Kubantu abanesifo esinzima se-aortic valve, ukutshintshwa kwe-valve yokutshintsha kudla ngokuba yonyango kuphela olunikeza uncedo olukhulu. Nangona kunjalo, ukuhlinzwa kwe-valor i-aortic kubandakanya ubungozi obukhulu. I-Transcatheter i-aortic valve implantation (TAVI) yaphuhliswa njengenzame yokwenza indlela encinci yokususa i- valor aortic .
Kwi-TAVI, i-valve ye-aortic yokufakelwa yenziwe ngokusetyenziswa kwenkqubo yokwenza i-catheterization.
Nangona i-TAVI isabonwa njengenkqubo entsha, ivunyiwe kwi-United States kunye neYurophu yeNyunyana yokunyanga izigulane ezithile ezibeka ingozi kwi-aortic stenosis. EYurophu, ikwavunywa kwakhona ekuphatheni abanye abantu abane-aortic.
Ngee-Aortic Valve Disease
Kwi-aortic stenosis, i-valor i-aortic iyanqandwa, nto leyo eyenza intliziyo isebenze nzima kakhulu ukupompa igazi emzimbeni. Kwi- aortic kwakhona , i-aortic valve ihluleka ukuvala ngokupheleleyo, ivumela igazi ukuba libuyele ngaphakathi entliziyweni xa ivalve ifanele ivalwe. Ekugqibeleni, enye yeemeti ze-aortic zingaphumelela entliziyweni yokuhluleka , kubangele i-edema (ukukhukhuma), i- dyspnea , kunye (kaninzi) nokufa.
Nangona iimpawu ze-aortic isifo se-valve zingalawulwa ngethuba kusetyenziswa unyango lwezokwelapha ukuhluleka kwentliziyo , akukho nyeza inokukhupha ingxaki ye-aortic.
Ukuphela kwonyango olusebenzayo kuphela kukunyusa indawo ye-aortic valve enegciwane.
Ngelishwa, indlela eqhelekileyo yokutshintsha i-aortic valve idinga inkqubo enkulu yokuvula intliziyo, kwaye, ingakumbi kwizigulane ezikhulile ezona ziqulunqa i-aortic stenosis, yinkqubo enomngcipheko omkhulu.
Inkqubo ye-TAVI iye yaphuhliswa njengendlela ephantsi yokubeka ingozi ekutshintsheni i-aortic valve.
I-TAVI Devices ifakiwe njani?
Izixhobo ezimbini ze-TAVI zivunyelwe i-FDA e-United States-i-valves SAPIEN valves, kunye ne-Medtronic CoreValve. Izixhobo ezininzi ze-TAVI ezongezelelweyo zivunyiwe eYurophu. Zonke ezi zixhobo zisebenza ngokufanayo: I-valve yokufakelwa ifakwe kwisakhelo socingo oludibeneyo, esiqhotyoshelwe kwikhenta. I-cathterta ifakwe kwisitya segazi (ngokuqhelekileyo, umthambo wesibhobho kufuphi ne-groin), kwaye iqhubekele kwindawo ye-aortic valve. Xa esesikhundleni, ifreyimu yocingo iyanwetshwa ngokuvuthela ibhaluni. Oku kuvumela i-valve yokufakelwa ukuba ivule, kwaye iqalise ukusebenza.
Ziziphi iziphumo kunye ne-TAVI?
Izifundo zokuqala kunye ne-TAVI zazingaphelelanga kwizigulane ezine-storosis eziqatha kakhulu ezazibonakala zigula kakhulu ukuba zisebenze ngokuvakalayo kwentliziyo. Kwizi gulane ezigula kakhulu, abo babenomdla wokufumana i-TAVI banciphise izinga lokufa kwabantu kwaye baphucula kakhulu iimpawu emva konyaka omnye, xa kuthelekiswa nalabo bafumana unyango lonyango kuphela.
Nangona kunjalo, izigulane ezingazange zenzeke kwi-TAVI zineziganeko ezi-5% zesibalo esikhulu, xa kuthelekiswa ne-1% kuphela kwizigulane ezonyango.
Izibetha ezihlobene ne-TAVI zibuhlungu .
Uphononongo olulandelayo lufanisa i-TAVI kunye ne-aortic valve endaweni e-690 izigulane ezine-storosis e-aortic. Amanani okufa, amazinga omzimba, kunye nokuphuculwa kweempawu kwakufana konyaka omnye kumabini omabili.
Abo baphathwa nge-TAVI babe neengxaki ezinkulu kwiimithana yegazi, kwaye abo baphathwa ngokuhlinzwa ngentliziyo evulekileyo babe neengxaki ezininzi zokuphuma kwegazi kunye ne-post-operative fibrillation ye-atrial .
Iingxaki
Ngelixa i-TAVI ingenasiphelo esincinci ngaphezu kokuhlinzwa kwintliziyo evulekile, kusenokuba yingozi enkulu. Izingozi ezimbini eziqhelekileyo kunye nezibi kakhulu ziyingozi kakhulu emithanjeni yegazi kunye ne-stroke.
Ezi zombini ezi ngxaki zibangelwa uhlaselo olungaphephekiyo olubangelwa ngokufaka umbane onamandla kwaye unzima kakhulu kwiimitha zokuhlala zigugu. Ngenxa yeengxaki ezinjalo, umngcipheko wokufa kunye ne-TAVI ungama-6% kwiintsuku ezingama-30 kule nkqubo.
Ubungqina bwanamhlanje bubonisa ukuba kukho "intambo yokufunda" ehambelana nokuqhuba inkqubo ye-TAVI. Ngokukodwa, umngcipheko weengxaki ezinzima zibonakala ziphezulu kwiindlela ezingama-30 ze-TAVI ugqirha ozenzayo.
Iinkampani eziphuhlisa ii-TAVI zixhobo ziqhubeka nokusebenza ekuphuculeni ubugcisa, kumzamo wokunciphisa ingozi ehambelana nokusetyenziswa kwazo. Okwangoku, nangona kunjalo, izingozi zihlala zikhulu.
I-Current State ye-TAVI
Okwangoku e-US, i-TAVI ivunyiwe yi-FDA kuphela kwizigulane ezine-storosis eziqatha kakhulu ezibonakala zingengozini enkulu kakhulu yokumisela i-aortic valve esikhundleni.
Ukuba i-TAVI isinconywa ukuba wena okanye othandekayo, kufuneka uqinisekise ukuba inkqubo iya kwenziwa ngugqirha oye wafumana amava amaninzi ngale ndlela.
Kwixesha elizayo, mhlawumbi i-TAVI iya kuba yindlela evuyiweyo yokuvuthwa kwentliziyo-bhanya ubuncinane kwezinye izigulane ezine-storosis ephawulekayo "ezingaguli kakhulu" ukwenzela ukuhlinzwa ngokukhululekile kwentliziyo. Kodwa kunikezelwa iingxaki ezinokuthi zihlangene ne-TAVI, asikho apha.
> Imithombo:
> Zajarias A, Cribier AG. Iziphumo kunye noKhuseleko lwe-Aortic Valve Replacement. J Am Coll Cardiol 2009; 53: 1829.
> Leon MB, Smith CR, Mack M, et al. I-Transcatheter i-Aortic Valve Implantation ye-Aortic Stenosis kwizigulane ezingenakuguqulwa kwezifo. N Engl J Med 2010; 363: 1597.
> Smith CR, Leon MB, Mack MJ, et al. I-Transcatheter kunye noVavanyo lwe-Aortic I-Valor esikhundleni se-Patients High-Risk. N Engl J Med 2011; 364: 2187.
> Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA / ACC Isikhokelo soLawulo lwezilwelisi ezine-Valvular Heart Disease: Ingxelo ye-American College of Cardiology / American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63: e57.