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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
sTandard medical TherapY* Tema 20% ABSOLUTE REDUCTION IN ALL-CAUSE mORTALITy AT ONE yEAR 1 Balloon-expandaBle TranscaTheTer aorTic ValVe implanTaTion (TaVi) a new option for your aortic stenosis patients who cannot undergo surgery In Cohort B of the landmark clinical study - The PARTNER Trial - patients receiving an Edwards SAPIEN balloon-expandable transcatheter aortic valve demonstrated a 20% absolute reduction in all-cause mortality compared to the standard medical therapy control group at one year. 1 For more information and to find a TAVI center near you, please visit edwards.com/eu/products/transcathetervalves. *Patients in control arm received best medical management which frequently (78.2%) included balloon aortic valvuloplasty. Reference: 1. Leon MB, Smith CR, Mack M, et al; PARTNER Trial Investigators. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363(17):1597-1607. Edwards Lifesciences devices placed on the European market meeting the essential requirements referred to in Article 3 of the Medical Device Directive 93/42/ECC bear the CE marking of conformity For professional use. See instructions for use for full prescribing information, including indications, contraindications, warnings, precautions, and adverse events. Edwards, Edwards Lifesciences, the stylized E logo, Edwards SAPIEN, PARTNER, and SAPIEN are trademarks of Edwards Lifesciences Corporation. © 2012 Edwards Lifesciences Corporation. All rights reserved. E2385/10-11/THV. Edwards Lifesciences Irvine, USA I Nyon, Switzerland I Tokyo, Japan I Singapore, Singapore I São Paulo, Brazil edwards.com Kirurgen nr. 2, 2012 93
Page 1 and 2: Til medlemmer av norsk kirurgisk fo
Page 3 and 4: innhold redaksjon: Hans Skari (reda
Page 5 and 6: Utdannelse og etterutdannelse Olaug
Page 7 and 8: TEMA Teknologisk utvikling innen ki
Page 9 and 10: Kateterbasert hjerteklaffbehandling
Page 11 and 12: Tema Figur 4. Edwards SAPIEN system
Page 13 and 14: som har fått gjennomslag: ”Edge-
Page 15: Tema Figur 10. Prosedyre klaff-i-ri
Page 19 and 20: i Norge hvor prosedyrekrav nå godk
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Page 55 and 56: NTLF-Nytt | 2012 | Årgang 19 | Nr.
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