|
Percutaneous aortic valve replacement (PAVR), also known as transcatheter aortic valve implantation (TAVI) or transcatheter aortic valve replacement (TAVR), is the replacement of the aortic valve of the heart through the blood vessels (as opposed to valve replacement by open heart surgery). The replacement valve is delivered via one of several access methods: transfemoral (in the upper leg), transapical (through the wall of the heart), subclavian (beneath the collar bone), direct aortic (through a minimally invasive surgical incision into the aorta), and transcaval (from a temporary hole in the aorta near the belly button through a vein in the upper leg). == Background == Severe symptomatic aortic stenosis carries a poor prognosis. Until recently, surgical aortic valve replacement has been the standard of care in adults with severe symptomatic aortic stenosis. However, the risks associated with surgical aortic valve replacement are increased in elderly patients and those with concomitant severe systolic heart failure or coronary artery disease, as well as in patients with comorbidities such as cerebrovascular and peripheral arterial disease, chronic kidney disease, and chronic respiratory dysfunction. Transcatheter aortic valve replacement (TAVR) has been developed as an alternative to the surgical approach in this high-risk population. The catheter procedure was developed in France, initially performed in 2002 on April 16 by Prof Alain Cribier in Hopital Charles Nicolle, at the University of Rouen. It is now approved in more than 50 countries. It is effective in improving functioning in the patients with severe aortic stenosis. In the US, it received FDA approval in November 2011 for use in inoperable patients and in October 2012 for use in patients at high surgical risk.〔http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm278348.htm〕 Transcatheter aortic-valve replacement (TAVR) using a self-expanding transcatheter aortic-valve bioprosthesis (CoreValve) was associated with a significantly higher survival rate at 1 year follow-up than surgical aortic-valve replacement in a recent randomized study of 795 patients with severe aortic stenosis who were at increased surgical risk. The PARTNER Trial (Placement of AoRtic TraNscathetER Valves) was the world’s first randomized, controlled study to test the safety and effectiveness of transcatheter heart valves in people with severe aortic stenosis; it published in 2011 and showed that the procedure was as safe and effective as open-heart surgery, and in those unable to receive surgery, it drastically improved survival While there was high mortality (24.3% at 1 year and 33.9% at 2 years), it changed the standard of care for these people. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Percutaneous aortic valve replacement」の詳細全文を読む スポンサード リンク
|