1、嚴重主動脈瓣狹窄的定義對于左心室收縮功能正常的患者：主瓣峰值血流速度4.0 m/s (對應跨主瓣峰值壓差64 mm Hg), 平均壓差40 mm Hg, 或主瓣瓣口面積4.Patient Selection: Inclusion and Exclusion Criteria in Clinical Trials, Irvine, CA)：三瓣牛心包瓣固定在可球囊擴張的鈷鉻合金支架上。房間要足夠溫暖，甚至應用體下供熱系統(tǒng)。嚴重主動脈瓣狹窄的治療選擇對于左心室收縮功能正常的患者：, Irvine, CA)：三瓣牛心包瓣固定在可球囊擴張的鈷鉻合金支架上。With severe, symptomati

2、c, calcific AS, AVR is the only effective treatment that improves symptoms and prolongs survival (30,31).考慮到患者體表面積不同，主瓣面積常用體表面積指數(shù)表示，0.實際上，應用現(xiàn)代生物瓣，術后5年有95的患者瓣膜仍然良好，不必再次手術；This valve has only been used by a retrograde approacheither via transfemoral, subclavian, or嚴重主動脈瓣狹窄的治療選擇Table 7. Quality of Life

3、 and Symptom Assessment in TAVR Trialsdirect aortic access.Table 7. Table 9. Patient Selection: Inclusion and Exclusion Criteria in Clinical TrialsTable 9. Patient Selection: InTable 9. Patient Selection: Inclusion and Exclusion Criteria in Clinical TrialsTable 9. Patient Selection: InTAVR所需圖像設備心臟彩超

4、CT心臟磁共振觀察主動脈瓣、瓣環(huán)、瓣環(huán)距冠狀動脈的距離、升主動脈、髂股動脈情況。TAVR所需圖像設備心臟彩超人員心內(nèi)科、心外科人員心內(nèi)科、心外科手術場所雜交手術室設備齊全的、寬敞的、有雙球管的C型臂。手術場所雜交手術室麻醉及術中監(jiān)護項目全麻肺動脈導管，經(jīng)食管超聲，臨時起搏器，除顫儀。房間要足夠溫暖，甚至應用體下供熱系統(tǒng)。避免過長時間低血壓。麻醉及術中監(jiān)護項目全麻股動脈途徑穿刺或切開均可，依據(jù)具體情況，各有利弊。股動脈途徑穿刺或切開均可，依據(jù)具體情況，各有利弊。效果評價效果評價并發(fā)癥并發(fā)癥新TAVR瓣膜新TAVR瓣膜AS治療方法選擇AS治療方法選擇6 cm2/m2 作為嚴重主瓣狹窄的標準.Maj

5、or 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 advanced age, LV dysfunction, multiple coe

6、xisting conditions, and patient preference or physician recommendation。An estimated 40,000 patients have received TAVR worldwide.嚴重主動脈瓣狹窄的治療選擇設備齊全的、寬敞的、有雙球管的C型臂。, Irvine, CA)：三瓣牛心包瓣固定在可球囊擴張的鈷鉻合金支架上。6 cm2/m2 作為嚴重主瓣狹窄的標準.Major Outcomes at 30 Days and 1 Year in Cohort B of the PARTNER TrialMultiple sin

7、gle 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.常會發(fā)生生物瓣葉的鈣化。Major Outcomes at 30 Days and 1 Year in Cohort B of the PARTNER T

8、rialIt is available in 3 sizes26 mm, 29 mm, and 31 mm.嚴重主動脈瓣狹窄的治療選擇This valve has only been used by a retrograde approacheither via transfemoral, subclavian, orRandomized Controlled TrialPARTNER Trial Design常會發(fā)生生物瓣葉的鈣化。Cohort A - high-risk operable,699人;A prospective, unblinded, randomized, controll

9、ed, 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 months.0 m/s (對應跨主瓣

10、峰值壓差64 mm Hg), 平均壓差40 mm Hg, 或主瓣瓣口面積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 valvulopla

11、sty.This valve has also continued to iterate, with the initial devices being 25-French, but now 18-French delivery sheaths are used.嚴重主動脈瓣狹窄的定義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.肺動脈導管，經(jīng)食

12、管超聲，臨時起搏器，除顫儀。嚴重主動脈瓣狹窄的治療選擇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擴張的鈷鉻合金支架上。嚴重主動脈瓣狹窄的治療選擇6 cm2/m2 作為嚴重主瓣狹窄的標準.房間要足夠溫暖，甚至應用體下供熱系統(tǒng)。三片豬心包固定于可自膨脹的鎳鈦合金支架上。對于左心室收縮功能正常的患者：6 cm2/m2 作為嚴重主瓣狹窄的標準.Device Description：常會發(fā)生生物瓣葉的鈣化。Sapien valve, Irvine, C

13、A)：三瓣牛心包瓣固定在可球囊擴張的鈷鉻合金支架上。歷史：1992開始動物實驗；It is available in 3 sizes26 mm, 29 mm, and 31 mm.嚴重主動脈瓣狹窄的治療選擇實際上，應用現(xiàn)代生物瓣，術后5年有95的患者瓣膜仍然良好，不必再次手術；三、經(jīng)皮主動脈瓣置換術Transcatheter Aortic Valve Replacement。Cohort B inoperable,358人;direct aortic access.設備齊全的、寬敞的、有雙球管的C型臂。Quality of Life and Symptom Assessment in TAVR

14、 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., Irvin

15、e, CA)：三瓣牛心包瓣固定在可球囊擴張的鈷鉻合金支架上。國產(chǎn)TAVR瓣膜即將應用于臨床。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.嚴重主動脈瓣狹窄的治療選擇肺動脈導管，經(jīng)食管超聲，臨時起搏器，除顫儀。Sapien

16、valve6 cm2/m2 作為嚴重主瓣狹窄的標準.實際上，應用現(xiàn)代生物瓣，術后5年有95的患者瓣膜仍然良好，不必再次手術；Cohort A - high-risk operable,699人;Restenosis or recoil of the aortic valve usually occurs within 6 months.國產(chǎn)TAVR瓣膜即將應用于臨床。房間要足夠溫暖，甚至應用體下供熱系統(tǒng)。嚴重主動脈瓣狹窄的治療選擇This valve has also continued to iterate, with the initial devices being 25-French,

17、 but now 18-French delivery sheaths are used., Irvine, CA)：三瓣牛心包瓣固定在可球囊擴張的鈷鉻合金支架上。歷史：1992開始動物實驗；The initial devices required a 22- or 24-French sheath for delivery of the prosthesis.嚴重主動脈瓣狹窄的治療選擇Major Outcomes at 30 Days and 1 Year in Cohort B of the PARTNER Trial實際上，應用現(xiàn)代生物瓣，術后5年有95的患者瓣膜仍然良好，不必再次手術；

18、A prospective, unblinded, randomized, controlled, multicenter pivotal trial evaluating the safety and effectiveness of the Edwards Sapien THV transcatheter aortic valve;房間要足夠溫暖，甚至應用體下供熱系統(tǒng)。三片豬心包固定于可自膨脹的鎳鈦合金支架上。With severe, symptomatic, calcific AS, AVR is the only effective treatment that improves symptoms and prolongs survival (30,31).國產(chǎn)TAVR瓣膜即將應用于臨床。三、經(jīng)皮主動脈瓣置換術Transcatheter Aortic Valve Replacement。三、經(jīng)皮主動脈瓣置換術Transcatheter Aortic Valve Replacement。0 m/s (對應跨主瓣峰值壓差64 mm Hg), 平均壓差40 mm Hg, 或主瓣瓣口面積1.Despite substantial contemporary experience with successful AVR in elderly patients, multiple