVI: Clinical data sequence,Enrollment complete September 2009,Awaiting final approval Post CE registry ongoing,Post CE mark European nation registries,1. Improving procedural success,Summary: procedural
7、success,(n=279),(n=772),(n=833),(n=872),(n=248),(n=1038),(n=1483),Summary derived from multiple data EuroPCR 2010,2. Mortality: The standard is set high Open AVR is a safe procedure in selected elderly patients,Operative mortality in octogenarians prior to 2000 11.5% Logeais et al J Heart Valve Dise
8、ase 1995 13.7% Gehlot et al J Thorac Cardiovasc Surg 1996 8% Atkins et al Ann Thorac Surg 1997 16.7% Bloomstein et al Ann Thorac Surg 2001 AVR +/- other procedures in octogenarians is getting safer 8.5% Chiappini B 2004 115 octogenarians, AVR 71pts, AVR+CABG 44pts 8.8% Collart F 2005 213 octogenaria
9、ns, AVR 159pts, MVR 42pts, AVR+MVR 14 pts 4.6% David TE 2006 132 octogenarians, AVR 95 pts, MVR 36 selected patients 8 % Urso S 2007 100 octogenarians, isolated AVR 9% Melby SJ 2007 245 octogenarians, AVR 140 pts, AVR+CABG 105 pts 13% Kohl P 2007 220 octogenarians, AVR 162 pts, AVR+CABG 58 pts,2. Mo
10、rtality: Corevalve post CE mark expanded evaluation n=1483,Schuler TCT 2009,2. Mortality post Edwards SOURCE registry,Thomas et al, Circulation 2010,2. Mortality in SOURCE at 12 months,2. Mortality (30d) and learning curve Vancouver Edwards experience n=250,Webb TCT 2009,2. Registry summary: 30 day
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- 穿刺 治疗 心脏 瓣膜 置换 术后 瓣周漏 英文 课件
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