经导管主动脉瓣置换术：心脏外科新纪元、新机遇、新挑战  

Transcatheter aortic valve replacement： the new era, new opportunity and new challenge of cardiac surgery

作　　者：魏来[1] 杨晔[1] 王春生[1] 刘欢[1] 

机构地区：[1]复旦大学附属中山医院心外科,上海200032

出　　处：《中华外科杂志》2016年第8期577-581,共5页Chinese Journal of Surgery

摘　　要：目前常规主动脉瓣置换术仍是治疗主动脉瓣疾病的＂金标准＂ ，但仍有大量手术高危患者难以耐受常规手术。经导管主动脉瓣置换术（TAVR）的出现使这部分患者可以得到及时有效的治疗，针对TAVR的应用指南也相继公布。近10年来，随着TAVR的广泛使用，SAPIEN、CoreValve、Lotus、ACURATE neo等各类植入装置不断面世并获得改进，其应用效果在多个大型临床研究中得到了证实。目前最常使用的是经股动脉入路的TAVR，经心尖和经升主动脉也是两种常用的有效入路，三者之间各有优劣。目前TAVR的常见并发症有大出血、外周血管损伤、Ⅲ度房室传导阻滞、冠状动脉堵塞、瓣膜错位、瓣膜退化等，但随着植入系统的改进，并发症发生率逐渐降低。对于心脏外科医师来说，TAVR的出现既是机遇也是挑战；外科医师在获得它提供的新的治疗方案的同时，也需要学习新的技术去掌握它。Conventional surgical aortic valve replacement is still the current ＂gold standard＂ in treatment of aortic valve disease, but part of the high-risk elder patients couldn＇t tolerate the surgical trauma. Now those people could receive timely and effective treatment with the application of transcatheter aortic valve replacement, and the related guidelines have been published in recent years. With its wide use in recent 10 years, different implantation systems, such as SAPIEN, CoreValve, Lotus, ACURATE neo, have been gradually improved and provened in several large clinical trials. Transfemoral, transapical and transaortic approaches are approved for the access and used according to different indications. Bleeding, vascular events, Ⅲ grade atrioventricular block, coronary obstruction, valve malpositioning, valve degeneration are the major complications for this skill, but would be overcome with the improvement of the system. The transcather aortic valve replacement brings not only the opportunity to develop new treatment protocols, but the challenge for cardiac surgeons to learn new skills to control.

关 键 词：心脏瓣膜假体植入 外科手术 微创性 主动脉瓣 

分 类 号：R654.2[医药卫生—外科学]