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“SOSTITUZIONE” PERCUTANEA DELLA VALVOLA AORTICA

“SOSTITUZIONE” PERCUTANEA DELLA VALVOLA AORTICA. Gennaro Santoro SOD ” Diagnostica e interventistica ” Dipartimento cardiologico e dei vasi AOU Careggi – Firenze Centro di riferimento regionale Cardiopatie Congenite in Età Adulta Follow up e Interventistica delle Valvulopatie.

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“SOSTITUZIONE” PERCUTANEA DELLA VALVOLA AORTICA

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  1. “SOSTITUZIONE” PERCUTANEA DELLA VALVOLA AORTICA Gennaro Santoro SOD ”Diagnostica e interventistica” Dipartimento cardiologico e dei vasi AOU Careggi – Firenze Centro di riferimento regionale Cardiopatie Congenite in Età Adulta Follow up e Interventistica delle Valvulopatie

  2. EPIDEMIOLOGY • AS is the most common form of the adult valvular heart disease • Population Incidence in USA of moderate-severe AS is 0,4% and in aged > 75 y is 2,8% (4% > 85 y) • 33% of patients with severe AS and NYHA fc III-IV did not undergo intervention (high risk).

  3. KAN 1982 LABABIDI 1983 INOUE 1984 CRIBIER 1986 Cardiologia S.Luca Careggi Firenze

  4. VALVULOPLASTICA AO

  5. VALVULOPLASTICA AO TECNICA

  6. VALVULOPLASTICA AO

  7. valvuloplastica percutanea Stenosi aortica calcifica Incremento area valvolare: da 0,4 a 0,9 cmq Mortalità 3 –15% Restenosi a 18 mesi 80%

  8. Stenosi aortica calcifica Valvuloplastica percutanea • * ”PONTE ALLA CHIRURGIA: • -AREA VALVOLARE <0,4 CMQ, • -FE < 0,35 • -IV classe NYHA • Pazienti in scompenso cardiaco refrattario e disfunzione multiorgano • Pazienti in shock • Pazienti in cui non è possibile la sostituzione • valvolare(?) • Paziente sintomatici che devono essere sottoposti ad interventi chirurgici urgenti per altra patologia

  9. VALVULOPLASTICA AO

  10. VALVULOPLASTICA AO

  11. Percutaneous Aortic Valve Implantation

  12. : Lancet. 2000 Oct 21;356(9239):1403-5. Related Articles, Links • Percutaneous replacement of pulmonary valve in a right-ventricle to pulmonary-artery prosthetic conduit with valve dysfunction.Bonhoeffer P, Boudjemline Y, Saliba Z, Merckx J, Aggoun Y, Bonnet D, Acar P, Le Bidois J, Sidi D, Kachaner J.

  13. Percutaneous pulmunary valve

  14. Percutaneous pulmunary valve

  15. Percutaneous Heart Valve • PHV • Equine pericardium • Highly resistant balloon expandable stent • Optimal hemodynamics with durability > 5 years on bench testing

  16. Crimping phase

  17. Patent Coronary Arteries RCA LM

  18. Antegrade transseptal approach

  19. Hemodynamic Results

  20. Cribier-Edwards Aortic PHV • Valve maintains circular geometry despite stenotic environment • Calcific native leaflets help secure valve and maintain fixation

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