Ga mutanen da ke fama da mummunan cututtuka na kwandon ruwa, mai sauyawa na sauƙaƙe ne sau ɗaya ne kawai magani wanda ke ba da taimako mai yawa. Duk da haka, yin amfani da valve aortic ya shafi hadarin gaske. An kafa fasalin kwalliya mai kwakwalwa (TAVI) a matsayin ƙoƙari na ƙaddamar da matakan gaggawa don maye gurbin kwastom ɗin aortic marasa lafiya .
A TAVI, an kafa kwandon mai kwakwalwa ta hanyar hanyar ƙwaƙwalwar kamala.
Duk da yake TAVI har yanzu ana daukar sabbin hanyoyin, an amince da shi a Amurka da Tarayyar Turai don magance wasu marasa lafiya mai tsanani da ciwo mai tsanani. A Turai, an kuma amince da ita don zalunta wasu mutane tare da rikici mai tsanani.
Game da cutar Aortic Valve
A cikin ɓawon ƙwayar cuta, kwarjin kwarin ya zama ɓangare wanda aka hana shi, wanda ya tilasta zuciya ya yi aiki da wuya wajen zub da jini ga jiki. A cikin tsararraki mai kwakwalwa, bawul din ya kasa rufewa gaba ɗaya, ya sa jini ya sake dawowa cikin zuciya lokacin da za'a iya kulle valve. A ƙarshe, ko dai daga waɗannan yanayin yanayin kwastar zai iya cigaba da rashin ciwo zuciya , haifar da edema (ƙumburi), dyspnea , da kuma (sau da yawa) mutuwa.
Duk da yake ana iya gudanar da bayyanar cututtuka na kwarjin valve don wani lokaci ta yin amfani da maganin likita don ƙin zuciya , babu maganin da zai iya taimakawa matsala ta hanyar inji tare da kwandon daji.
Abin sani kawai magani mai mahimmanci shine a maye gurbin kwastar aortic marasa lafiya tare da bashi na wucin gadi.
Abin takaici, hanyar da za a yi na gyaran valve aortic yana buƙatar babban aikin ƙwaƙwalwar zuciya, kuma, musamman a cikin marasa lafiya marasa lafiya wadanda suka fi yawan ci gaba da ciwon zuciya, yana da wata hanyar da take kawo hadarin gaske.
An tsara hanyar TAVI a matsayin mai yiwuwar ƙananan haɗari don maye gurbin kwastar aortic.
Yaya aka sa kayan aikin TAVI?
Na'urorin TAVI guda biyu an yarda da FDA a Amurka - Edft SAPIEN valve, da Medtronic CoreValve. Akwai ƙarin na'urorin TAVI da aka yarda a Turai. Duk waɗannan na'urorin sunyi aiki kamar haka: Ƙarfin artificial an haɗa shi zuwa tarkon waya, wadda aka haɗe zuwa wani catheter. An saka kullun a cikin jirgi na jini (yawanci, ƙwaƙwalwar ƙwararrakin a kusa da kullun), kuma yana ci gaba zuwa yankin valve. Yayin da yake cikin matsayi, an shimfiɗa filayen filayen ta hanyar busawa da zakara. Wannan yana ba da damar bashi na wucin gadi ya buɗe, da kuma fara aiki.
Menene Sakamakon TAVI?
Binciken farko tare da TAVI sun iyakance ga marasa lafiya da ke fama da mummunan cututtukan da suka kamu da rashin lafiyarsu don samun aikin tiyata wanda ya kamata a sauya sauyawa na kwalliya. A cikin marasa lafiyar marasa lafiyar, waɗanda aka bazu don karɓar TAVI sun rage yawan ƙwayar mace-mace kuma sun inganta alamun bayyanar cutar bayan shekara guda, idan aka kwatanta da wadanda suka karbi magani kawai.
Duk da haka, marasa lafiya da aka ƙaddamar zuwa TAVI sun kamu da kashi 5% na fashewar cutar , idan aka kwatanta da kawai 1% cikin marasa lafiya.
Tatsun da aka shafi TAVI sune shagunan bugun jini .
Wani bincike na baya idan aka kwatanta da TAVI a matsayin mai sauyawa na kwastar a cikin 690 marasa lafiya tare da mummunan cututtuka. Hanyoyin mace-mace, ƙwayar cuta, da kuma cigaba da alamar alama sun kasance kamar wannan shekara a cikin ƙungiyoyin biyu.
Wadanda aka bi da TAVI suna da matsaloli masu yawa ga tasoshin jini, kuma waɗanda aka bi da tiyata da ƙwaƙwalwar zuciya suna da ƙarin rikitarwa na zubar da jini da kuma karin samfurori da suka shafi aikin jin dadi.
Matsaloli
Yayinda TAVI ya fi raguwa fiye da motsa jiki na zuciya, har yanzu tana ci gaba da hadarin gaske. Wadannan hatsari mafi tsanani da tsanani shine mummunan lalacewar manyan jini da fashewa.
Duk wadannan matsalolin sun faru ne saboda sau da yawa-abin da ba zai yiwu ba wanda ya haifar da shigar da sassauci mai sauƙi da sauƙi a cikin suturar ƙwayar cuta. A sakamakon wannan rikitarwa, haɗarin mutuwa tare da TAVI yana kewaye da 6% a cikin kwanaki 30 na hanya.
Shaidu na yanzu suna nuna cewa akwai "ɓangaren ilmantarwa" mai zurfi da aka haɗa da yin hanyar TAVI. Musamman, haɗarin matsaloli mai tsanani zai kasance mafi girma a lokacin farkon 30 TAVI hanyoyin da likita ke yi.
Kamfanoni masu tasowa na TAVI suna ci gaba da aiki a kan inganta fasaha, a ƙoƙari na rage halayen da ke hade da amfani. Amma a halin yanzu, duk da haka, hadarin ya kasance mahimmanci.
Yanayin TAVI na yanzu
A halin yanzu a Amurka, FDA ne kawai ya yarda da marasa lafiya da tsananin mummunar cututtukan da ake zaton sun zama babban haɗari ga daidaituwa, sauyawa mai sauya kwalliya.
Idan an bada shawarar TAVI ko dai ku ko ƙaunataccen ku, ya kamata ku tabbata cewa likita wanda ya sami kwarewa ta hanyar wannan fasaha zai yi aiki.
A nan gaba, mai yiwuwa TAVI zai zama wata hanyar da za a yarda da ita don aikin tiyata don a kalla wasu marasa lafiya da ƙananan cututtukan da ba su da mawuyacin "marasa lafiya" don aikin tiyata. Amma ya ba da matsalolin cewa, ya zuwa yanzu, ana danganta su da TAVI, ba a nan ba.
> Sources:
> Zajarias A, Cribier AG. Sakamakon da Tsaro na Sauya Ƙarƙashin Ƙarƙashin Ƙarya. J Am Coll Cardiol 2009; 53: 1829.
> Leon MB, Smith CR, Mack M, et al. Ƙarƙashin Magungunan Ƙwayar Aiki na Transcatheter don Aortic Stenosis a cikin marasa lafiya wanda ba zai iya magance tiyata ba. N Engl J Med 2010; 363: 1597.
> Smith CR, Leon MB, Mack MJ, et al. Transcatheter Game da Canjin Canji na Yammacin Cutar A cikin marasa lafiya. N Engl J Med 2011; 364: 2187.
> Nishimura RA, Otto CM, Bonow RO, et al. 2014 Dokta / ACC Tsarin Dokar Kula da Marasa lafiya Tare da Ciwon Zuciya Valvular: Rahoton Cibiyar Harkokin Kasuwancin Amirka da Cibiyar Harkokin Kasuwancin Amirka game da Sharuɗɗan Ɗaukaka. J Am Coll Cardiol 2014; 63: e57.