Plenary Session 12
3月28日［日］08:00-09:30
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Strategic treatment for Heart Valve
DiseaseCatheter interventional treatment vs Lessinvasive cardiac surgery
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我が国では社会の高齢化とともに大動脈弁狭窄症が増加を続けており、これに伴って高齢患者に対する大動脈弁置換施行件数も増加を続けている。しかしながら高齢患者が多いこともあり、大動脈弁狭窄症としては手術適応であるものの併存疾患やfrailtyなどのために手術リスクが高いと判断され開心術が見送られてしまう例も少なくなかった。このような手術リスクの高い患者を対象とする低侵襲治療として経カテーテル的大動脈弁置換術（TAVR）が我が国でも保険償還され，認定施設において実施されている。既にPARTNERIII試験では、Low RiskのAS症例における、AVRに対するTAVRのRCTによる比較試験も行われ、その結果によって今後のAS治療に対するパラダイムシフトが予想される。一方、高リスクの僧帽弁閉鎖不全症例に対する非侵襲的治療としてMitraClip?が承認され、我が国でも保険診療が開始され、一方TMVRやNeochordの臨床試験も始まっている。一方、外科治療もMICS手術やロボット手術そしてSutureless Valveが保険適用され、低侵襲化が進んでいる。本セッションでは、このような弁膜症に対する経カテーテル低侵襲的治療法について、外科治療と比較しながらその安全性や有用性、医療経済の面から最新の外科治療との比較からも議論し、次世代治療法の確立の一助となればと考える
Aorta stenosis (AS) keeps being increased in our country in association with social aging, and the number of aorta valve replacement for elder patients has also grown. However, there were an ineligible number of inoperable patients with AS because of comorbidity and/or high frailty. For these patients, transcatheter aorta valve replacement (TAVR) has been developed in Japan. Moreover, results of PARTNER-lll trial for low risk AS will change the paradigm of AS treatment. For mitral regurgitation with high operative risks, in particular with severe ventricular dysfunction, the therapeutic strategy has not been established. MitraClip? has been approved as a noninvasive procedure for patients with severe mitral regurgitation and high operative risks, and Clinical trial for approval of TMVR and Neochord has been already started in Japan. On the other hand, less invasive surgical treatment such as MICS surgery, Robotics surgery and Sutureless valve for AS have been developed.
In this session, we would like to reconfirm points to be kept in mind to exert benefits through the transcatheter noninvasive therapy for Structure heart diseases and to discuss a plan for issues to be resolved.
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Yoshiki Sawa
Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine, Suita
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Kentaro Hayashida
Department of Cardiology, Keio University School of Medicine, Tokyo
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Joseph Woo
Department of Cardiothoracic Surgery, Stanford University School of Medicine, California, USA
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Makoto Amaki
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita
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Kentaro Hayashida
Department of Cardiology, Keio University School of Medicine, Tokyo
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Shin-ichi Shirai
Department of Cardiology, Kokura Memorial Hospital, Kitakyushu
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Minoru Tabata
Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu/Toranomon Hospital, Tokyo
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Koichi Toda
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita
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