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1、2012经皮主动脉瓣置换专家共识c历史背景主动脉瓣狭窄常见于老年（﹥75岁）的主动脉瓣钙化、风湿性心脏病和先天性二叶瓣。主动脉瓣狭窄会逐渐进展，左心室壁肥厚，最终导致左心衰竭。一旦出现症状，预后极差。从症状出现到死亡的平均时间：心衰2年，昏厥3年，心绞痛5年。药物治疗1、2年死亡率为25％、50％。严重主动脉瓣狭窄的定义对于左心室收缩功能正常的患者：主瓣峰值血流速度>4.0m/s(对应跨主瓣峰值压差64mmHg),平均压差>40mmHg,或主瓣瓣口面积<1.0cm2.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，≤0.6cm2
2、/m2作为严重主瓣狭窄的标准.严重主动脉瓣狭窄的治疗选择二、Balloonaorticvalvuloplasty.预后较差。Restenosisorrecoiloftheaorticvalveusuallyoccurswithin6months.Patientstreatedwithballoonaorticvalvuloplastyalonehaveshownpoorprognosis,withsurvivalratesof50%at1year,35%at2years,and20%at3years.Inaddition,seriou
3、scomplicationsduetoballoonaorticvalvuloplastyoccurin15%to25%ofpatients。严重主动脉瓣狭窄的治疗选择三、经皮主动脉瓣置换术TranscatheterAorticValveReplacement。TAVR。经皮主动脉瓣置换术历史：1992开始动物实验；2002年实现经皮置入人体第一个可扩张的马心包支架瓣膜。之后多种TAVR瓣膜问世。经皮主动脉瓣置换术DeviceDescription：（一）Sapienvalve(Figure1)EdwardsLifeSciences,
4、Inc.,Irvine,CA)：三瓣牛心包瓣固定在可球囊扩张的钴铬合金支架上。TheSapienvalveisavailablein23-mmand26-mmsizesintheUnitedStatesand23-mm,26-mm,and29-mmsizesinEurope.Theinitialdevicesrequireda22-or24-Frenchsheathfordeliveryoftheprosthesis.Recentiterations(NovaFlex)havedecreasedthisto18-French.Sapi
5、envalve经皮主动脉瓣置换术（二）CoreValve(Figure2)(Medtronic,Inc.,Minneapolis,MN).三片猪心包固定于可自膨胀的镍钛合金支架上。经皮主动脉瓣置换术CoreValve：Itisavailablein3sizes—26mm,29mm,and31mm.Thisvalvehasalsocontinuedtoiterate,withtheinitialdevicesbeing25-French,butnow18-Frenchdeliverysheathsareused.Thisvalvehas
6、onlybeenusedbyaretrogradeapproach—eitherviatransfemoral,subclavian,ordirectaorticaccess.经皮主动脉瓣置换术Anestimated40,000patientshavereceivedTAVRworldwide.Multiplesingleandmulticenterregistries,andasinglerandomizedtrial,havedocumentedfavorableoutcomesusingawidespectrumofendpoi
7、nts,includingsurvival,symptomstatus,qualityoflife,andneedforrepeathospitalization.经皮主动脉瓣置换术ThereareonlylimitedclinicaldataonthedurabilityofTAVRvalves—upto2years—inthePARTNERtrialandupto5yearsinotherregistryexperiences.Table1.EdwardsSapienTranscatheterHeartValveRegistrie
8、sTable2.MedtronicCoreValveTranscatheterHeartValveRegistriesRandomizedControlledTrial －PARTNERTrialDesignAprosp
