高度大動脈弁狭窄症患者に対する経カテーテル的大動脈弁置換術
要 旨：高度の大動脈弁狭窄症患者の治療として，外科的大動脈弁置換術はゴールドスタンダードである。しかし実臨床の場では高齢，低心機能，併存疾患による手術リスクの上昇のために手術が必要な患者の30%以上が，外科的治療を受けていない。このようなハイリスク患者に対して，外科的大動脈弁置換術に代わる非侵襲的な治療法として，経カテ—テル的大動脈弁置換術が開発された。現在はEdwards SAPIEN systemとCoreValve systemの2種類が臨床使用されている。病的石灰化大動脈弁に対して，心拍動下での大動脈弁へステントを留置する手技であるため，合併症に注意を払う必要がある。PARTNERトラ...
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| Published in | 脈管学 Vol. 53; no. January; pp. 9 - 18 |
|---|---|
| Main Authors | , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本脈管学会
10.01.2013
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0387-1126 1880-8840 |
| DOI | 10.7133/jca.53.9 |
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| Abstract | 要 旨：高度の大動脈弁狭窄症患者の治療として，外科的大動脈弁置換術はゴールドスタンダードである。しかし実臨床の場では高齢，低心機能，併存疾患による手術リスクの上昇のために手術が必要な患者の30%以上が，外科的治療を受けていない。このようなハイリスク患者に対して，外科的大動脈弁置換術に代わる非侵襲的な治療法として，経カテ—テル的大動脈弁置換術が開発された。現在はEdwards SAPIEN systemとCoreValve systemの2種類が臨床使用されている。病的石灰化大動脈弁に対して，心拍動下での大動脈弁へステントを留置する手技であるため，合併症に注意を払う必要がある。PARTNERトライアルをはじめとした臨床試験結果が報告されつつあり，概要について解説する。 |
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| AbstractList | 要 旨：高度の大動脈弁狭窄症患者の治療として，外科的大動脈弁置換術はゴールドスタンダードである。しかし実臨床の場では高齢，低心機能，併存疾患による手術リスクの上昇のために手術が必要な患者の30%以上が，外科的治療を受けていない。このようなハイリスク患者に対して，外科的大動脈弁置換術に代わる非侵襲的な治療法として，経カテ—テル的大動脈弁置換術が開発された。現在はEdwards SAPIEN systemとCoreValve systemの2種類が臨床使用されている。病的石灰化大動脈弁に対して，心拍動下での大動脈弁へステントを留置する手技であるため，合併症に注意を払う必要がある。PARTNERトライアルをはじめとした臨床試験結果が報告されつつあり，概要について解説する。 |
| Author | 西岡, 利彦 佐々木, 英樹 塩田, 隆弘 佐々木, 修 |
| Author_xml | – sequence: 1 fullname: 西岡, 利彦 organization: 埼玉医科大学総合医療センター心臓内科 – sequence: 1 fullname: 佐々木, 修 organization: 埼玉医科大学総合医療センター心臓内科 – sequence: 1 fullname: 佐々木, 英樹 organization: 愛媛県立中央病院心臓血管外科 – sequence: 1 fullname: 塩田, 隆弘 organization: シーダーズ・サイナイメディカルセンター |
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| Copyright | 2013 日本脈管学会 |
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| References_xml | – reference: 16)Piazza N, Onuma Y, Emile Jesserun E, et al: Early and Persistent Intraventricular Conduction Abnormalities and Requirements for Pacemaking After Percutaneous Replacement of the Aortic Valve. J Am Coll Cardiol Intv 2008; 1: 310-316 – reference: 49)Ruel M, Al-Faleh H, Kulik A, et al: Prosthesis-patient mismatch after aortic valve replacement predominantly affects patients with preexisting left ventricular dysfunction: effect on survival, freedom from heart failure, and left ventricular mass regression. J Thorac Cardiovasc Surg 2006; 131: 1036-1044 – reference: 33)Leon MB, Smith CR, Mack M, et al: Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 2010; 363: 1597-1607 – reference: 50)Bleiziffer S, Ali A, Hettich IM, et al: Impact of the indexed effective orifice area on mid-term cardiac-related mortality after aortic valve replacement. 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Circ J 2010; 74: 1513-1517 – reference: 36)Aregger F, Wenaweser P, Hellige GJ, et al: Risk of acute kidney injury in patients with severe aortic valve stenosis undergoing transcatheter valve replacement. Nephrol Dial Transplant 2009; 24: 2175-2179 – reference: 8)Sharony R, Grossi EA, Saunders PC, et al: Aortic valve replacement in patients with impaired ventricular function. Ann Thorac Surg 2003; 75: 1808-1814 – reference: 39)Moreno R, Calvo L, Salinas P, et al: Causes of peri-operative mortality after transcatheter aortic valve implantation: a pooled analysis of 12 studies and 1223 patients. J Invasive Cardiol 2011; 23: 180-184 – reference: 19)Wilimski R, Huczek Z, Szczawin ´ski W, et al: Transcatheter aortic valve implantation using direct aortic access: first procedures in Poland. 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| Title | 高度大動脈弁狭窄症患者に対する経カテーテル的大動脈弁置換術 |
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