经皮主动脉瓣植入tavi课件

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1、TAVIXIONGRAN2014-11-25QUIZStreetAvenueStreetAvenueHospitalofUAHospitalofUAHospitalofUAHospitalofUASummarizeofTAVITranscatheteraorticvalveimplantation(TAVI)Itwasintroducedasanalternativetreatmentinpatientswithsevereaorticvalvestenosis(AS)CribierA,EltchaninoffH,BashA,Circulation2002;106:3006–3008.F

2、irstCaseofTAVIIn2002,CribieretaldemonstratedforthefirsttimethefeasibilityofapercutaneousvalveimplantationinapatientwithASProvidingapromisinglessinvasivealternativetreatmentforvalvularheartdiseaseCribierA,EltchaninoffH,BashA,Circulation2002;106:3006–3008.twodifferentTAVIdevicesarewidelyusedtheball

3、oon-expandableEdwardsSAPIENTranscatheterHeartValvetheself-expandingMedtronicCoreValve™BothreceivedCEMarkapprovalforEuropeancommercialsalein2007EdwardsSAPIENvalvereceivedFDApre-marketapprovalintheUSAinNovember2011TwodifferentTAVIdevicesEdwardsballoonexpandabledeliverysystemsCoreValveReValvingSyste

4、m(a)schemataand(b)followingdeploymentwithaortographyPatientsSelectionFeasibleinmostpatientswithsevereaorticstenosisGenerallyutilizedinpatientsnotsuitableforsurgicalAVR,whoarelikelytoderivefunctionalandsurvivalbenefitTworiskscoresareusedtocalculatetheriskofcardiacsurgery“High-risk”surgicalpatients

5、HavingaSocietyofThoracicSurgeonsPredictedRiskofMortality(STS-PROM)at30daysofgreaterthan10%LogisticEuroSCOREofgreaterthan20%LimitedDonotaccountforseveralpertinentclinicalriskfactors,suchaspreviousCABG,porcelainaorta,previouschestradiotherapy,severelungdisease,andlivercirrhosisTworiskscoresTworisk

6、scoresAssessmentsofTAVIToassesstheaorticannulusdimensionsandgeometry,accesssite,andapproachTransthoracicechocardiographyCoronaryangiographyAorticangiographyMDCTAssessmentofarterialaccessTheevaluationisfundamentalintheassessmentoftheTAVIpatientinminimizingpotentialmajorvascularcomplicationsArteria

7、ldimensionsThepresenceorabsenceofatheroma,CalcificationTortuosityAssessmentofarterialaccessArterialaccessisassessedwiththecombinationofinvasiveangiographyandcontrast-enhancedCTIliofemoralassessmentwith(a)angiographyand