循環器ジャーナル66巻2号

2018年04月発行

特集 Structural Heart Diseaseインターベンション—「新しい」インターベンションのすべて Ⅰ．TAVI

冠動脈疾患合併例に対するTAVI

著者： 長沼亨¹

所属機関： ¹新東京病院心臓内科

ページ範囲：P.188 - P.194

Point
・経カテーテル大動脈弁植込み術（transcatheter aortic valve implantation;TAVI）前の冠動脈完全血行再建は議論のあるところ（少なくとも，必須とはいえない）．
・冠動脈ステント留置術（percutaneous coronary intervention;PCI）を先行すると，抗血小板薬2剤併用療法（dual antiplatelet therapy;DAPT）下にTAVIを施行することになり得，TAVI周術期の出血性合併症のリスクが懸念される．
・植込み時に高頻拍ペーシングが必要となるバルン拡張型のEdwards Lifesciences社 SAPIENは，XTから3に進化したことで，前拡張の必要性が乏しくなった．また自己拡張型のMedtronic社CoreValve/Evolut-Rはそもそも高頻拍ペーシングが必要でない．つまり現在の新世代人工弁を用いた洗練されたTAVIストラテジーでは，意図的な血圧低下，冠血流低下時間が極めて短く，冠動脈狭窄のインパクトが小さくなっている．

参考文献

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