中国经导管主动脉瓣置换术临床路径专家共识(2024版)  

2024 expert consensus on clinical pathway for transcatheter aortic valve replacement in China

作　　者：中国医师协会心血管内科医师分会结构性心脏病学组 亚太结构性心脏病俱乐部 宋光远 潘文志[3] 周达新[3] 吴永健 刘新民[2] 王墨扬 Structural Cardiology Committee of Cardiovascular Physicians Branch;Chinese Medical Doctor Association,Asia Pacific Structural Heart Disease Club;SONG Guangyuan;PAN Wenzhi;ZHOU Daxin;WU Yongjian

机构地区：[1]不详 [2]首都医科大学附属北京安贞医院 [3]复旦大学附属中山医院 [4]中国医学科学院阜外医院

出　　处：《中国胸心血管外科临床杂志》2024年第12期1713-1727,共15页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家重点研发计划(2020YFC2008100);首都临床特色诊疗技术研究及转化应用项目(Z221100007422117)。

摘　　要：本文采用德尔菲法更新了《中国经导管主动脉瓣置换术临床路径专家共识(2021版)》,通过检索近4年PubMed、中国知网及万方数据库经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)临床路径相关的证据,在TAVR团队的构成与临床评估、围术期影像学评估、手术过程、患者围术期及远期管理4个方向提出了35个核心观点。具体更新点包括:细化TAVR团队的职责与构成,明确临床评估的步骤与内容;强调CT在围术期影像学评估中的核心地位,并介绍了人工智能、数值仿真及3D打印等新技术的应用;优化TAVR手术流程,包括麻醉选择、入路建立、瓣膜选择及释放等关键环节;提出针对特殊类型患者(如急诊TAVR、简化TAVR、单纯主动脉瓣反流、合并冠状动脉粥样硬化性心脏病及心房颤动等)的管理策略。此外,共识还强调了术后随访和康复的重要性,并提供了详细的抗血栓及康复指导。本共识的更新将进一步推动我国TAVR技术的规范发展,提升临床治疗效果。We update the"2021 expert consensus on clinical pathway for transcatheter aortic valve replacement in China"using the Delphi method.By searching for evidence related to the clinical pathways of transcatheter aortic valve replacement(TAVR)in PubMed,CIKI,and Wanfang Database over the past four years,35 core viewpoints were proposed in four directions:TAVR team composition and clinical evaluation,perioperative imaging assessment,surgical process,and perioperative and postoperative long-term management of patients.The specific updates include:refining the responsibilities and composition of the TAVR team,clarifying the steps and content of clinical evaluation;emphasizing the core position of CT in perioperative imaging assessment,and introducing the application of new technologies such as artificial intelligence,numerical simulation,and 3D printing;optimizing the TAVR surgical process,including anesthesia selection,access establishment,valve selection and release,and others;and proposing management strategies for special types of patients(such as emergency TAVR,simplified TAVR,pure aortic regurgitation,combined coronary heart disease and atrial fibrillation).In addition,the consensus also emphasizes the importance of postoperative follow-up and rehabilitation,and provides detailed antithrombotic and rehabilitation guidance.The update of this consensus will further promote the standardized development of TAVR technology in China and improve clinical treatment effects.

关 键 词：经导管主动脉瓣置换术 临床评估 影像学评估 规范化手术流程 围术期管理 专家共识 

分 类 号：R654.2[医药卫生—外科学]