Percutaneous Heart Valve Replacement. Effective Health Care Program, Technical Brief Number 2

摘要

Percutaneous heart valve replacement is a relatively new interventional procedure involving the insertion of an artificial heart valve using a catheter, rather than through open heart surgery. The portal of entry is typically either via the femoral vein or artery, or directly through the myocardium via the apical region of the heart. An expandable prosthetic heart valve is delivered and deployed at the site of the diseased native valve. The percutaneous heart valve replacement procedure usually takes less time to perform and is less invasive than open heart surgery. The Agency for Healthcare Research and Quality (AHRQ) has commissioned this Technical Brief to describe the types of conventional and percutaneous heart valves now in use or in development and their theoretical advantages and disadvantages for different patient populations; describe the literature comparing various types of conventional heart valves in adults and determine whether a systematic review of this literature is feasible and needed; describe the literature evaluating percutaneous heart valves in adults, including the patient populations and major outcomes studied to date, and describe implantation techniques for percutaneous heart valves and the factors associated with surgery or setting that may impact outcomes. The intended audience of this Technical Brief includes policymakers, decisionmakers for third-party payers, clinicians, patients, and investigators.