Kubantu abanesifo esinzima se-aortic valve, ukushintshwa kwe-valve yokuhlinzwa kuvame ukuphela kokwelapha okunikeza ukukhululeka okukhulu. Noma kunjalo, ukuhlinzwa kwe-valve kuhlanganisa izingozi ezinkulu. Ukufakelwa kwe-valve i-transcatheter i-aortic valve (TAVI) yasungulwa njengomzamo wokwakha indlela encane engavumayo yokufaka amagagasi e-aortic asebegulayo .
Ku-TAVI, i-aortic valve yokufakelwa isetshenziselwa inqubo eyinkimbinkimbi yokwelashwa.
Nakuba i-TAVI isabhekwa njengendlela entsha, ivunyiwe e-United States nase-European Union ekwelapheni iziguli ezithile ezingozi kakhulu ezine-aortic stenosis. EYurophu, futhi kuvunyelwe ukuphatha abanye abantu abane-aortic yokuvuselela.
Mayelana ne-Aortic Valve Disease
Ku-aortic stenosis, i-valve ye-aortic iyavinjelwa kancane, okwenza inhliziyo isebenze kanzima ukupompa igazi emzimbeni. Ngokuphindaphindiwe kwe-aortic , i-valve ye-aortic ihluleka ukuvala ngokuphelele, ivumela igazi ukuba libuyele enhliziyweni uma i-valve ifanele ivaliwe. Ekugcineni, noma yikuphi kwezimo ze-valor aortic kungathuthuka ekuhlulekeni kwenhliziyo , kubangele i-edema (ukuvuvukala), i- dyspnea , futhi (kaningi) yokufa.
Nakuba izimpawu ze-aortic isifo se-valve zingaphathwa isikhathi esisebenzisa ukwelapha kwezokwelapha ukuhluleka kwenhliziyo , akukho mithi engakwazi ukukhulula inkinga yokusebenza nge-valve ye-aortic.
Ukuphela kokwelashwa okuphumelelayo kuphela ukuhlinzekela ngokuzenzakalelayo i-valve ye-aortic enezifo nge-valve yokufakelwa.
Ngeshwa, indlela ejwayelekile yokuguqula i-aortic valve idinga inqubo enkulu yokuhlinzwa enhliziyweni, futhi, ikakhulukazi ezigulini asebekhulile ezivame ukuthuthukisa i-aortic stenosis, yinkqubo ephethe ingozi enkulu.
Inqubo ye-TAVI iye yasungulwa njengendlela engase ibe yingozi kakhulu ekushintsheni i-valve ye-aortic.
Amadivayisi we-TAVI afakiwe kanjani?
Amadivaysi amabili we-TAVI afakwa i-FDA e-United States - i-valve SAPIEN valve, ne-Medtronic CoreValve. Amadivaysi amaningi engeziwe we-TAVI avunywa eYurophu. Wonke lawa madivaysi asebenza ngendlela efanayo: I-valve yokufakelwa ifakwe kufolda yocingo elahliwe, elumathiselwe kumcathisi. I-catheter ifakwa emzimbeni wegazi (ngokuvamile, umthambo wesifazane eduze nendawo ye-groin), futhi iqhubekela phambili endaweni ye-aortic valve. Uma esesikhundleni, ifreyimu yocingo inwetshwa ngokushaya ibhaluni. Lokhu kuvumela i-valve yokufakelwa ukuthi ivule, futhi iqale ukusebenza.
Yiziphi Imiphumela Nge-TAVI?
Izifundo zakuqala nge-TAVI zazilinganiselwe iziguli ezine-aortic stenosis ezinzima ezazibonakala zigula kakhulu ukuba zenze ukuhlinzwa kwenhliziyo evulekile ukuze kusetshenziswe i-aortic valve esikhundleni "sokujwayelekile". Kulezi ziguli ezigula kakhulu, labo ababengenangqondo ukuthola i-TAVI banciphise izinga lokufa kwabantu kakhulu futhi baphuthukisa kakhulu izimpawu emva konyaka owodwa, uma kuqhathaniswa nalabo abathola ukwelashwa ngokweqile.
Kodwa-ke, iziguli ezazingakaze zenzeke ku-TAVI zinezifo eziyisihlanu ze- stroke enkulu, uma kuqhathaniswa ne-1% kuphela ezigulini eziphathwe ngemithi.
Izigubhu ezihlobene ne-TAVI ziyingozi zomzimba.
Ucwaningo oluthile lwaqhathanisa i-TAVI ne-standard aortic valve esikhundleni samagciwane angu-690 ane-aortic stenosis enzima. Amanani okufa, amazinga okushaya, nokuthuthukiswa kwesimpawu kwakufana nonyaka owodwa kuwo wonke womabili amaqembu.
Labo abaphathwa nge-TAVI babenezinkinga ezinkulu emithanjeni yegazi, futhi labo abaphathwa ngokuhlinzwa enhliziyweni evulekile babe nezinkinga eziningi zokuphuza igazi kanye nokuphefumula okungaphezulu kwe- postrial opera.
Izinkinga
Ngenkathi i-TAVI ingenangqondo kakhulu kunokuba ihlinzekwe inhliziyo evulekile, isengcupheni enkulu. Izingozi ezimbili ezivame kakhulu nezingozi kakhulu ukulimala okukhulu emithanjeni enkulu yegazi kanye nesifo sohlangothi.
Zombili lezi zinkinga zibangelwa ukuhlukumezeka okungenakuvinjelwa okubangelwa ukufaka umshini we-valve obukhulu futhi obunzima emithanjeni evame ukugula. Ngenxa yezinkinga ezinjalo, ingozi yokufa ne-TAVI iphakathi kuka-6% zingakapheli izinsuku ezingama-30 zenkambiso.
Ubufakazi bamuva bubonisa ukuthi kukhona "i-curve yokufunda" eqondile ehambisana nokwenza inqubo ye-TAVI. Ikakhulukazi, ingozi yezinkinga ezinkulu kubonakala sengathi iphakeme kakhulu phakathi nezinqubo zokuqala ezingu-30 ze-TAVI udokotela ozenzayo.
Izinkampani ezikhula amadivayisi we-TAVI ziyaqhubeka nokusebenza ekuthuthukiseni ubuchwepheshe, ngomzamo wokunciphisa izingozi ezihambisana nokusetshenziswa kwazo. Kodwa okwamanje, izingozi zihlala zikhulu.
I-State Current ye-TAVI
Njengamanje e-US, i-TAVI ivunywe yi-FDA kuphela ngeziguli ezine-aortic stenosis ezinzima ezithathwa njengengozi enkulu kakhulu yokuguqula i-aortic valve ejwayelekile.
Uma i-TAVI inconywa ukuthi wena noma othandekayo, kufanele uqiniseke ukuthi inqubo izokwenziwa udokotela oye waba nesipiliyoni esikhulu ngale ndlela.
Esikhathini esizayo, kungenzeka ukuthi i-TAVI izoba enye indlela evunyelwe ukuhlinzekwa kwenhliziyo okungenani iziguli ezithile ezine-aortic stenosis ebalulekile "engaguli kakhulu" ekuhlinzekeni kwenhliziyo evulekile. Kodwa kunikezwe izinkinga ezikude kakhulu, ezihlobene ne-TAVI, asikho okwamanje.
> Imithombo:
> Zajarias A, i-Cribier AG. Imiphumela kanye Nokuphepha kwe-Aortic Valve Replacement Percutaneous. J Am Coll Cardiol 2009; 53: 1829.
> Leon MB, Smith CR, Mack M, et al. Ukufakelwa kwe-Transcatheter Aortic Valve ye-Aortic Stenosis Kwabeziguli Abahluleka Ukuhlinzwa. N Engl J Med 2010; 363: 1597.
> Smith CR, Leon MB, Mack MJ, et al. I-Transcatheter Versus Valve Aortic Yokufaka Indawo Ezingeni Eziphezulu Zengozi. N Engl J Med 2011; 364: 2187.
> Nishimura RA, Otto CM, Bonow RO, et al. Umhlahlandlela we-AHA / ACC we-2014 we-Management of Patients With Valvular Heart Disease: Umbiko we-American College of Cardiology / American Heart Association Task Force on Guidelines Practice. J Am Coll Cardiol 2014; 63: e57.