经皮主动脉瓣置换专家共识课件精美版.pptx

1、 对于左心室收缩功能正常的患者：主瓣峰值血流速度4.0 m/s(对应跨主瓣峰值压差64 mm Hg),平均压差40 mm Hg,或主瓣瓣口面积4.Patient Selection:Inclusion and Exclusion Criteria in Clinical Trials,Irvine,CA)：三瓣牛心包瓣固定在可球囊扩张的钴铬合金支架上。房间要足够温暖，甚至应用体下供热系统。严重主动脉瓣狭窄的治疗选择对于左心室收缩功能正常的患者：,Irvine,CA)：三瓣牛心包瓣固定在可球囊扩张的钴铬合金支架上。With severe,symptomatic,calcific AS,AVR i

2、s the only effective treatment that improves symptoms and prolongs survival(30,31).考虑到患者体表面积不同，主瓣面积常用体表面积指数表示，0.实际上，应用现代生物瓣，术后5年有95的患者瓣膜仍然良好，不必再次手术；This valve has only been used by a retrograde approacheither via transfemoral,subclavian,or严重主动脉瓣狭窄的治疗选择Table 7.Quality of Life and Symptom Assessment i

3、n TAVR TrialsTable 9.Patient Selection:Inclusion and Exclusion Criteria in Clinical TrialsTable 9.Patient Selection:Inclusion and Exclusion Criteria in Clinical Trials 心脏彩超 CT 心脏磁共振 观察主动脉瓣、瓣环、瓣环距冠状动脉的距离、升主动脉、髂股动脉情况。心内科、心外科 杂交手术室 设备齐全的、宽敞的、有双球管的C型臂。全麻 肺动脉导管，经食管超声，临时起搏器，除颤仪。房间要足够温暖，甚至应用体下供热系统。避免过长时间低血

4、压。穿刺或切开均可，依据具体情况，各有利弊。6 cm2/m2 作为严重主瓣狭窄的标准.Major Outcomes at 30 Days and 1 Year in Cohort B of the PARTNER TrialDespite substantial contemporary experience with successful AVR in elderly patients,multiple series have documented that 30%to 40%of patients with severe AS do not undergo surgery owing to

5、 advanced age,LV dysfunction,multiple coexisting conditions,and patient preference or physician recommendation。An estimated 40,000 patients have received TAVR worldwide.严重主动脉瓣狭窄的治疗选择设备齐全的、宽敞的、有双球管的C型臂。,Irvine,CA)：三瓣牛心包瓣固定在可球囊扩张的钴铬合金支架上。6 cm2/m2 作为严重主瓣狭窄的标准.Major Outcomes at 30 Days and 1 Year in Coh

6、ort B of the PARTNER TrialMultiple single and multicenter registries,and a single randomized trial,have documented favorable outcomes using a wide spectrum of endpoints,including survival,symptom status,quality of life,and need for repeat hospitalization.常会发生生物瓣叶的钙化。Major Outcomes at 30 Days and 1 Y

7、ear in Cohort B of the PARTNER TrialIt is available in 3 sizes26 mm,29 mm,and 31 mm.严重主动脉瓣狭窄的治疗选择This valve has only been used by a retrograde approacheither via transfemoral,subclavian,orRandomized Controlled TrialPARTNER Trial Design常会发生生物瓣叶的钙化。Cohort A-high-risk operable,699人;A prospective,unblin

8、ded,randomized,controlled,multicenter pivotal trial evaluating the safety and effectiveness of the Edwards Sapien THV transcatheter aortic valve;This valve has only been used by a retrograde approacheither via transfemoral,subclavian,orRestenosis or recoil of the aortic valve usually occurs within 6

9、 months.0 m/s(对应跨主瓣峰值压差64 mm Hg),平均压差40 mm Hg,或主瓣瓣口面积4.Multiple single and multicenter registries,and a single randomized trial,have documented favorable outcomes using a wide spectrum of endpoints,including survival,symptom status,quality of life,and need for repeat hospitalization.二、Balloon aortic

10、 valvuloplasty.This valve has also continued to iterate,with the initial devices being 25-French,but now 18-French delivery sheaths are used.严重主动脉瓣狭窄的定义This valve has also continued to iterate,with the initial devices being 25-French,but now 18-French delivery sheaths are used.direct aortic access.肺

11、动脉导管，经食管超声，临时起搏器，除颤仪。严重主动脉瓣狭窄的治疗选择Restenosis or recoil of the aortic valve usually occurs within 6 months.,Irvine,CA)：三瓣牛心包瓣固定在可球囊扩张的钴铬合金支架上。严重主动脉瓣狭窄的治疗选择6 cm2/m2 作为严重主瓣狭窄的标准.房间要足够温暖，甚至应用体下供热系统。三片猪心包固定于可自膨胀的镍钛合金支架上。对于左心室收缩功能正常的患者：6 cm2/m2 作为严重主瓣狭窄的标准.Device Description：常会发生生物瓣叶的钙化。Sapien valve,Irvin

12、e,CA)：三瓣牛心包瓣固定在可球囊扩张的钴铬合金支架上。历史：1992开始动物实验；It is available in 3 sizes26 mm,29 mm,and 31 mm.严重主动脉瓣狭窄的治疗选择实际上，应用现代生物瓣，术后5年有95的患者瓣膜仍然良好，不必再次手术；三、经皮主动脉瓣置换术Transcatheter Aortic Valve Replacement。Cohort B inoperable,358人;direct aortic access.设备齐全的、宽敞的、有双球管的C型臂。Quality of Life and Symptom Assessment in TAV

13、R TrialsPatients treated with balloon aortic valvuloplasty alone have shown poor prognosis,with survival rates of 50%at 1 year,35%at 2 years,and 20%at 3 years.This valve has also continued to iterate,with the initial devices being 25-French,but now 18-French delivery sheaths are used.,Irvine,CA)：三瓣牛

14、心包瓣固定在可球囊扩张的钴铬合金支架上。国产TAVR瓣膜即将应用于临床。This valve has only been used by a retrograde approacheither via transfemoral,subclavian,orRandomized Controlled TrialPARTNER Trial Design主瓣峰值血流速度4.Recent iterations(NovaFlex)have decreased this to 18-French.严重主动脉瓣狭窄的治疗选择肺动脉导管，经食管超声，临时起搏器，除颤仪。Sapien valve6 cm2/m2

15、作为严重主瓣狭窄的标准.实际上，应用现代生物瓣，术后5年有95的患者瓣膜仍然良好，不必再次手术；Cohort A-high-risk operable,699人;Restenosis or recoil of the aortic valve usually occurs within 6 months.国产TAVR瓣膜即将应用于临床。房间要足够温暖，甚至应用体下供热系统。严重主动脉瓣狭窄的治疗选择This valve has also continued to iterate,with the initial devices being 25-French,but now 18-French

16、 delivery sheaths are used.,Irvine,CA)：三瓣牛心包瓣固定在可球囊扩张的钴铬合金支架上。历史：1992开始动物实验；The initial devices required a 22-or 24-French sheath for delivery of the prosthesis.严重主动脉瓣狭窄的治疗选择Major Outcomes at 30 Days and 1 Year in Cohort B of the PARTNER Trial实际上，应用现代生物瓣，术后5年有95的患者瓣膜仍然良好，不必再次手术；A prospective,unblind

17、ed,randomized,controlled,multicenter pivotal trial evaluating the safety and effectiveness of the Edwards Sapien THV transcatheter aortic valve;房间要足够温暖，甚至应用体下供热系统。三片猪心包固定于可自膨胀的镍钛合金支架上。With severe,symptomatic,calcific AS,AVR is the only effective treatment that improves symptoms and prolongs survival

18、(30,31).国产TAVR瓣膜即将应用于临床。三、经皮主动脉瓣置换术Transcatheter Aortic Valve Replacement。三、经皮主动脉瓣置换术Transcatheter Aortic Valve Replacement。0 m/s(对应跨主瓣峰值压差64 mm Hg),平均压差40 mm Hg,或主瓣瓣口面积1.Despite substantial contemporary experience with successful AVR in elderly patients,multiple series have documented that 30%to 40%of patients with severe AS do not undergo surgery owing to advanced age,LV dysfunction,multiple coexisting conditions,and patient preference or physician recommendation。三、经皮主动脉瓣置换术Transcatheter Aortic Valve Replacement。