经股动脉vs经心尖部主动脉瓣置换术-那种创伤更小PPT.ppt

经股动脉 VS 经心尖部主动脉瓣置换术-那种创伤更小?;声明;经皮主动脉瓣置换术;主动脉狭窄和PVD;Corevalve;REVIVAL II 包括 备选入路:经心尖;12/2006-2/2008 纳入标准: PVD 排除经股动脉途径 STS ≥ 15%, 或不适宜手术 AoV 面积 ≤ 0.7 cm2 70 y NYHA ≥ II ;经股动脉AVR汇总分析REVIVE REVIVAL II (n=161);经心尖部 AVRREVIVAL II (n=40);* One patient on CVVHD prior to valve implantation;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;;REVIVAL II 经心尖途径手术成功率;术中与定位相关的事件;术中处理;术中处理;Slide courtesy of John Webb;经心尖途径手术成功率 (n=58);TRAVERCE: 换瓣成功率: 93 %;TRAVERCE: 中转: 7 %;TA 学习曲线 (n=175)TRAVERCE;;PARTNER EU TF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;;;Transfemoral Vs Transapical Valves – Which is Less Invasive?;Disclosure;Percutaneous Aortic Valves;Aortic Stenosis and PVD;Corevalve;;REVIVE and REVIVAL IIFeasibility Studies;REVIVAL II included Alternate Access: Transapical;12/2006-2/2008 Inclusion criteria: PVD precluding TF approach STS ≥ 15%, or inoperable AoV area ≤ 0.7 cm2 70 yrs of age NYHA ≥ II ;Pooled Transfemoral AVRREVIVE REVIVAL II (n=161);Transapical AVRREVIVAL II (n=40);* One patient on CVVHD prior to valve implantation;Transapical Access;Vascular Complications;;Zero Tolerance for Vascular Access Complications;Facilitated Access: Iliac conduit;Fundamental Assumption;Unable to cross - 3;;REVIVAL II TransapicalTechnical Success;Other Intra-Procedural Events Related to Positioning;Intra-operative Management;Intra-operative Management;Slide courtesy of John Webb;Transapical Procedural success (n=58);TRAVERCE: Implant Success: 93 %;TRAVERCE: Conversion: 7 %;TA Learning Curve (n=175)TRAVERCE;;PARTNER EU TFComplications;SAPIEN? THV Commercial Experience  The SOURCE Registry ;34 cardiac intervention centers 598 implants 15% of cases proctored;THV Learning Curve Percent Successful Implant;Comparison;NO!;Axillary Conduit Avoids Arch Transit ;Next Generation Devices;Conclusion;