Martin B. Leon, M.D., Craig R. Smith, M.D., Michael Mack, M.D., D. Craig Miller, M.D., Jeffrey W. Moses, M.D., Lars G. Svensson, M.D., Ph.D., E. Murat.

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Presentation transcript:

Martin B. Leon, M.D., Craig R. Smith, M.D., Michael Mack, M.D., D. Craig Miller, M.D., Jeffrey W. Moses, M.D., Lars G. Svensson, M.D., Ph.D., E. Murat Tuzcu, M.D., John G. Webb, M.D., Gregory P. Fontana, M.D., Raj R. Makkar, M.D., David L. Brown, M.D., Peter C. Block, M.D., Robert A. Guyton, M.D., Augusto D. Pichard, M.D., Joseph E. Bavaria, M.D., Howard C. Herrmann, M.D., Pamela S. Douglas, M.D., John L. Petersen, M.D., Jodi J. Akin, M.S., William N. Anderson, Ph.D., Duolao Wang, Ph.D., and Stuart Pocock, Ph.D., for the PARTNER Trial Investigators* n engl j med 363;17 nejm.1598 org october 21, 2010 R1 Kim Kwang-Yeol /prof. Kim Woo- Sik

Aortic stenosis - insidious disease with a long latency period - rapid progression after the appearance of symptoms  high rate of death(50% in first 2years after symptoms appear) - surgical replacement of aortic valve  reduce symptoms and improves survial - but patients who high surgical risk : don’t undergo surgery - less invasive treatment may be worthwhile alternative

Transcatheter aortic-valve implantation(TAVI) - bioprosthetic valve is inserted through a catheter and implanted within the diaseased native aortic valve - treatment of severe aortic stenosis : in patients who are at high surgical risk - rate of death from any cause at 1year : 25%  the outcomes with TAVI vs. Standard therapy

Patients selection - Between May 11, 2007 and March 16, severe stenosis - NYHA(New York Heart Association) class II, III, IV - patients with aortic stenosis : not suitable candidate for surgery Study divice and procedure - The Edwards SAPIEN heart valve system(Edwards Lifesciences)  : consist of trileaflet bovine pericardial valve, balloon-  expandable, stainless-steel support frame Aortic-valve area < 0.8 cm² Aortic-valve gradient ≥ 40 mmHg Peak aortic-jet velocity≥ 4.0 m/s

TAVI(Transcatheter Aortic-Valve Impantation) - In patients with severe aortic stenosis who were not suitable candidates for surgery  - compared with standard therapy, significantly reduced the  rates of death from any cause, the composite end point of  death from any cause or repeat hospitalization  -despite the higher incidence of major strokes and major  vascular events.