Last ned 2/2012 - Kirurgen.no

Tema
Figur 11. Eksempel på bearbeidelse av CT bilder for TAVI prosedyre
Ved bruk av software OsiriX for Mac kan man konstruere CT bildene for måling av annulus diameter, leie av aorta og
form på femoralkar ved hjelp av ulike 3D rekonstruksjoner. Her er eksempel på leie og vinkel på aorta.
Konklusjon
Åpen kirurgi for aortastenose har lav mortalitet
og morbiditet (29). Det er også svært
gode resultater for reparasjon av mitralklaffe-insuffisiens,
spesielt degenerativ (29).
Åpen kirurgi på hjertelungemaskin vil derfor
fremdeles være gullstandard for behandling
av aortastenose og mitalinsuffisiens, men
høyrisikopasienter vil kunne ha nytte av
kateterklaff behandling. Det er heller ikke
langtidsoppfølging av kateterintervensjoner
siden de har vært benyttet i mindre enn
10 år. Man er derfor svært restriktive til å
utvide indikasjonsstillingene, spesielt hos
yngre pasienter.
For ”redo”-prosedyerer synes metodene
lovende.
Pasienter som er behandlet med kateterklaffer,
må postoperativt følges på like linje
som konvensjonelt opererte pasienter.
Kirurger kan ved transkateter klaff implantasjon
velge den tilgangen som er den beste
for pasienten, da alle teknikker beherskes.
Kirurger har bred erfaring i å kommuniserer
med ekkokardiologer i forbindelse med
mitral-klaffereparasjoner, og har derfor godt
grunnlag for å utføre MitraClip prosedyrer.
Kirurger bør fortsatt ha en dominerende
rolle i all hjerteklaffbehandling, og på sikt
må derfor spesialistutdanningen tilpasses
denne nye utviklingen •
Referanser
1) Bonhoeffer P, Boudjemline Y, Saliba Z et al.
Percutaneous replacement of pulmonary valve in a
right-ventricle to pulmonary-artery prosthetic conduit
with valve dysfunction. Lancet 2000; 356(9239): 1403-5.
[CrossRef] [Medline] [CAS]
2) Cribier A, Eltchaninoff H, Bash A et al. Percutaneous
transcatheter implantation of an aotic valve prosthesis
for calsific aortic stenosis: First human case
description. Circulation 2002; 106: 3006-8.
3) Condado JA, Acquatella H, Rodriguez L et al.
Percutaneous edge-to-edge mitral valve repair: 2-year
follow-up in the first human case. Cath Cardiovasc Int
2006; 67: 323-5.
4) Davies H. Catheter mounted valve for temporary relief
of aortic insufficiency, Lancet 1965;1: 250.
5) Cribier A, Savin T, Berland J, et al. Percutaneous
transluminal balloon valvuloplasty of adult aortic
stenosis: report of 92 cases. J Am Coll Cardiol 1987; 9:
381–6.
6) Andersen HR et al . Transluminal implantation of
artificial heart valves. Description of a new expandable
aortic valve and initial results with implantation by
catheter technique in closed chest pigs. Eur Heart J
1992; 13(5): 704-8.
7) Cribier A, Eltchaninoff H, Troh C, et al.. Early experience
with percutaneous transcatheter implantation of
heart valve prosthesis for the treatment of end-stage
inoperable patients with calcific aortic stenosis. J Am
Coll Cardiol 2004; 43: 698–703.
8) Hanzel GS, Harrity PJ and Schreiber TL, et al.
Retrograde percutaneous aortic valve implantation for
critical aortic stenosis. Catheter Cardiovasc Interv 2005;
64: 322–6.
9) Chandavimol M, McClure SJ, Carere RG et al
Percutaneous aortic valve implantation: A case report.
Can J Cardiol 2006; 22: 1159–61.
10) Dewey TM ,Walther T, Doss M et al. Transapical aortic
valve implantation: An animal feasibility study. Ann
Thorac Surg 2006; 82:110–6.
11) Ye J, A. Cheung, Lichtenstein SV et al. Transapical aortic
valve implantation in humans. J Thorac Cardiovasc
Surg 2006;131: 1194–6.
12) Grube E, Laborde JC, Gerckens U et al. Percutaneous
implantation of the CoreValve self-expanding valve
prosthesis in high-risk patients with aortic valve
disease: The Siegburg first-in-man study. Circulation
2006; 114: 1616–24.
13) Leon MB, Smith CR, Mack M, et al. Transcatheter aorticvalve
implantation for aortic stenosis in patients who
cannot undergo surgery. N Engl J Med 2010; Oct 21:
1597-1607.
14) Smith CR, Leon MB, Mack MJ et al. Transcatheter
versus Aortic-Valve Replacement in High-Risk Patients.
N Engl J Med 2011; 364: 2187-98.
14) SOURCE: One-year results for Sapien transcatheter
valve suggest mortality edging downward
[Interventional/Surgery > Interventional/Surgery; May
25, 2010]
15) Kodali, S, Williams MR, Smith CR et al. Two-Year
Outcomes after Transcatheter or Surgical Aortic-Valve
Replacement. N Engl J Med 2012; 366: 1686- 95.
16) Sinning JM, Hammerstingl C, Vasa-Nicotera M et
al. Aortic Regurgitation Index Defines Severity of
Peri-Prostetic Regurgitation and Predicts Outcome in
Patients After Transcatheter Aortic Valve Implantaion. J
Am Coll Cardiol 2012; 59: 1134-41.
17) Enriquez-Sarano M, Schaff HV, Orzulak TA. Valve
repair improves the outcome of surgery for mitral
regurgitation: a multivariate analysis. Circulation 1995;
91:1022-8.
18) Maisano F, Torracca L, Oppizzi M et al. The edge-toedge
technique: a simplified method for correct mitral
insufficiency. Eur J Cardiothoracic Surg 1998; 13: 240-5.
19) Heuvel FM, Alfieri O, Mariani MA. Editorial. MitraClip
in end stage heart failure: a realisstic alternative to
surgery. Eur Heart J 2011; 13: 472-4.
20) Feldman T, Kar S, Rinaldi M et al EVERESTI
investigators. Percutanous mitral Repair with the
MitraClip System. Safety and Midterm Durability in
the initial EVEREST (Endovascular Valve Edge-to-Edge
REpair Study) Cohort. JACC 2009; 54:686-94.
21) Feldman T, Foster E, Glower D et al .EVERESTII
investigators. Percutanous repair of Surgery for Mitral
Regurgitation. NEJM 2011; 264(15): 1395-1406.
22) Gaia DF, Palma JH, Marcondes JA et al. Tricuspid
transcatheter valve-in-valve: an alternative to high-risk
patients. Eur J Card Thorac Surg 2012; 41: 696-8.
23) Robert P, Boudjemline Y, Cheatham JP et al.
Percutaneous Tricuspid Valve Replacement in
Congenital and Acquired Heart Disease. J Am Coll
Cardiol. 2011; 58: 117-22.
24) Webb JG, Wood D, Ye J, Gurvitch R, et al. Transcatheter
Valve-in-Valve Implantation for Failed Bioprosthetic
Heart Valves. Circulation 2010;12:848-57.
25) Cheung AW, Gurvitch R, Ye J, et al. Transcatheter
transapical mitral valve-in-valve implantations for a
failed biorostehsis: A case series. J Thorac Cardiovsc
Surg. 2011; 141:711-5.
26) De Weger A, Ewe SH, Delgado V, Bax JJ. First-in-man
implantation of a transcatheter aortic valve in a mitral
annuloplasty ring: novel treatment modality for failed
mitral valve repair. Eur J Cardiothorac Surg. 2011; 39:
1054-56.
27) Casselman F, Martens S, De Bruyne B, Degrieck I.
Reducing operative mortality in valvular reoperations:
The ”valve-in-ring” procedure. J Thorac Cardiovasc
Surg 2011; 141(5): 1317-8.
28) Mølstad P, Veel T, Rynning S. Long-term survival after
aortic valve replacement in octogenerian and high-risk
subgroups. Eur J Cardio Thorac Surg. 2012, May 2nd.
29) Detaint D, Sundt T, Nkomo VT et al. Surgical Correction
of Mitral Regurgitation inthe Elderly. Outcomes and
Recent Improvements. Circulation. 2006; 114: 265-72.
92 Kirurgen nr. 2, 2012