Transcatheter Aortic Valve Replacement (TAVR) Expands Options for Inoperable Severe Aortic Stenosis Patients
Surgical aortic valve replacement is extremely low-risk for most patients. However, a significant number of patients are at high-risk for surgical valve replacement or are ineligible for surgery because of comorbidities. The less invasive TAVR procedure allows a new valve to be inserted within the native, diseased aortic valve, and can be performed utilizing multiple approaches (e.g., transfemoral, transapical, or transaortic).¹
Penn State Heart and Vascular Instituteis unusual in its balanced case mix, according to chief of cardiac surgery,小沃尔特·佩（Walter E. Pae），医学博士, “Our practice is fairly evenly divided among congenital pediatric heart defects, adult coronary disorders, and adult cardiac valve abnormalities. We perform up to 100 aortic valve replacements per year.” Interventional cardiologistMark Kozak, MD, concurs, noting that coronary disease is the focus of many institutions, due to its far greater frequency.
AtPenn State Health Milton S. Hershey Medical Center，外科医生使用Edwards Sapien XT TAVR设备，该设备已在全球近70,000名患者中植入，并且由于其多功能性和低传导障碍发生率而受到优先选择。在美国的伴侣（主动脉经导管瓣的放置）试验中，研究了TAVR的安全性和有效性，该试验包括两名队列中的3,300多名患者。中级和高危患者中的TAVR与手术AVR进行了比较；队列B比较了第一代SAPIEN经导管心脏瓣膜与未手术患者中的第二代SAPIEN XT经导管心脏瓣膜。在无法使用的队列中，有77.6％的Sapien XT瓣膜患者幸存至一年。288％的可操作和无法手术的Sapien XT Valve患者在纽约心脏协会（NYHA）类别I或II.2时为2。这项研究，有12.5％的患者观察到血管并发症（例如严重的环破裂），而中风的风险为4.6％。2。
Patients are identified as potential TAVR candidates by echocardiogram showing severe aortic stenosis. Physicians perform a risk analysis with the胸外科医生学会（STS）风险计算器to determine treatment, and in high-risk or inoperable patients, they begin evaluation for TAVR. At Penn State Hershey, cardiovascular surgeons and interventional cardiologists work closely with anesthesiologists to ensure that the largely elderly and frail TAVR patient population spends as little time as possible under anesthesia. Says Kozak, “We’ve been able to send between one-quarter and one-third of our patients home within forty-eight hours, a rate comparable to that achieved by facilities performing percutaneous aortic valve replacement, which requires no general anesthesia whatsoever.”
Both cardiologists and cardiac surgeons are part of the Heart and Vascular Institute, with skill sets of each discipline contributing to a successful TAVR result. This cooperation, as well as the presence of a specialty outpatient clinic just steps away from the main hospital, forms the core of the Heart and Vascular Institute’s multidisciplinary approach to TAVR. Pae adds that the superior infrastructure present at a teaching hospital – including intensive care and extracorporeal mechanical oxygenation (ECMO) – helps improve patient outcomes, as well.
沃尔特·E·佩（Walter E. Pae Jr.），医学博士
威廉·皮尔斯教授
Chief, Cardiac Surgery
电话：717-531-8329
Email:wpae@pennstatehealth.psu.edu
Residency:Cardiothoracic surgery and general surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pa.
Medical School:Penn State College of Medicine, Hershey, Pa.
Connect with Walter E. Pae Jr., MD, on Doximity
Mark Kozak, MD
医学和放射学副教授
介入心脏病专家
电话：717-531-5888
电话：mkozak@pennstatehealth.psu.edu
奖学金：Cardiology, University of Utah Hospital and Clinics, Salt Lake City, Utah
Residency:Internal medicine, Johns Hopkins University Hospital, Baltimore, Maryland
Medical School:约翰·霍普金斯大学，马里兰州巴尔的摩医学院
Connect with Mark Kozak, MD, on Doximity
参考
- http://newheartvalve.com/hcp/treatment-options#sthash.dDm92jai.dpbs. Accessed January 26, 2015.
- http://newheartvalve.com/hcp/tavr-clinical-results#sthash.meQxbc1l.dpbs. Accessed January 26, 2015.